HomeMy WebLinkAboutRBPR-07-2012-16017.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2012-16017
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building New
IV L
ti
r A
%Std0,7112- IMPROVEMENT - AUTH CONST - NEW WELL - `� U
P(, � I EXPANSION -ABANDONMENT no
Applicant HEATHER AND STACEY FULBRIGHT, 6050 SMITH RD, VALE NC 28168
C:8286385082
Contact Person MORETZ WELL DRILLING,....._......._-_..,._....._..-.�.,,..,....._._... .,,.,._._..,_.........,.__._._ ..
6159 W NC 10 HWY, HICKORY NC 28602
B:828-244-1420
Contractor _ DIXON CONSTRUCTION, 1706 BRENTWOOD DR, NEWTON NC 28658
B:828 -464 -5709C:828 -244-6564F:828-464-5709 SEP_T23JSC@YAHOO.COM
Owner STACY FULBRIGHT, 932 12TH ST SE, HICKORY NC 28602
NAME TO APPEAR ON PERMIT
HEATHER AND STACEY FULBRIGHT
SITE ADDRESS: 6050 SMITH RD, VALE NC 28168 PIN # 268702955497
NAME of SUBDIVISION: l Lot # TR A Section/Block
PROPERTY SIZE: Square Feet Acres %
DIRECTIONS: HWY 10 W LEFT ON SMITH RD GC OX 1.5 1 PROPERTY ON LEFT
PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
Public water is **NOT** available for this property.
DESCRIBE WORK: NEW 3 BEDROOM MOBILE HOME. PREVIOUS 2 BEDROOM HOME HAS BEEN REMOVED
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF mobile home has been removed
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 0
# OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 42 X 37
# OF NEW BEDROOMS:: 3
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Yes
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Bored
I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal
system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for
evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is
transferable and may be eligible for a non -expiring date, but may be revoked if this information, site plans or intended use changes for the proposed
facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure
location should conform to applicable setbacks.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
L9 - chapplicaticm 08/22/2012 11:59
Pagel of 8
I inch = 50 feet
Catawba County, North Carolina
This map product was prepared from the Catawba Com!y, NC, Geographic Information System.
Catawba CountY has made substantial efforts to ensure the accuracy oflocation and labeling information
contained on this neap. Catawba County promotes and recommends the independent verification of any
data contained on this map product by the user. The County of Catawba, its employees, agents and
personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect
or consequential which arises o• mny arise from this map product or the use thereof by any person at, entity. Legend
Selected Parcel Number: 2687-02-95-5497
Prepared for:
164-60
�
TR A
N 1.02A
Q) 14co
5497 co
�0
/Plat 71-165 W
(239)
/ THIS IS NOT A LEGAL DOCUMENT Monday, August 27, 2012 08:43 AM
i in% -1i /
THIS IS NOT A PERMIT Case # RBPR-07-2012-16017
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building New
IMPROVEMENT - AUTH CONST - NEW WELL - EXPANSION - ABANDONMENT
Applicant HEATHER AND STACEY FULBRIGHT, 6050 SMITH RD, VALE NC 28168
C:8286385082 Ptp>,i�� �'►�' ► a,
Contact Person MORETZ WELL DRILLING, 6159 W NC 10 HWY, HICKORY NC 28602
B:828-244-1420
Contractor DIXON CONSTRUCTION, 1706 BRENTWOOD DR, NEWTON NC 28658
B:828 -464 -5709C:828 -244-6564F:828-464-5709 SEPT23JSC@YAHOO.COM
Owner STACY FULBRIGHT, 932 12TH ST SE, HICKORY NC 28602
NAME TO APPEAR ON PERMIT
HEATHER AND STACEY FULBRIGHT
SITE ADDRESS: 6050 SMITH RD, VALE NC 28168 PIN # 268702955497
NAME of SUBDIVISION: Lot # TR A Section/Block
PROPERTY SIZE: Square Feet Acres 0.98
DIRECTIONS: HWY LEFT ON SMITH RD GO APPROX 1.51 PROPERTY ON LEFT
PRIMARY CONTACT: Contract SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
Public water is **NOT** available for this property.
DESCRIBE WORK: NEW 3 BEDROOM MOBILE HOME. PREVIOUS 2 BEDROOM HOME HAS BEEN REMOVED
APPLICATION FOR:
STRUCTURE TYPE:
New Structure
PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF:obile home has been removed
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: (� # OF OCCUPANTS:
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: V_�37
# OF NEW BEDROOMS:: (,3
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Yes
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Bored
I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal
system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for
evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is
transferable and may be eligible for a non -expiring date, but may be revoked if this information, site plans or intended use changes for the proposed
facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure
location should conform to applicable setbacks.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
**********************************************************************************************************************
MINIMUM SETBACKS FRONT: 80 SIDE: 15 REAR: 30 MAX HEIGHT:
r:) - ehapplication 08/14/2012 16:54 Page t of 8
THIS IS NOT A PERMIT i
a
2 CATAWBA COUNTY HEALTH DEPARTMENT)
Application for Environmental Services 01, 1
1842
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑
Septic Expansion ❑ New Well P•--rmit 0 Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑
Application is for New Construction ❑ Existing Facility ❑
Property Address �/V-(-
() sMI-14i /?� Subdivision
/�/
r (- Po� 16 </ Lot # Acres
,p�SectionBlock/Phase
Driving Directions to Property _X,'4 bf
0
W
a NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant FAContractor
ZApplicant Contact Information
0
U I Name ' 41
W I Address J� v�/3Y / / ° ' �s
OD
Phone t� ��dcvCell PhoneOwner Contact Info m ti
Name
Z I Address �% �, l SL �� / 1Y r7
Q I PhoneiCglhone V a
Contractor Contact Information A /
U I Name ` 1 lA_ AI(k h rz" _ e -
W
Address °% U d� �U/►f ?;
X I Phone - I Cell Phone
WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Contractor
z Description of Existing Structures on Site
Q # of Bedrooms *'j Structure Dimensions # of Occupants
I• Basement ❑ Yes 0 No Basement Fixtures ❑ Yes ❑ No
Planned Future Additions or Improven eats (Building Permit NOT re nested at this time)
,g
ODescribe ��" � 1✓�
� Proposed Future Structure Dimensi ,j # of Bedrooms *'j' ii'applicable
? Are there easements or right-of-ways recorded on this property ❑ Yes No
Describe
Is a public water supply available on or adjacent to the above property ** ❑ YesNo
Check type available ❑ Community Well E]Semi-Public Well E]Cout !y/city/Township Water Line
Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well
❑ County/City/Township Water Line
❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION
(SEE COMBINED EVALUATION PROCEDUES)
Q
LWW
a
V
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H
9
THIS IS NOT A PERMIT
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 2
1842 sm
Proposed Facility Type
j9] Primary Residence -0 New Residence ❑ Addition to Residence # of New Bedrooms
Project Description
Structure Dimensions of Occupants
Basement ❑ Yes 19 No Basement Fixtures ❑ Yes ❑ No
❑ Accessory Structure(s) Describe
# of New Bedrooms *'t if applicable Structure Dimensions
# of Occupants Accessory Dwelling ❑ Yes ❑ No
Plumbing ❑ Yes ❑ No Describe Plumbing Needed
❑ Multi -Family Residence # Units #Bedrooms per Unit*t
Total # Bedrooms *-%I Structure Dimensions
❑ Food Service Specify Type
# Seats Floor Space -Entire Food Service Facility (Sq Ft)
# Employees per Shift # of Shifts Dining Area (Sq. Ft.)
❑ Business Specific Type of Business Retail Floor Space
# of Employees per Shift # of Shifts
❑ Other Facility Type Specify
If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy
Application for Well Construction/Abandonment/Repair
Proposed Well Type ® Individual Well ❑ Semi -Public Well ❑ Community Well
Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑ Yes ❑ No Describe
Calculated Design Flow, Commercial j Additional information may be required to
determine design flow from certain facilities. This value will be determined during consultation with on-
site staff.
*Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a
bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a
bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. i If
structure is plumbed but no bedrooms, calculated design flow is required.
** If No, a well permit must be issued with the Authorization to Construct.
Note: You must obtain Zoning approval prior to locating a home or structure on this property. Any representation by you of
house or structure location should conform to applicable setbacks.
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN
ADDITIONAL CHARGE (SEE FEE SCHEDULE)
I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental
Health employees to go on this property for evaluation purposes. 1 certify the above information to be correct and understand
that an Improvement Permit issued as a result of this information is valid for 5 years or may be non -expiring under certain
specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site
plans or intended use changes for the proposed facility. An Authorization to'Eonstruct issued by this department is valid for
(5) five years from the date issued and is not transferable
Signature of Owner or Agent
9.
Printed Name of Owner or Agent ,V� c7 i�/V cj�yyi✓ �'M �I'`S
Date sl' —
- J
Print Parcel Map
@nlmt a .�� o M9
Page 1 of 2
ul-\M Ca.l
[E M03
Samirch
Parcel Summary Printed Map Scale 1 inch = 100ft
Parcel ID: 268702955497 Parcel Address: 6050 SMITH RD, VALE
I Owner: FULBRIGHT HEATHER II Address: 932 12TH ST SEII City: HICKORY
MOSER
Owner2: FULBRIGHT STACEY II Address2:II State/Zip: NC, 28602-4111
NEAL
Building(s) Value: Land Value: 11 Total Value:
II DISCLAIMER: This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made II
substant4iall efforts to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County
V
http://www.gis.catawba.nc.us/website/ParcellprintMap.asp?pinc=268702955497&paddr=6... 8/10/2012
Catawba County, North Carolina
This map product was prepared from the Catawba County, NC, Geospatial Information System.
N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map Catawba County promotes and recommends the independent verification of any
data contained on this map product by thr� user. The County of Catawba, its employees, agents and
personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect
or consequential which arises or may arise from this map product or the use thereof by any person or entity.
1
1 inch = 97 feet
...�8$ 94
388.0
2.17A
240
J
N
R-40
1 46 6,
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5497 C ,
Ph t'-74-165`
Selected Parcel Number: 2687-02-95-5497
Prepared for:
(342) �. /' (63) (238)
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6.9} " 52.75
�y CO 1.99A
/ (4210
R-40
- -T-R 1
178.00 / 426.40
THIS IS NOT A LEGAL DOCUMENT Date: 8/14/2012 Time: 3:58:24 PM ``.
2.16A
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SMITH RD
VICINITY MAP NOT To SCALE
NOTES
1 THE PURPOSE OF THI6 SURVEY IS r0 CiNOE 1.0 ACRE FROM PARCEL
268)-02-95-8424.
2 SUBJECT PARCEL 0 NO 2681-02-95-8424
3 THIS SURVEY WAS PERFORMED MLNOUT THE BENEFR OF A TILE SEARCH.
MIS PROPERLY MAY BE SUBJECT TO RIGMS OF AYS OR F- NOT
SHOWN HEREON
4 IRIS PROPERTY IS CURRENRY ZPNED R-40 AND IS LOG7ED IN PEA U
S_ AREA
5, SUBJECT PARCEL 5 NOT LOG W A WATERSHED PROTECTED A—
S. OWNER OF SUBJECT PROPERTY DENNIS R PAUL FULBRIGHT OF 3268
PL RD NEWTON. NC 28658
]/4YgwtF
NOTARY
��T>i1bi�WC64eNT Pt� r
fAwA B. FUL8c1eNT
ur muu¢sgN LxwREs 2OY _ ¢-: NOTARY
;n PUOLIC _
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6 GERIIFlGlE
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_ (DEED DESCRwMw RECORDED M AVK
21
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-w A5 AUEN�T,Nr TB6:KPREPARED x+MY
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W'� p� F�w„ru�N�p�RIM EifS ALL SrA1UI0m
RONALD h AIA.Ril1A NLBRIGHT
1032-906 8 APPRO✓Al GERnFi FOR FAMILY SUBOM.SpN PGT
IN, SUBpWSY.N GUr —N NMS &FEN FOUND TO MTB ME
SU6CMSLN RFGVUIgNS GIAWTN F.D A AND S APP 4D FOR RELCRTNNG w ME
CiTKE
OF
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y
CArosSES u+E Jn z.Y l EE TE
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69.60 — x
ilMiFOR 11e6 pAT WAS APFRO�ED UvOER INE PAbM61065 aF A FnuuY
-I of AF GUWBA cvuNn uwFlm
_� yr FUTNLR wrw Nc wY FOF onRc¢s r?E -Y
cEuiowLT+r w`ENrs. w nroRGNCF wm+ cATnMu calNrc
�ARlH4ONLBaIGHr
RONALD "A
ONEYCUTT LAND SURVEYING'.
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o
2`27•T_
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Sw7Z-Iz
^;. .,R .e.,mm
J710266600J
EFF, OATS 9/5/2001
`
.�/,.i (. %,;;fl
1.77 ACRES TOTAL
62J6`
OM+FR/sueorvmLR GrF
.N' o�ry
h� ^, 0- 17 ACRES IN R/W
/y 1.00 ACRE NET o wcu w
Pw 2687-02-95-8424
HLS FILE: B- 2605
OENNIE X PAULGULBRIGNT
tn
N 'U 74
L
149 8-310
1
2.61 ACRES+- REMAINING
R/w_ _
KELLY BOLLINGER
3019-1891
250.59" M� -� —
PUT 21-113
u
/
.N.
LEGEND
• EXISTING IRON (TYPE NOTED)
O NEW IRON (TYPE NOTED)
0 PK NAIL
0 MAGNAIL
®
RIR
SPIKE
0 CONCRETE MONUMENT
• STONE
X COMPUTED POINT
NAIL
W NCS/NCGS GRID MONUMENT
UTILITY POLE
v LIGHT POLE
O DUKE POWER BOX
- O TELEPHONE PEDISTAL
SANITARY SEWER MANHOLE
s STORMDRAIN MANHOLE
_ " WATERLINE MANHOLE
IB WATER METER
® WATER VALVE
® SEWER CLEAN OUT
® GAS VALVE
—__— R/W
FOS
R/W N 86005;lW B76.92' TOTAL --2633'
SMITH RD. wR
60' R,1W FROM CIS RECORDS
\ Anr �3 E' IvR SPIKE
0 60 120 160 240
1"=60'
,?may
FFILED Jun 13, 2012 03 51 pm
K 00071 CATAWBA COUNTY NC
DONNA HICKS SPENCER
E 0165 REGISTER OF DEEDS
# 10365
F.E.M.A. CERTIF7CAT70N
PRONom � (BUD). FETK'FAL wsUPANCE bM,N51RAIxlN, 0
FEDER11 EMERGENCY uNMOFMENr ADNORI
REMT2N. INSURwCF ADMIN6rRAnON (GTAW80 LUUNIY NORM GItJIIN.I).
EwM RryPANEI No n,msesm]. cTTc _ —
IMS (✓EEty OETERMM[D TO UE OUISNIE OF A SPECML FLOoO
1.17 ACRES TOTAL
AREA BY COORDINATE COMPUTATION
FAMILY SUBDIVISION FOR.
STAGY & HEATHER FULBRIGHT
BANDYS TSP., CATAWBA CO., N.0
ONEYCUTT LAND SURVEYING'.
P�mBw - u s�A.. sw. la2A
Giw
2eefie : e2e-4e4-arm
L -1J60 Randal t[ L -4J99
ro
FEMA RLOOD PANEL NO
naycutt
r
I COORD.nFILL 12057017.CRO
J710266600J
EFF, OATS 9/5/2001
DEED. 1496-310
DWG HLF 12057011,1*, -
DATE. 5-21-12
SCALE: i "= 60'
Pw 2687-02-95-8424
HLS FILE: B- 2605
CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID:
2687-02-95-5497
Name:
FULBRIGHT HEATHER MOSER
Name2:
FULBRIGHT STACEY NEAL
Address:
932 12TH ST SE
Address2:
City:
HICKORY
State:
NC
Zip:
28602-4111
Account:
159781105
Calc Acreage:
0.98
Tax Map:
LRK:
101186
Deed Book:
3131
Deed Page:
0337
Subdivision Name:
Subdivision Block:
Lots:
TRA
Plat Book:
71
Plat Page:
165
Building Number:
6050
Street Name:
SMITH RD
Site Zip:
28168
Township:
BANDY'S
Fire Code:
PROPST
City Code:
COUNTY
State Road:
2040
Total Bldgs Value:
Land Value:
Total Value:
Year Built:
Year Remodeled:
Last Sale Date:
Last Sale Amount:
Neighborhood:
Watershed:
Watershed Split:
Voter Precinct:
P2
E911 District:
COUNTY
Zoning:
R-40
Zoning2:
Zoning3:
Zoning Split:
N
Zoning Overlay: DWMH-0
Zoning District:
COUNTY
Split Zoning Dist:
N
Split Zoning Dist(1):
0
Split Zoning Dist(2): 0
School District:
COUNTY
Elementary School: BANOAK
Middle School:
JACOBS FORK
High School:
FRED T FOARD
School Split:
NO
P&Z Case Number:
Census Tract 2010: 011802
Census Block 2010:
3031
Small Area Plan:
PLATEAU
Agricultural District:
Printed: Tuesday,
August 14, 2012 03:58 PM
�2_ � P�L-
THIS IS NOT A PERMIT Case # RBPR-07-2012-16017
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
18 42 SM Residential Building -ie Ian Rev - B ' 44ng Al
IMPROVEMENT- AUTH CONST (PEW WELL EXPANS/O - ABANDONMENT
Applicant HEATHER AND STACEY FU RIGHT, SMI RD VA�NC 28168
Contact Person — T�MORETZ WELL DRILLING, 6159 W NC 10 HWY, HICKORY NC 28602 -�` t41 1 a. � ra�AvaYv
8:828-244-1420
Contractor DIXON CONSTRUCTION, 1706 BRENTWOOD DR, NEWTON NC 28658
B:828 -464 -5709C:828 -244-6564F:828-464-5709 SEPT23JSC YAHOO.COM
Owner STACY FULBRIGHT, 932 12TH ST SE, HICKORY NC 28602
NAME TO APPEAR ON PERMIT
HEATHER AND STACEY FULBRIGHT
SITE ADDRESS: 6050 SMITH RD, VALE NC 28168 PIN # 268702955497
NAME of SUBDIVISION: Lot # TR A SectionBlock
PROPERTY SIZE: Square Feet Acres 0.98
DIRECTIONS: HWY 10 W LEFT ON SMITH RD GO APPROX 1.51 PROPERTY ON LEFT
PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank
GALLONS PER DAY: WATER SUPPLY: Private Well
Public water is **NOT** available for this property.
DESCRIBE WORK: NEW HOME
APPLICATION FOR:
STRUCTURE TYPE:
FACILITY TYPE: Single Family Residence
DESCRIPTION OF NONE
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS:
NEW STRUCTURE DIM:: 42 X 37
New Structure
PRIMARY RESIDENCE
OTHER DESCRIPTION:
# OF OCCUPANTS:
PROPOSED CONSTRUCTION
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Yes
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Bored
I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal
system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for
evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is
transferable and may be eligible for a non -expiring date, but may be revoked if this information, site pians or intended use changes for the proposed
facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or
structure locationoulld conform to applicable setbacks.
Date: n // U/ �/ Signature of Applicant or Agent //1 i A
l n Environmental Health Specialist will contact you with n'2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
MINIMUM SETBACKS FRONT: 80 SIDE: 15 REAR: 30 MAX HEIGHT:
1:9 - ehapplication 08/14/2012 16:23 Pagel of 8
1842 sm
Contact Person
THIS IS NOT A PERMIT Case # RBPR-07-2012-16017
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
Residential Building Plan Review - Building New
ABANDONMENT
MORETZ WELL DRILLING, 6159 W NC 10 HWY, HICKORY NC 28602
B:828-244-1420
Owner STACY FULBRIGHT, 932 12TH ST SE, HICKORY NC 28602
NAME TO APPEAR ON PERMIT
Stacy Fulbright
SITE ADDRESS: 6050 SMITH RD, VALE NC 28168 PIN # 268702955497
NAME of SUBDIVISION: Lot # TR A Section/Block
PROPERTY SIZE: Square Feet Acres 0.98
DIRECTIONS: HWY 10 W LEFT ON SMITH RD GO APPROX 1.51 PROPERTY ON LEFT
PRIMARY CONTACT: Contact Person
GALLONS PER DAY:
DESCRIBE WORK: NEW HOME �?�
APPLICATION FOR:
SEWER TYPE:
WATER SUPPLY:
Public water is "`NOT** available for this property.
New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS:
PROPOSED CONSTRUCTION
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Bored
I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal
system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for
evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is
transferable and may be eligible for a non -expiring date, but may be revoked if this information, site plans or intended use changes for the proposed
facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable.
Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or
structure location should conform to applicable setbacks.' �
Date: ��� D / Signature of Applicant or Agent �,��� / '% rg,,, �
An Environmental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
MINIMUM SETBACKS FRONT: SIDE: REAR: MAX HEIGHT:
FEENAME
Well Abandonment Fee
TOTAL FEES
DATE FEE AMOUNT
07/20/2012 $100.00
$100.00
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
F,9 - elhapplication 07/20/2012 12:07 Page I of 7
THIS IS NOT A PERMIT
a CATAWBA COUNTY HEALTH DEPARTMENT
�P �c Application for Environmental Services Page 1
I84Z SM
Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑
Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment
Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑
Application is for New Construction
Property Address 6,D 'y, 17,
Ad
-f/o,1t' A/L Z�16
❑ Existing Facility ❑
Subdivision
Lot #
/ SectionBlock/Phase
Driving Directions to PropertyiV / j tri% -s j (5
J
MT - /2ro✓J.- D v`
NAME TO APPEAR ON PERMIT? [Owner ❑ Applicant P(ontractor
Applicant Contact Information
Acres
Name
Address 1-71 '- /'7t'9' AIL .2 V o Z
Phone Cell Phoi(e�_
Owner Contact Information
Name 1�6_4,,e,- -,SfAc ej I�1,11 Y)�i 5 14
Address
Phone I Cell Phone
Contact Information
Name ��r �,e.�� %►/� �� ��f ��i�
Address
Phone Cell Phone
WHO WILL BE THE PRIMARY CONTACT? [:]owner Applicant ❑ Contractor
Description of Existing Structures on Site vC,'LC,,A �-
# of Bedrooms * j Structure Dimensions # of Occupants
Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No
Planned Future Additions or Improvements (Building Permit NOT requested at this time)
Describe I've- - /-h 0.0,
Proposed Future Structure Dimensions # of Bedrooms *j if applicable
Are there easements or right-of-ways recorded on this property ❑ Yes [P-fIo
Describe
Is a public water supply available on or adjacent to the above property ** ❑ Yes ErNo
Check type available ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line
Existing water supply in use Individual Well ❑ Community Well ❑ Semi -Public Well
❑ County/City/Township Water Line
❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION
(SEE COMBINED EVALUATION PROCEDUES)
Q
LWW
a
V
W
m
THIS IS NOT A PERMIT
CATAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 2
1842 w
Proposed Facility Type
❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j
Project Description
Structure Dimensions # of Occupants
Basement ❑ Yes ❑ No Basement FiXtUres ❑ Yes ❑ No
❑ Accessory Structure(s) Describe
# of New Bedrooms *'j if applicable Structure Dimensions
# of Occupants Accessory Dwelling ❑ Yes ❑ No
Plumbing ❑ Yes ❑ No Describe Plumbing Needed
❑ Multi -Family Residence # Units
Total # Bedrooms *t
❑ Food Service Specify Type
#Bedrooms per Unit*t
Structure Dimensions
# Seats Floor Space -Entire Food Service Facility (Sq Ft)
# Employees per Shift # of Shifts Dining Area (Sq. Ft.)
❑ Business Specific Type of Business Retail Floor Space
# of Employees per Shift # of Shifts
❑ Other Facility Type Specify
If Church # of Seats Kitchen [:]Yes ❑ No If Daycare Specify Occupancy
Application for Well Construction/Abandonment/Repair
Proposed Well Type ❑ Individual Well ❑ Semi -Public Well ❑ Community Well
Abandonment Type ❑ Drilled Aff Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑ Yes ❑ No Describe
Calculated Design Flow, Commercial j Additional information may be required to
determine design flow from certain facilities. This value will be determined during consultation with on-
site staff.
*Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a
bedroom and counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans as a
bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. i If
structure is plumbed but no bedrooms, calculated design flow is required.
** if No, a well permit must be issued with the Authorization to Construct.
Note: You must obtain Zoning approval prior to locating a home or structure on this property. Any representation by you of
house or structure location should conform to applicable setbacks.
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN
ADDITIONAL CHARGE (SEE FEE SCHEDULE)
I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental
Health employees to go on this property for evaluation purposes. I certify the above infonnation to be correct and understand
that an Improvement Permit issued as a result of this information is valid for 5 years or may be non -expiring under certain
specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site
plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for
(5) five years from the date issued and is not transferable
Signature of Owner or Agent
Printed Name of Owner or Agent %vS 1,7-/ /)7�0-<- �2-
Date 17--2o-1'2
Catawba County, North Carolina
N This map product was prepared from the Calmvba County, NC, Geographic Information System.
Catawba Counh, has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map. Catawba Countypromotesand recommends the independent verification ofany
data contained on this map product by the user. The Comity of Catawba, its employees, agents and
personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect
ar consequential which arises or may arise f-om this map product or the use thereof by any person or entity. Legend
Selected Parcel Number: 2687-02-95-5497
1 inch = 50 feet Prepared for:
FA
� -Q)
N
63)
Plat
164&60
5)7
(238)
.11
co
co
1�
cw
THIS IS NOT A LEGAL DOCUMENT / Friday, July 20, 2012 11:40 AM
CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID:
2687-02-95-5497
Name:
FULBRIGHT HEATHER MOSER
Name2:
FULBRIGHT STACEY NEAL
Address:
932 12TH ST SE
Address2:
City:
HICKORY
State:
NC
Zip:
28602-4111
Account:
159781105
Calc Acreage:
0.98
Tax Map:
LRK:
101186
Deed Book:
3131
Deed Page:
0337
Subdivision Name:
Subdivision Block:
Lots:
TR A
Plat Book:
71
Plat Page:
165
Building Number:
6050
Street Name:
SMITH RD
Site Zip:
28168
Township:
BANDY'S
Fire Code:
PROPST
City Code:
COUNTY
State Road:
2040
Total Bldgs Value:
Land Value:
Total Value:
Year Built:
Year Remodeled:
Last Sale Date:
Last Sale Amount:
Neighborhood:
Watershed:
Watershed Split:
Voter Precinct:
P2
E911 District:
COUNTY
Zoning:
R-40
Zoning2:
Zoning3:
Zoning Split:
N
Zoning Overlay: DWMH-O
Zoning District:
COUNTY
Split Zoning Dist:
N
Split Zoning Dist(1):
0
Split Zoning Dist(2):
0
School District:
COUNTY
Elementary School:
BANOAK
Middle School:
JACOBS FORK
High School:
FRED T FOARD
School Split:
NO
P&Z Case Number:
Census Tract 2010: 011802
Census Block 2010:
3031
Small Area Plan:
PLATEAU
Agricultural District:
Printed: Friday, July
20, 2012 11:40 AM
PAYOR
MORETZ WELL DRILLING
MORETZ WELL DRILLING
CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON, NORTH CAROLINA 28658
PHONE: 828.465.8399
www.catawbacountync.gov
PAYMENTS
TRANSACTION NUMBER: TRC -249064-20-07-2012
PAYMENT DATE: 07/20/2012
PAYMENT TYPE: Credit Card
INVOICE NUMBER FEE NAME
07-12-288469 Well Abandonment Fee
TOTAL PAYMENTS:
RBPR-07-2012-16017
RECEIPT
Friday, July 20, 2012
FEE AMOUNT
$100.00
5100.00
CASE TYPE: Residential Building Plan Review WORK CLASS: Building New
SITE ADDRESS: 6050 SMITH RD, VALE NC 28168
Contact Person MORETZ WELL DRILLING, 6159 W NC 10 HWY, HICKORY NC 28602
B:828-244-1420
** NO PEOPLESOFT ACCOUNT ASSIGNED **
Owner STACY FULBRIGHT, 932 12TH ST SE, HICKORY NC 28602
E9 - receipt 07/20/2012 12:06 Page 1 of 1
PAYOR: DIXON CONSTRUCTION
DIXON CONSTRUCTION
CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON, NORTH CAROLINA 28658
PHONE: 828.465.8399
www.catawbacountync.gov
PAYMENTS
TRANSACTION NUMBER: TRC-249958-22-08-2012
PAYMENT DATE: 08/22/2012
PAYMENT TYPE : Check 2469
NCDL-819156 DOB 1/31/34 XP-1/31/13
INVOICE NUMBER FEE NAME
08-12-289361 Authorization to Construct Fee
(New/Expansion) Fee
08-12-289361_ Improvement Permit Fee
08-12-289361 Well Permit & Inspection Fee
TOTAL PAYMENTS :
RBPR-07-2012-16017
RECEIPT
Wednesday, August 22, 2012
FEE AMOUNT
$150.00
$300.00
$600.00
CASE TYPE:
Residential Building Plan Review WORK CLASS: Building New
SITE ADDRESS:
6050 SMITH RD, VALE NC 28168
Applicant
HEATHER AND STACEY FULBRIGHT, 6050 SMITH RD, VALE NC 28168
C:8286385082
Contact Person
MORETZ WELL DRILLING, 6159 W NC 10 HWY, HICKORY NC 28602
B:828-244-1420
Owner
STACY FULBRIGHT, 932 12TH ST SE, HICKORY NC 28602
Contractor
DIXON CONSTRUCTION, 1706 BRENTWOOD DR, NEWTON NC 28658
B:828 -464 -5709C:828 -244-6564F:828-464-5709 SEPT23JSC@YAHOO.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED **
E9 - receipt 08/22/2012 16:59 Page 1 of 1