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Home My WebLink AboutRBPR-07-2014-19556.TIFContractor THIS IS NOT A PERMIT Case # RBPR-07-2014-19556 CATAWBA COUNTY HEALTH DEPARTMENT me! PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES { J Residential Building Plan Review - Building New IMPROVEMENT - AUTHI CONST - NEW WELL -d- 0 CLARKS CREEK CONSTRUCTION CO (TOMMY OVERTON ), 1958 IRA DRIVE, NEWTON NC 2 13:828-464-7969 C:(828)851-8057 JT00722@ATT.NET Owner JOSHUA DUCKWORTH, , H:8282347638 HOME:8282347638 NAME TO APPEAR ON PERMIT Joshua Duckworth SITE ADDRESS: 9359 MULL RD, VALE NC 28168 NAME of SUBDIVISION: Lot # PROPERTY SIZE: Square Feet Acres 3.77 DIRECTIONS: 10W/ right Concord/Mull Rd / 3/4 mile on right PRIMARY CONTACT: Owner SEWER TYPE GALLONS PER DAY: 360 WATER SUPPLY DESCRIBE WORK: 1 story dwelling w/ attached & w/ unfinished 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: FACILITY TYPE: Single Family Residence DESCRIPTION OF vacant lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: PIN # 266703033983 1 Section/Block Septic Tank Private Well # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 76 x 40 # 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 APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - chapplicauon 07/21/2014 14:58 Page I of 4 va,,�A CATAWBA COUNTY Case # RBPR-07-2014-19556 Public Health Department Subdivision Environmental Health Division PIN# 266703033983 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1 g 2 S, NAME ON PERMIT: ( JOSHUA DUCKWORTH), , ( Joshua Duckworth) Site Address: 9359 MULL RD, VALE NC 28168 Property Size: Square Feet Acres 3'77 Directions: 10W/ right Concord/Mull Rd / 3/4 mile 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 lab ling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: -71,2- /Z2 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further infonnation or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 80 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME DATE FEE AMOUNT.. Authorization to Construct Fee (New/Expansion) 07/21/2014 $150.00 Fee Improvement Permit Fee 07/21/2014 $150.00 Well Permit & Inspection Fee 07/21/2014 $300.00 TOTAL FEES $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) 1=9 - ehapplicalion 07/21/2014 14:58 Page 2 o1`4 CATA j BA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence KI New Residence ❑ Addition to Residence # of New Bedrooms *f 3 Project Description 51ne(t 1';" -Ci �.r:Ge bm).-c Structure Dimensions 7by-4 v 1 # of Occupants q Basement M Yes ❑ No Basement Fixtures RYes ❑ 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 Unt t*t Total # Bedrooms Structure Dimensions . ❑ Food Ser _ vice S.,.ecif Y.. ...... .. ._... ._ ., .... , ..... , .... .. . .......... .,. ... .. ..,... . p 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 F oor 1 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/Re . .. pair 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. 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 riles. 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 ,y`w.ei Date -% 019f- Printed 1TPrinted Name of Owner or Agent _ _SLa -ti) dcwo el.� CATAWBA THIS IS NOT A PERMIT 1COUNTY �.V �'. CATAWBA COUNTY HEALTH DEPARTMENT Nort; �o,o Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Construct ® Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit [%J Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New 1 /Con/structipn ® Existing Facility [:1Property Address 7 Sg 14V � VC/C � G Subdivision ?l� �/G 8 Lot # Acres 3.77 Section/Blo k/Phase Driving Directions to Property /lbv JO, Gan�.r�/�'jliL� �� 3/-1 m;/l 6,t 4� NAME TO APPEAR ON PERMIT? [X Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name�S7t1L�� Address 2/8 p3oY PSS y� Phonc/,F�.,,O/ ).3'I 7&Jy I Cell Phone Owner Contact Information Name Address Phone I Cell Phone Contractor Contact Information , Name —1vV'/vtPt y a7✓Gr -oro r'CS G✓�i Ge,�f�r�a?�•a�- Co - Address /CJS ZI�,Q 1� �:.iC ��4e n 14 C//� �g . PhoncF4t1Gq -7 qh q l� I Cell Phone(pxg/ $ S( 01 —7 WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *j Structure Dimensions _ # of Occupants Basement ® Yes ❑ No Basement Fixtures [ Yes ❑ No The Applicant shall notify the local health department upon submittal of this a lica g apply pp tion if any of the followin a 1 to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes It6No Does the'site contain any jurisdictional wetlands? ❑ Yes 1A No Does the site contain any existing wastewater systems? ❑ Yes X -No Is any wastewater going to be generated on the site other than domestic sewage? $l Yes No Is the site subject to approval by any other public agency? ❑ Yes %No Are there any casements or right of ways on this property? Describe Existing water supply 1 in use F1Individual Well ElCommunity Well ❑ 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 Desire ... stem Desired Sy Type(s): (systems can be ranked in order of your preference) 0 Accepted 13 Alternative Conventional ❑ Innovative ❑ Other /Any I inch = 80 feet Prepared for: �`n's -- - --- = ��176.94i v 5 c r\a IM Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. rj 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: 2667-03-03-3983 I inch = 80 feet Prepared for: �`n's -- - --- = ��176.94i v 5 c r\a IM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcell,D: - 2667-03-03-3983 Name: DUCKWORTH JESSICA MARIE ESTATE Name2: DUCKWORTH KATHY RANDALL CUSTODIAN Address: 9297 MULL RD Address2: City: VALE State: NC Zip: 28168-9267 Account: Calc Acreage: 3.77 Tax Map: LRK: 100858 Deed Book: 2308 Deed Page: 1982 Subdivision Name: Subdivision Block: Lots: 1 Plat Book: 54 Plat Page: 69 Building Number: 9359 Street Name: MULL RD Site Zip: 28168 Township: BANDYS Fire Dist: COOKSVILLE City/Tax: State Road: 1103 Total Bldgs Value: Land Value: $25,800 Total Value: $25,800 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 89 Watershed: WS-111 Protected Area Watershed Split: NO Voter Precinct: P2 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 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: 1020 Small Area Plan: PLATEAU Agricultural District: Printed: Monday, July 21, 2014 02:25 PM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel -ID: - 2667-03-03-3983 Name: DUCKWORTH JESSICA MARIE ESTATE Name2: DUCKWORTH KATHY RANDALL CUSTODIAN Address: 9297 MULL RD Address2: City: VALE State: NC Zip: 28168-9267 Account: Calc Acreage: 3.77 Tax Map: LRK: 100858 Deed Book: 2308 Deed Page: 1982 Subdivision Name: Subdivision Block: Lots: 1 Plat Book: 54 Plat Page: 69 Building Number: 9359 Street Name: MULL RD Site Zip: 28168 Township: BANDYS Fire Dist: COOKSVILLE City/Tax: State Road: 1103 Total Bldgs Value: Land Value: $25,800 Total Value: $25,800 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 89 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P2 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 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: 1020 Small Area Plan: PLATEAU Agricultural District: Printed: Monday, July 21, 2014 02:39 PM N -1 inch = 80 feet . rn V W Catawba County, forth 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: 2667-03-03-3983 Prepared for: 0 _1\ l THIS IS NOT A LEGAL DOCUMENT 58.20 Date Slaved: 6/111014 / Time: 2:25:35 PM