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Home My WebLink AboutRBPR-07-2013-17749.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2013-17749 CATAWBA COUNTY HEALTH DEPARTMENT FRI PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES me Residential Building Plan Review -Building New IMPROVEMENT - AUTHI CONST Applicant FOX CONSTRUCTION, INC., PO BOX 6065, HICKORY NC 28603- B:(828)38113887 FOXBRENT@BELLSOUTH.NET Contractor FOX CONSTRUCTION, INC., PO BOX 6065, HICKORY NC 28603- ___-_._ B_(828)381-3887 FOXBRENT@BELLSOUTH`NET Owner WILLIAM KERLEY, 21 SHOOK LN, TAYLORSVILLE NC 28681 C:8283029255 NAME TO APPEAR ON PERMIT William Kerley SITE ADDRESS: 4214 54TH AV NE, HICKORY NC 28601 NAME of SUBDIVISION: CAROLINA POINT Lot # PROPERTY SIZE: Square Feet Acres 0.95 DIRECTIONS: Sulphur Springs Rd/left on 37th/righ on 54th Ave NE/end of street on right PRIMARY CONTACT: Applicant SEWER TYPE: GALLONS PER DAY: 360 WATER SUPPLY: DESCRIBE WORK: 70 x 80 single family home 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? No Is any of the wastewater going to be generated on the site other than domestic sewage? 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: FACILITY TYPE: Single Family Residence DESCRIPTION OF none EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: PIN # 373512860974 4 Section/Block Septic Tank Public Water # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 70 x 80 # OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: YES 1i4 - ehapphcalion 07/29/2013 16:06 Page 1 of 4 `a$A CATAAVBA COUNTY Case 4 RBPR-07-2013-17749 Q t Public Health Department Subdivision CAROLINA POINT Environmental Health Division PIN# 373512860974 v a°� PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1842 NAME ON PERMIT: WILLIAM KERLEY, 21 SHOOK LN, TAYLORSVILLE NC 28681 Site Address: 4214 54TH AV NE, HICKORY NC 28601 Property Size: Square Feet Acres 0.95 Directions: Sulphur Springs Rd/left on 37th/righ on 54th Ave NE/end of street on right 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 sit cessi so that aqomsite evaluation can be performed. Date: 7 2 C/ / 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: SIDE: REAR: MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/29/2013 $150.00 Fee Improvement Permit Fee 07/29/2013 $150.00 TOTAL FEES $300.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) F4 - chapplicalion 07/29/2013 16:06 Page 2 of 4 { ! / 4q CAf'AWBA THIS IS NOT A PERMIT cou�r� CATAWBA COUNTY HEALTH DEPARTMENT 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 El" Existing Facility ❑ Property Address -12le/. 14ve-, k/, e, . //,G'/,-(3/,�, h/, C, i Driving Directions to Property �li ur Y vii �ncQ o ( n` Subdivision Lot # Acres nBlock/Phase j .-J 32y " /Z /L SVc(t �. ,A v = /y. c l NAME TO APPEAR ON PERMIT? Qwner ❑ Applicant ❑ Contractor Applicant Contact Information ) / Name I Address Phone Owner Contact Information I Name - Address C'�� Phone'z� Contractor Contact information IName Address Cell Phone e2 �� Z& - 38 e 7 I Cell Phone Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner cant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t Structure Dimensions P -o _ _ `# of Occupants —11-15 Basement [`Yes ❑ No Basement Fixtures �s ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in uestion. If the answer to any question is "yes". applicant must attach supporting documentation. ❑ Yes��o Does the site contain any jurisdictional wetlands? C3Yes �o Does the site contain any existing wastewater systems'? 11 Yes ;� o Is any wastewater going to be generated on the site other than domestic sewage? 1VYes } oo Is the site subject to approval by any other public agency? ❑ Yes Are there any easements or right of ways on this property'? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available'? ** es ❑ 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 ❑ Alternative 11 Conventional 0 Innovative 0 Other l -Any TAWBA THIS IS NOT A PERMIT eco NTI CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Proposed Facility Type ❑ Primary Residence [ 'New Residence ❑ Addition to Residence # of New Bedrooms *t Project DescriptionCev V43Y %0 ' X � 6 bu tii�th y C�vP��_� "Sr /tY—e Structure Dimensions # of Occupants Basement 211�es ❑ No Basement Fixtures g -1Y-9 ❑ 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* 'I 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 E]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 I 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. 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 RETRIP 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 (S) 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 that a complete site evaluation can be performed. Signature of Owner or Agent/ j Date Printed Name of Owner or Agent 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 anv and all damages, loss or liability, whether direct, indirect J4 or consequential which arises or may arise from this map product or the use thereof by any person or entity. Selected Parcel Number: 3735-12-86-0974 1 inch = 50 feet Prepared for: 79 4226. 1.27 2 01` 1 �1 30 i \ �61 (0CO 45.61 �9 SIJn COO,, 4214 w� 0974 42 33.22 �„, ' ,.� • ��--�'�f � �'2 20.4 .,% ky� ; - ,.�' .� --52.:.6.7..-_w.. ��6 • c��. � ct THIS IS NOT A LEGAL DOCUMENT Date: 7/29/2013 Time: 3:50:29 PM r 5 k, CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3735-12-86-0974 Name: KERLEY WILLIAM GUY Name2: KERLEY CONNIE D Address: 21 SHOOK LN Address2: City: TAYLORSVILLE State: NC Zip: 28681-8864 Account: Calc Acreage: 0.95 Tax Map: LRK: 404181 Deed Book: 2903 Deed Page: 0302 Subdivision Name: CAROLINA POINT Subdivision Block: Lots: 4 Plat Book: 67 Plat Page: 47 Building Number: 4214 Street Name: 54TH AV NE Site Zip: 28601 Township: CLINES Fire Dist: ST STEPHENS City/Tax: State Road: Total Bldgs Value: $22,200 Land Value: $138,700 Total Value: $160,900 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 58 Watershed: Watershed Split: NO Voter Precinct: P33 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,FPM-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SNOW CREEK Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 010301 Census Block 2010: Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Monday, July 29, 2013 03:50 PM CA•tTAWB,;, COUNTY Case # WLS_006-00489 Public Health Department Environmental Health Division Subdivision FR -D SIGMON \' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 SecUBL/Ph/Lot # 4 �� / .(828) 465-8270 FAX (828) 465-8276 TDD (828) 465-8200 pIN# 911373512768845-4 Applicant/Owner FRED SIGMON C/O NANCY SIGMON BUTCHART . Site Address: 54TH AV NE HICKORY NC ,Property Size: SF .88 ACRES Directions: SULPHUR SPRINGS RD/ LEFT 37TH / RT 54TH AV NE/ GO TO END OF ROAD Improvement Permit Permit Valid For: .Five years No Expiration Facility (Residential): House House X Mobile Home Multi -Family Bedrooms _3 New? ✓ Addition? Projected Daily Flow I E 0 g.p.d Water Supply Private Well? Public? t/ Semi -Public? Basement: y Basement Plumbing: Y HotTub/Spa: N Special Fixtures (explain): Proposed Wastewater System l' r S_ 6°o�' �- Type:' Proposed Repair: J��/51" 5 J�v ✓�r% f,w. Permit Conditions: (Wfi�i,,,.l C��r w /v2zc ad ovi f4w� .,rL,f 4er.tv.r Owner or Legal Representative Signature:)"C-')i.1 d 1 nen (VU/20 Date: a Authorized State Agent: % ih �� _ g _ r Date: Z - (2— v 4L �: Tr, issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property �.�,er to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewaze Treatment and Disposal Svstems' (15A NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater Svstem (Required for Building Permit) * See site plan and additional attachments (� Proposed Wastewater System: Type: Wastewater Flow New Repair Expansion Soil LTAR: g.p.d./ft2 Type of Facility: Basement: y Basement Plumbing: Y HotTub/Spa: N Special Fixtures (explain): Wastewater Svstem Reauirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth Trench Width ft Minimum Soil Cover Minimum Trench Seperation Distribution: Distribution Box Seri�InDistribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date: 04/25/2011 I have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: i~r•.: r.•,1 T i de m ark%Forms Ung, S4 ao. ro t in g.p.d Form B i� CATAWBA COUNTY Case # WLS2006-00489 Public Health Departtrienl �; ... Environmental Health Division Subdivision FRED SIGMON / j PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # 4 (828) 465-8270 FAX (828) 465.8276 TDD (828) 465-8200 PrN# 911373512768845-4 Applicant/Owner FRED SIGMON C/O NANCY Site Address: 54TH AV NE HICKORY NC Property S SF .88 ACRES Directions: SULPHUR SPRINGS RD/ LEFT 37TH / RT 54TH AV NE/ GO TO END OF ROAD Improvement Permit Authorization To Construct 1:6o Well Permit Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of -,revocation if the site plan or site conditions are altered. Authorized State Agent Date Form C r. ITid-,k1F-,VR7SA- mt