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HomeMy WebLinkAboutRBPR-07-2012-16030.TIFBA COQ THIS IS NOT A PERMIT Case # RBPR-07-2012-16030 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Residential Building Plan Review - Deck/Porch pveul-,-A -1 I� la _ IMPROVEMENT - AUTH CONST - EXPANSION Applicant SEAN KELLEY, 5815 KINGSWAY BLVD, HICKORY NC 28602 C:8282343840 Contractor BOUREANU, CONSTANTIN CLAUDIU, 5155 ORCHARD PARK DR, HICKORY NC 28602- B:(828)320 -4225F:(866)530-4588 ADVANCEDELECTRICAL@HOTMAIL.COM NAME TO APPEAR ON PERMIT SEAN KELLEY SITE ADDRESS: 5815 KINGSWAY BLVD, HNC 28602 PIN # 269905199764 NAME of SUBDIVISION: INGSWA t # 5 Section/Block PROPERTY SIZE: Square Feet s 0.49 DIRECTIONS: HWY 127 S/ RT KINGSWAY BLVD/ 1S HOUSE ON LF PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY : Public Water Public water IS available for this property. DESCRIBE WORK: EXTENDING EXISTING DECK TO MAKE IT LARGER AND COVERED permit is for 3 br. house is 4 must expand and move system that will be too close to new deck APPLICATION FOR: STRUCTURE TYPE: Existing Structure PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF SINGLE FAMILY DWELLING EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 40'X 70' NUMBER OF EXISTING BEDROS: 4 # OF OCCUPANTS: 5 ,Q MPROPERTY EASEMENTS: ( ONE PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 14' X 28' EXTENDING DECK 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 AREA 2 MINIMUM SETBACKS FRONT: SIDE: REAR: MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/25/2012 $300.00 Fee Improvement Permit Fee 07/25/2012 $150.00 TOTAL FEES $450.00 F9 - ehapplication 07/25/2012 16:42 Page 1 of 3 Applicant THIS IS NOT A PERMIT Case # RBPR-07-2012-16030 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch IMPROVEMENT - AUTH CONST - EXPANSION SEAN KELLEY, 5815 KINGSWAY BLVD, HICKORY NC 28602 0:8282343840 Contractor BOUREANU, CONSTANTIN CLAUDIU, 5155 ORCHARD PARK DR, HICKORY NC 28602- B:(828)320 -4225F:(866)530-4588 ADVANCEDELECTRICAL@HOTMAIL.COM NAME TO APPEAR ON PERMIT SEAN KELLEY SITE ADDRESS: 5815 KINGSWAY BLVD, HICKORY NC 28602 PIN # 269905199764 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres DIRECTIONS: HWY 127 S/ RT KINGSWAY BLVD/ 1ST HOUSE ON LF PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water Public water is **NOT** available for this property. DESCRIBE WORK: EXTENDING EXISTING DECK TO MAKE IT LARGER AND COVERED permit is for 3 br. house is 4 must expand and move system that will be too close to new deck APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF SINGLE FAMILY DWELLING EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 4 # OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 14'X 28' EXTENDING DECK 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 p perty . y rep esentation by you of house or structure location should conform to applicable setbacks. Date: ��i L Signature of Applicant or Agen �� t' \Jl/� �i C> An Environmental Health Specialist will contact you within2 working days of application date. If you need further information or assistance please call 828-466-7291 2 MINIMUM SETBACKS FRONT: SIDE: REAR: MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/25/2012 $300.00 Fee Improvement Permit Fee 07/25/2012 $150.00 TOTAL FEES $450.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 69 - ehapplieation 07/25/2012 11:05 Page I of 3 CATAWBA COUNTY 4Q Public Health Department d Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 NAME ON PERMIT: SEAN KELLEY, 5815 KINGSWAY BLVD, HICKORY NC 28602 Site Address: 5815 KINGSWAY BLVD, HICKORY NC 28602 Property Size: Square Feet Acres Directions: HWY 127 S/ RT KINGSWAY BLVD/ 1ST HOUSE ON LF �$ CATAWBA COUNTY, NC Environmental Health Boundaries l� Case # RBPR-07-2012-16030 Subdivision PIN# 269905199764 N 7 A W✓ E E'po�a��M'ewN�nn 66W and S Your application for Environmental Health (EH) services has been assigned to 2 An Environmental Health Specialist (EHS) working in this area will contact you within two business days of receip by the EH Division. If you are not contacted within this time, or if you would like to leave a message with an EHS, please call (828) 466-7291. Be sure to first state your case number from the top right corner of your application, and clearly state, your name, area number, and a number where you can be reached during normal business hours. L4 - chapplication 07/25/2012 11:05 Page 2 of 3 O W J O. Z 0 W m c� C V H H cc Z FCS C 0 Z 5� 6THD RVe 017-2,012 -/A THIS IS NOT A PERMITCATAWBA COUNTY HEAARTMENT Application for Environmental Services Page 1 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 l --:--->j1 1.� K""-\ (3 S ��'�(11 7j Y4 `-ViC(�JiZ� r Driving Directions to Property NAME TO APPEAR ON PERMIT? ❑ Owner Applicant Contact Information Name Address Phone Owner Contact Information Name Addressj��`_rA Phone Contractor Contact Information Name Address Phone ❑ Existing Facility ❑ Subdivision Y\,r\ Lot # C'�cres I Section/Block/Phase r ❑ Applicant Contractor NL 2B6v z Cell Phone boLQ� 023%0 Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Description of Existing Structures on Site Ll # of Bedrooms *f li Structure Dimensions 10 X 9 O Basement ❑ Yes ❑ No Basement Fixtures [Yes ❑ No L� Contractor # of Occupants 5 Planned Future Ad itions�or Imp ovements (Building Permit NOT requested at this time) Describe �� C\'_6<, WJe � <_�eC K Proposed Future Structure Dimensions of Bedrooms *_ if applicable Are there easements or right-of-ways recorded on this property ❑ Yes [�J'No Describe Is a public water supply available on or adjacent to the above property ** 0, Yes ❑ No Check type available ❑ Community Well ❑ Semi -Public Well ©bounty/City/Township Water Line Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well i Q County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) C `z eG C Cell Phone a?"6 3 p 1d�a S' NL 2B6v z Cell Phone boLQ� 023%0 Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Description of Existing Structures on Site Ll # of Bedrooms *f li Structure Dimensions 10 X 9 O Basement ❑ Yes ❑ No Basement Fixtures [Yes ❑ No L� Contractor # of Occupants 5 Planned Future Ad itions�or Imp ovements (Building Permit NOT requested at this time) Describe �� C\'_6<, WJe � <_�eC K Proposed Future Structure Dimensions of Bedrooms *_ if applicable Are there easements or right-of-ways recorded on this property ❑ Yes [�J'No Describe Is a public water supply available on or adjacent to the above property ** 0, Yes ❑ No Check type available ❑ Community Well ❑ Semi -Public Well ©bounty/City/Township Water Line Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well i Q County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) LU W a U W m V) t� THIS IS NOT A PERMIT r CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 18 SAI Pr gposed Facility Type Primary Residence ❑ New Residence ['/Addition to Residence # of New Bedrooms *T Project Description Structure Dimensions I I'1 of Occupants Basement F9 Yes ❑ 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 *f 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 T 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. t1f 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 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 Construct issued by this department is valid for (5) five years from the date issued and is not transferable Signature of Owner or Agent �rr Printed NaTe of O}vner or AgentLonS����`� Date q2 � I / 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 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 or may arise from this map product or the use thereof by any person or entity. 1 inch = 50 feet SWAY t 66.00 53.9 1 j I i f 1 00 �i---- 8755 j 6 l I 117.78 Selected Parcel Number: 2699-05-19-9764 Prepared for: i J�J,UU/ -----_� C 128. 120,00' 87 j r l t i 1 I I 00 64-- ti 5 '125.004 24-96L 2 150.0 THIS IS NOT A LEGAL DOCUMENT Date:'7/25/2012 Time:4:, 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 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 or may arise from this map product or the use thereof by any person or entity. Selected Parcel ,Number: 2699-05-19-9764 1 inch = 97 feet Prepared for: a 14 145.00 ~--- _ ___.-15� 7 16 235.00 Lj 17 0 o 6999°' ��� "� Co 8928 9947 co N 0976 j 2975 x.00 J 20.00 r ---� - y-- --x__120.00 130.00 _ �z$�00 24.96 230,04 K.INGSwAy �'D �24.00 12 66.00 53.91 120.00' 87.20 57.89 197.11 '07 c� u — 7736 8755 `— ; ! 76 F $ 7 1 6 1703 2792 0.00 120 2.22` 4 5 4 117.78 1,25.00 3 150.00 230.00 R-20 I. 13.42A 9405 THIS IS NOT A LEGAL DOCUMENT (1500) Date:,7/25/20121 Time:!10iO3:17 AMS 4 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2699-05-19-9764 Name: KELLEY SEAN C Name2: KELLEY SONIA L Address: 5815 KINGSWAY BLVD Address2: City: HICKORY State: NC Zip: 28602-9286 Account: 192823 Calc Acreage: 0.49 Tax Map: 189H 09026 LRK: 90876 Deed Book: 2555 Deed Page: 1075 Subdivision Name: KINGSWAY Subdivision Block: Lots: 5 Plat Book: 29 Plat Page: 16 Building Number: 5815 Street Name: KINGSWAY BLVD Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: Total Bldgs Value: $242,000 Land Value: $23,400 Total Value: $265,400 Year Built: 2000 Year Remodeled.- emodeled:Last LastSale Date: 2/26/2004 Last Sale Amount: $256,000 Neighborhood: 80 Watershed: WS -III Protected Area Watershed Split: NO Voter Precinct: P24 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning D!5 COUNTY Split Zonin D' Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011801 Census Block 2010: 1027 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Wednesday, July 25, 2012 10:03 AM �� file's a a,w 3 w 1444 v! (A^1 CATAWBA COUNTY 14EALTH DEPARTMENT N° 6 6 9 5 'I cicphunc (828) 465-8270 TDD 828) 465 8200 Pr-*d v lur I'ihu `l'ih. ons . Rpr. Prmt. Opr. Prmt. Sys. '-3 —L' Well Prmt. Well Rpr. Prmt. Owner/Agent Phone Address ,Q,t Subdivision /G4,." Section/Block/PhAe Lotl1 / („ Lot Size r�/ Directions:��7S/� J`7"— Facility: House Mobile Home Business Multi-family . Other: Tax Map or Pin N mber ! s 0 9 ?"L Other . Zoning Approval # # Bedrooms N Seats # Employees . Application Rate i 1f GPD Flow Si$'O Hot Tub or Sp o Special Fixtures Basementes no 100% Repair Arno Basement Plumbing yes/no Water Supply: Private Well Public_/,ff%emi-Public_ Type of System: Trench Bed Pump Pump/Panel Panel LPP Other.,a ^ Septic Tank Size /OOO�Pump Tank Size Nitrification Field: Total Square Feet -!0 Dep of Stone Bed Size Trench Width Total Length of All Trenches , ?PQ Number of Trenches Trench Length ire / l l ° 16A5/0Feet on Center 9 Maximum Trench Depth Distance of Nearest Wel//� °UO NOT INSTALL SEPTIC WH+` "'E'" *+ rnnr.'n +T Cp,ILPLETION rtrt***+«++*rrr*r+rrr«rrr«rtr«rrr+■«+««+rrrrr*««rtrt+«rtrt«+rtrt***rt+**rt**rrrrrrrrrrrrrr«+r«+rrrrrrrrtrrr*r««rtrt+«+++rt««r«rrrrrr Topo ?—'S' _% slopej Texture Structure _ r�O/ Clay Min.t-A Soil Wetness Soil Depth' b f/ Restric. Hoz .`3i Available spaceno f 1.1._ t✓ Overall Class S Comm lits: r,+ well, •. Filter Require �. Riser required why tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS S STEM WILL FUNCTION** rtrt*r*rt********rt«+r*rt«rt*++++rtrt+**+*++**+**********r*rt«rrr*rtrt++++rtrt**««*rt*******«rt*«+r+«+rtrrt+rt«++rrtrtrt««««+r*«**«rtrt«*rrrr►•rr *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) rive years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guarantegd at any site 11u,tl� Health Department. Permit Date G� -9 C�j EHS Owner/Agent� t y= ce, Septic Tank Installed ByDate 6J-7— ct) EHS A4-ItX_ talled By Well Giout Approval Date Well Head Approval Date Date Sample Collected Date of Resulis R,-milrc . • • � CLIC