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Home My WebLink AboutRBPR-07-2014-19454.TIFTHIS IS NOT A PERMIT Case # RBIIR-07-2014-19454 CATAWBA COUNTY HEALTH DEPARTIVIENI' PLAN REVIEW APPLICATION FOR ENVIRONMENT/1\1- S}'RVICES Residential Building Plan Review - Building New AUTH CONST C Applicant I IAIZRILi.. CONS'rRUC"I'ION COMPANY, AI,I X S. (ALEX HARRILL), 617N CENTER ST, HICKO NC 28601- 8:(828)228-1000 C:(828)228-1000 ASFIARRILL(i%Cf L1R11 R.1;F:T Contractor IIARRIE.1-CONS"IRUC"I'ION COMPANY, ALEX S. (ALEX HARRILL), 617N CENTER ST, HICKO NC 28601- 8:(828)228-1000 0:(828)228-1000 ASHARRII..Ltir7Cf-iAR"I'I-:R.NE"C Owner ABERNETHY PARK LIMITED, 2850 SAINT GF.ORGF RD, WINSTON SALEM NC 27106 NAME TO APPEAR ON PERMIT HARRILL CONSTRUCTION COMPANY, ALEX S. (ALEX HARRILL) SITE ADDRESS: 1471 KENSINGTON PARK CT, HICKORY ICKORY NC 28602 PIN ## 279008875771 NAME of SUBDIVISION: ABERNETHY PARK PH 11 Lol it> 82 Section/Block PROPERTY SIZE: Squarc Fect Acre 11 0.46 DIRECTIONS: left on BethelChurch Rd - ight on Pittstown - Left into Abernethany Park - Makre the first right - make the next right - at stopsign make a left - job on the right PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: Single Family Dwelling 4 bedroom / Attached garage / Bonus Room / No Basement 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? No APPLICATION FOR: 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 NEW STRUCTURE DIM:: 40 x 50 # OF NEW BEDROOMS:- 4 BASEMENT? No BASEMENT FIXTURES? PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 1:::.:; ::. 01/10v2014 11:43 Page i of4 CATAWBA COtiNTY l Public ticalth Department Rnviromurntal Flealdt Division / 110 Box 389. 100-A Southwest. Blvd. \'cwton• NC28658 Case # Subdi\ inion PINK RBI"R-07-2014-19454 ABERNETHY PARK PH 11 279008875771 NAME ON PERMIT: HARRILL CONSTRUCTION COMPANY, ALEX S. ( AI...EX HARRILL). 617 N CE:NTI:R ST, HICKORY NC 2 HARRILL CONSTRUCTION COMPANY, ALEX S. ( ALEX HARRILL) Site Address: 1474 KENSINGTON ON PARK CT, HICKORY NC 28603 Property Size: Square Feet Acres 0.46 Directions: left on BethelChurch Rd - ight on Pittstown - Left into Abernethany Park - Makre the first right - make the next right - at stopsign make a left - job on the 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 site access�i o tha com fete si aluation can be performed. Date: %- /c '1 �� Signature: of Applicant orAgcnt l � �� An Environmental Health Specialist will contact you within 3 working days of application date. If you need further information or assistance please call 323-466-7291 AREA2 MINIMUM SETBACKS I'R0NT: 20 SIDE: 9 REAR: 18 MAX HEIGIIT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07;10!2014 5300.00 Fee TOTAL FEES S300.00 FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 07110,,201-1 1143 Pa;e 2 of 4 C\,'ASL "A PHIS IS NO"I' A PERN41T :tcQc:xa�rr CATAWBA COUNTY HEALTH DEPARTMENT 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 ❑ Existing Facility ❑ Property Address /� %L% fifs.PSt,'ur tin%:n F%rjc. f SubdivisionG'<?, r2�Lr.11r�t_ t77c 1c w,` i i,� t Hca Z Lot #> Acres �S Section/Block/Phase Driving Directions to Property f/1Z j C r✓-c.i t "l J-rf o,,-, 441,,- t '1 41,,:1 0 %a a Ips k"-,— v t'C( ?. t NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name AddressPOr;1r l �in.1 , n,'c 2 Phone SZx�� /� �;, Cellthonc Owner Contact Information Name f-�/c.n Address Phone „ f Cell4one Contractor Contact Information Name )i I&N .`a /&,,, I 1 Address ;:�>o 1r30 c /& Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site lV�y # of Bedrooms * Structure Dimensions # of Occupants Basement ❑ Yes%-,�O Basement Fixtures ❑ Yes `f71—No The Applicant shall notify the local health department upon Submittal of this application if any of the followings apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes D"No Does the site contain any jurisdictional wetlands? ❑ Yes Q'�No Does the site contain any existing wastewater systems? ❑ Yes l No Is any wastewater going to be generated on the site other than domestic sewage? 121 -Yes ❑ No is the site subject to approval by any other public agency'? ❑ Yes i"No Are there any easements or right of ways on this property" Describe Existing water supply in use H Individual Well U Community Well U Semi -Public Well County/City/Township Water Line Is a public water supply available'? ** Yes ❑ 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) ❑ Accepted 0 Alternative 0 Conventional 0 innovative ❑ Other 0 Any CATAWB fl-ilS 1S NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence Ell �iew Residence ❑ Addition to Residence # of New Bedrooms *'; Project Description , ('tufo^^ Structure Dimensions 40 X --,u # of Occupants Basement ❑ Yes ❑ f` o Basement Fixtures ❑ Yes D-1�'o U 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 *t 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 'r 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. ** IfNo, 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 (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 intornrttion 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 rule. I understand that 1 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 he performed. y Signature of Owner or Agent tDate f ,t ""/ Printed Name of Owner or Agent N i I inch = 49 feet v 1 60 Catawba County, North Carolina I his map product was Impared titmt the Catauha Counh'. NC, Ucospatial Infi CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2790-08-87-5771 Narpe: ABERNETHY PARK LIMITED Name2: Address: 2850 SAINT GEORGE RD Address2: City: WINSTON SALEM State: NC Zip: 27106-5029 Account: Calc Acreage: 0.46 Tax Map: LRK: 606058 Deed Book: Deed Page: Subdivision Name: ABERNETHY PARK PH 11 Subdivision Block: Lots: 82 Plat Book: 73 Plat Page: 4 Building Number: 1474 Street Name: KENSINGTON PARK CT Site Zip: 28602 Township: HICKORY Fire Dist: MOUNTAIN VIEW C ity/Tax: State Road: 1131 Total Bldgs Value: Land Value: $25,200 Total Value: $25,200 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 80 Watershed: WS-111 Protected Area Watershed Split: NO Voter Precinct: P23 E911 District: COUNTY Zoning: Zoning2: Zoning3: Zoning Split: Zoning Overlay: Zoning District: Split Zoning Dist: Split Zoning Dist(1): Split Zoning Dist(2): 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: 2002 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Thursday, July 10, 2014 04:02 PM SpA CATAWBA COUNTI' -c� Public Health Department Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 rg 2 s� a] �r Qe Case # J_�P Subdivision PINS LOT# IMPV-08-2013-041328 KENSINGTON PARK PH 11 279008974976 82 NAME ON PERMIT: ABERNETHY PARK LIMITED, 2850 ST GEORGE RD, WINSTON-SALEM NC 27106-5724 Site Address: 1474 KENSINGTON PARK CT, HICKORY NC 28602 Property Size: Square Feet 19,558.44 Acres 0.449 Directions: BETHEL CHURCH RD, LEFT ON PITTSTOWN RD, LEFT ON ABERNETHY PARK DR, RIGHT ON ORCHARD PARK DR. RIGHT ON REGENTS PARK RD, LEFT ON KENSINGTON PARK CT, LOT ON RIGHT Improvement Permit Facility: Primary Residence - house Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Public Water Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: IIIG - OTHER NON -CONY TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50% REDUCTION Type: IVA - ANY SYSTEM WITH LPP DISTRIBUTION PUMP REQUIRED ***** OPERATOR REOUIRED Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner 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 Rales for Sewaee Treatment and Disposal Svstenrs' (15A NCAC ISA .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. Megen McBride AUTHORIZED STATE AGENT 08/23/2013 APPROVAL DATE Permit Expiration Date: 08/23/2018 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. 1 F.9 - chpcnnil 08/23/2013 08:19 Page I of 3 P EHfK-08'-20(3-17%0O t ill KmsiAth Pq✓k C4. Wckor 4t � zz . I t L4 lIn e5 5kown Qm � v fc6 p4 , Lol P uS f t CeCor AC, evM4 1 dPl� Or�Or �o ls5�a�,Ce. o� Tki5 purAIJ IS mot lylie►lded kor- sy tcm '051' � loh 1 �" �urpoSeS, Do ool drive, �Yak (of, by �ti( O v Se Tic G.rr P �l j} b,ji^ Rd, gt,17' 1----{ �.o(d roue{ W sep}►c arca 4 1h+��ai 15�„ rea a- v N Ke -fair SWO red ti W dist (55x lq5 ) Proposed 4 SR g056 Tor q0 x 50