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Home My WebLink AboutRBPR-07-2013-17643.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2013-17643 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Swimming Pool IMPROVEMENT Owner DAYNE WILLIS, 7583 PROVIDENCE CHURCH RD, VALE NC 28168 0:8286383691 NAME TO APPEAR ON PERMIT Dayne Willis SITE ADDRESS: 7583 PROVIDENCE CHURCI I RD, VALE NC 28168 PIN # 267903416841 NANIE of SUBDIVISION: Lot # 5 Section/Block PROPERTY SIZE: Syuara Feet 407,286.00 Acres 935 DIRECTIONS: Hwy 10/right on Providence Church Rd/3 miles to Providence Baptist Church/driveway is on left -at bottom of driveway, turn right @ fork and go the the brick house at the very end PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 20 x 38 In -ground swimming pool SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage2 No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACILITY TYPE: Other OTHER DESCRIPTION: DESCRIPTION OF single family dwelling EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: 50 x 50 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 20 x 38 Desired system types (Improvement Permit or Authorization to Construct) ACCEPTED ALTERNATIVE. CONVENTIONAL. OTHER, INNOVATIVE ANY. Other described: Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable, Improvement Permits and Well Permits are transferrable Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so th t Comte- devaluation can be performed Date: 7 — c) — /3 Signature of Applicant or Agent ,e� /,Jt�, An Em ironmental Health Specialist wilt contact you within 2 working tIppltcation date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 10 MAX HEIGHT: 1 li - c11"Pip n 111011 07/09/2013 16 05 Page I of 4 agn CATAWBA COUNTY Case RBPR-07-2013-17643 `T ifs Public Health Department Subdivision ® y) Environmental I Iealth Division PINK 267903416841 PO Box 389. 100-A Southwest Blvd, Ne. Nton. NC 28658 NAME ON PERMIT: DAYNE WILLIS, 7583 PROVIDENCE CHURCH RD, VALE NC 28168 Site Address: 7583 PROVIDENCE CHURCH RD, VALE NC 28168 Property Size: Square Peet 407,286 00 Acres 935 Directions: Hwv 10/riqht on Providence Church Rd/3 miles to Providence Baptist Church/driveway 1s on left -at bottom of driveway, turn right @ fork and go the the brick house at the very end FEENAME DATE FEE AMOUNT Improvement Permit Fee 07/09/2013 S150.00 TOTAL FEES $150.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) I 0 - chdpphLa1J11n 07/09/2013 16 05 Page 2 of 4 CATAVV BA THIS IS NOT A PERMIT ��6'"` v-7— 3C) I J_ f , (04- ) t_c0UNTr �--�� CATAWBA COUNTY HEALTH DEPARTMENT tee. Application for Environmental Services Page I 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 ❑ Existing Facility ❑ Property Address ❑ S b' S '8e-„" Ck Q Subdivision Ute I < -rN C 3 � ) (7 8 Lot # Acres Name Address—IS2s3Jt <e C .cls 2d r Phone SS LB - 19 y - a- o i-- a Owner Contact Information Name GP-N_z c.s abeam Address Phone Contractor Contact Information Name Address Phone W •lt s Vc�l�. l'tc -4'F(6t Cell Phone 8zy-91 (-L)"'n zi Cell Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? X Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site k o�'S� - 5 J fl -m"11 d we I I n # of Bedrooms *t 3 Structure Dimensions So x So # of Occupants 4 Basement ❑ Yes ® No Basement Fixtures ❑ Yes ® No The Applicant shall notifv the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes Jkl No Does the site contain any jurisdictional wetlands? ;XYes ❑ No Does the site contain any existing wastewater systems? ❑ Yes 5( No Is any wastewater going to be generated on the site other than domestic selvage? Yes ❑ No is the site subject to approval by any other public agency? Yes ❑ No Are there any easements or right of ways on this property? Describe Existing water supply in use Z Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes IN No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other 0 Anv Section/Block/Phase Driving Directions to Property H Ll ) b V w« C6.� ei,- 2d ( w r, qL i) 1 n (Z r ci (�fc J,�e .c L, O e J kALi ly p /� � 3 V"r It S i9 7to, dr ncr. 13C'vfo) - ckv.-r'G- (rte r,gkt) i s oh L e t— 0.^{- rl 0 +*% NAME TO APPEAR ON PERMIT? (Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address—IS2s3Jt <e C .cls 2d r Phone SS LB - 19 y - a- o i-- a Owner Contact Information Name GP-N_z c.s abeam Address Phone Contractor Contact Information Name Address Phone W •lt s Vc�l�. l'tc -4'F(6t Cell Phone 8zy-91 (-L)"'n zi Cell Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? X Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site k o�'S� - 5 J fl -m"11 d we I I n # of Bedrooms *t 3 Structure Dimensions So x So # of Occupants 4 Basement ❑ Yes ® No Basement Fixtures ❑ Yes ® No The Applicant shall notifv the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes Jkl No Does the site contain any jurisdictional wetlands? ;XYes ❑ No Does the site contain any existing wastewater systems? ❑ Yes 5( No Is any wastewater going to be generated on the site other than domestic selvage? Yes ❑ No is the site subject to approval by any other public agency? Yes ❑ No Are there any easements or right of ways on this property? Describe Existing water supply in use Z Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes IN No If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other 0 Anv THIS IS NOT A PERMIT CoLBAV0 1JA CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * t Project Description Structure Dimensions Basement ❑ Yes ❑ No # of Occupants Basement Fixtures ❑ Yes ❑ No �] Accessory Structure(s) Describe Poo # of New Bedrooms *'I if applicable Structure Dimensions 20 K 3 $ # of Occupants Accessory Dwelling ❑ Yes ,R] No Plumbing [>(Yes ❑ No Describe Plumbing Needed 0o1 p l tk"b q ❑ Multi -Family Residence # Units #Bedrooms per UI nit* 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 Page 2 Calculated Design Flow, Commercial'' 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 rooins identified on house plans as a bedroom at the tune of building permit issuance. This may prevent the need for septic system size increase in the future. t 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. SYSTEM REDESIGN AND/OR RETRH' WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that 1 am solely responsible for the proper identification and labelinlg of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Printed Name of Owner or Agent 1L tvN hr rG-. tP, LJ�11�5 I Date -7-1 —/3 Catawba County, North Carolina This mup product was prepared from the Catm�ba County, NC, Ceospm141 Information System N Catawba Counts has made substsnual chops to ensure the accuric� of location and labeling information contained on this in Lip Caum ha County paomotes and recommends the Independent verdiLat ion of Lane data contained un this map product be the user The County of Catawba, its employees, agents and personnel disc] aan, and shall not be held liable Ibr am and all damages, loss or Irain bq, whether direct, indirect or ionseyuenual which anses or may arise from this map product oI the use thereof by anv person or emits, Selected Parcel Number: 2679-03-41-6841 1 inch = 120 feet Prepared for: THIS IS NOTA LEGAL OCUNIEN' ?.00h n \ lot �. °' �\ . \,-Plat 6M01 <= j,\'off ^. �1 1, I�itDate:.7/9/2013 - Time: 3:38:54 P7 11 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID 2679-03-41-6841 Name: WILLIS DAYNE S Name2' Address: 7583 PROVIDENCE CHURCH RD Address2' City: VALE State: NC Zip: 28168-7542 Account. Calc Acreage 9.35 Tax Map. 004807007 LRK: 3406 Deed Book: 1897 Deed Page 0802 Subdivision Name Subdivision Block. Lots 5 Plat Book. 68 Plat Page. 80 Building Number 7583 Street Name. PROVIDENCE CHURCH RD Site Zip: 28168 Township: BANDYS Fire Dist, COOKSVILLE City/Tax: State Road 1116 Total Bldgs Value: $239,100 Land Value' $37,600 Total Value. $276,700 Year Built: 1999 Year Remodeled Last Sale Date: 8/1/1994 Last Sale Amount: $22,000 Neighborhood' 89 Watershed. WS -III Protected Area Watershed Split: NO Voter Precinct P2 E911 District. COUNTY Zoning* R-40 Zonmg2' Zonmg3 Zoning Split. N Zoning Overlay: WP-O,FPM-O Zoning District COUNTY Split Zoning Dist' N Split Zoning Dist(l) ' 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: 2008 Small Area Plan PLATEAU Agricultural District Proximity Printed Tuesday, July 09, 2013 03 38 PM *,*Op. Permit and/or /��orCert. Op �R7�e�gpu7�iTppr�ed�%_ (Mus t�b7egrcompleted prior to final) No --jj��j�7��j/n 7795 ,®� (704) 465-8270 Lot Eval. -A- Improve. Permit_ ( Repair Permit Cert. of Comp. PermitXOper. Permit_ Owner/Agent - ,et£ S L..ilW'S Phone 4Z Z_ 1!36 Address 4:$0£3 I+v'c toav 7, Ls Ajecl I. LLry Subdivision 6/J.t Fyr �� ®, c Seion/Block/Phaase`i� Lot#_,L Lot Size 9, ZG ,•c Directions: /p eAJ (R-) /'mat.. C/, - /Zd Drrli i /ern n F ( / . � � l� � a rc 721641-T of F�✓/c lfm�.c i C'/ /r //Li sz //rw O/r!w . ✓N 00&±u /•,..o [fi / 2/6ttT Facility: House Mobile Homed Business Other: Tax Map # zj� Y/.3- ? - ri multi -fa miit Other Zoning Approval 4 �95/ULrlS/ Bedrooms Seats Employees Application Rate e GL GPD Flow �j6 d Hot Tub or pa yes/0 Special Fixtures 100 Repair Area yes no REPAIR NOTICE: Basement yes/0 Basement Plumbing yes/no REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private_X Public DAYS FROM DATE OF PERMIT. Type of System: Trench 1," Bed_Pump_Pump /Pane l_Pane 1_LPP—Other Tank Size: Septic Tank ,Tpp �yJ Pump Tank Nitrification Field: Total Square Feet ,6�d Depth of Stone / Z Bed Size Trench Width 136 Total Length of All Trenches _ioA Number of Trenches 3 Individual Trench Length /cr//1CV/bol _/ Feet on Center_? Maximum Trench Depth -7-YDistance of Nearest Well �"d Lot Evaluation: Approved/no (Void After 24 months) Topo 4'-/U Slope Sketch of lot Evaluation Site - System Design - Final Texture (/ri�Y b� (VI DO NOT INSTALL Structure /%jorj, ,/ I I h�al� 1 l WHEN WET i (p Clay Min. ! v / ( i - _„_Soil Wetness- P-5 Soil Depth -> Restric. Hoz. at " Available space/no Overall Class S eu Comments: / e5 Septic Tank Contractors MUST contact the i Sanitarian BEFORE i changing permit. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** 444A4*w4wwwww4*+4+*YI**�c4-�w*www+4++ww44w4+**4 ww4++w+*444*w++**+++w*++ww�+w3Yw+www+4++w**w*4+ Permit Date z-/�_ /_J/ / j� /J / (Improvement,,Permit vp ryr after 60 months) Owner/Agent�J(q( /.��^ d �_Jn Sanitarian Installed By .(N�'�i',//`Cly -w Date -/�4S San tarilc (Nq� any changes/information in red or by sketcft on b k) ' *******IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE******** IS AN ADDITIONAL $25 CHARGE. White - Office Blue - Building Inspection Completion Yellow - Owner/Agent Green - Building Inspection IP