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Home My WebLink AboutRBPR-07-2014-19544.TIFApplicant Contractor Owner THIS IS NOT A PERMIT Case # RBPR-07-2014-19544 CATAWBA COUNTY HEALTH DEPARTMENT 0' FRI PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Modular IMPROVEMENT - AUTH CONST -NEW WELL KAREN BRYD, , H:8284780554 HOME:8284780554 O FREEDOM HOMES #667 (UNLICENSED GENERAL), 1124 CHARLOTTE HWY, TROUTMAN NC 28166- 6:(704)528-7960 ONEDA HARRISON, 6643 POPLAR TENT RD, CONCORD NC 28027 Paid By CMH HOMES, INC, 5000 CLAYTON RD, MARYVILLE TN 37804 NAME TO APPEAR ON PERMIT Karen Bryd SITE ADDRESS: 4517 LITTLE MOUNTAIN RD, CATAWBA NC 28609 PIN # 367804544308 NAME of SUBDIVISION: Lot # B Section/Block PROPERTY SIZE: Square Feet Acres 3.3 DIRECTIONS: 16S/ LEFT BUFFALO SHOALS RD/ RT LITTLE MOUNTAIN RD/ LOT ON RIGHT PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY : Public Water DESCRIBE WORK: 1 story on frame modular dwelling 32 x 64 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: FACILITY TYPE: Single Family Residence DESCRIPTION OF VACANT EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32 X 64 # OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: YES Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO C9- :happlicallnn 07/18/2014 12:56 Page I of CATAWBA COUNTY Case # RBPR-07-2014-19544 ` 1 Public Health Department Subdivision Environmental Health Division PIN#! 367804544308 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 184 sM NAME ON PERMIT: ( KAREN BRYD), , ( Karen Bryd) Site Address: 4517 LITTLE MOUNTAIN RD, CATAWBA NC 28609 Property Size: Square Feet Acres 3.3 Directions: 16S/ LEFT BUFFALO SHOALS RD/ RT LITTLE MOUNTAIN RD/ LOT 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 site accessib so that a o pletteys�ite evaluation can be performed. Date: 74--14 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 AREA1 MINIMUM SETBACKS FRONT: 80 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Authorization to Construct Fee (New/Expansion) Fee Improvement Permit Fee Well Permit & Inspection Fee TOTAL FEES DATE FEE AMOUNT 07/18/2014 $150.00 07/18/2014 $150.00 07/18/2014 $300.00 :. . $600.00 .. 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) 69-.happlicalion 07/18/2014 12.56 Page 2 of4 CA ARTBA THIS IS NOT A PERMIT COlATY ._�CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Cons uct §e Septic Repair ❑ Septic Malfunction ❑ Septic Expansion WNew Well Permit Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 4511 Lvh4e_ �Mbuv�k L^ C.�. Subdivision Lot # B Acres 3.44 Section/Block/Phase Driving Directions to Property __hW J Of-tz>Wa✓ ,V b 0aJ J£R- 'Tt410 Ru ca; •- - S%+eA4.5- ft 4u&A eL, k 1 bti► l L 4r Mt31jo dt a,* U Id j C dN tell h4 - NAME TO APPEAR ON PERMIT? ❑ Owner [RIpplicant ❑ Contractor Applicant Contact Information Name 1Fe4c, axep /keze&%& Address i i ZAP r "wiL ,+tv tt, Lm 4 Phone -7vs4- -98.3 -1 n L 44 Owner Contact Information Name Address Phone _704- 74Zdi 4i 3 Contractor Contact Information Name F eEi4)CM L -Ona Address t I Z 4 (,kgwlv�h OLW I Cell Phone f��('r i S f� ►�J Cell Phone Phone 7b t 5 74 40,6 4 I Cell Phone 764- PA3 - I014 WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *t 3 i Structure Dimensions X44 7° to 50 # of Occupants Basement ❑ Yes RNo Basement Fixtures Q Yes M -No The Applicant shall notify 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. 11 Yes No Does the site contain any jurisdictional wetlands? El Yes XIJo Does the site contain any existing wastewater systems? Yes JffNo Is any wastewater going to be generated on the site other than domestic sewage? * Yes ,dNo Is the site subject to approval by any other public agency? ID Yes J�(No 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? ** ❑ Yes dNo 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 13 Conventional Innovative ❑ Other 0 Any THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence R<New Residence ❑ Addition to Residence # of New Bedrooms *t 3 Project Description M kko__ Structure Dimensions " c� �- (Dq # of Occupants Basement ❑ Yes '-No Basement Fixtures 0 Yes No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling El Yes, [:]No Plumbing ❑ Yes ❑ No Describe Plumbing Needed -Multi-Family Residence # Units ' - #Bedrooms per Unit*t 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 Dayeare 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. - J *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 (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 comers and making the site accessible so that a complete site evaluation can be performed 4 Signature of Owner or Agent F�' l� Date Printed Name of Owner or Agent W'A4Z�q :1 inch = 100 feet Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System - 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: 3678-04-54-4308 Prepared for: I r ��- i THIS IS NOT A LEGAL DOCUMENTA jL Date Sav`led: 6/11/2014 Time:,I2:11:27 PM ?Y