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HomeMy WebLinkAboutRBPR-07-2014-19583.TIFContractor THIS IS NOT A PERMIT Case # RBPR-07-2014-1983 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Deck/Porch IMPROVEMENT v 3❑ U JAMES SWANSON (.TAMES SWANSON), P. O. BOX 593, HILDEBRAN NC 28637 C:828-612-1605 Owner JERRY WAGNER, 5629 VALLEY FIELD RD, IIICKORY NC 28602 0:828-294-0299 NAME TO APPEAR ON PERMIT Jerry Wagner SITE ADDRESS: 5629 VALLEY FIELD RD, HICKORY NC 28602 PIN # 279010369910 NAME of SUBDIVISION: HOMESTEAD Lot # 11 Section Block C PROPERTY SIZE: Square Peet acres 0.34 DIRECTIONS: Hwy 127 South, Turn Left onto Valley Field House # 5629 On Right PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Community Well DESCRIBE WORK: 12 x 24 uncovered deck (removing old deck) 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 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 fJ;i�llfL•�li[L+I:I�•I:�i STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF I House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 30 x 50 NUMBER OF EXISTING BEDROOMS: 3 Existing Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 12 x 24 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES 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 that a co plete site evaluation can be performed. Date: `? — t{ - Signature of Applicant or Agentd- An Environmental Health Specialist will contact you within 2 wfirking days of a lication date. If you need further infonnation or assistance please call 828-466-7291 AREA2 iY sli;:it;:' s 07/24/2014 00:22 Page I ot'4 �A CATAWBA COUNTY Case # G� Public Health Department Subdivision U �s® Environmental Health Division PIN# PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1$ 2 srn NAME ON PERMIT: ( JERRY WAGNER), 5629 VALLEY FIELD RD, HICKORY NC 28602 ( Jerry Wagner) Site Address: 5629 VALLEY FIELD RD, HICKORY NC 28602 Property Size: Square Feet Acres 0.34 Directions: Hwy 127 South, Turn Left onto Valley Field House # 5629 On Right MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 FEENAME Improvement Permit Fee TOTAL FEES RBPR-07-2014-19583 HOMESTEAD 279010369910 MAX HEIGHT: DATE FEE AMOUNT 07/24/2014 $150.00 $150.00 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) E9 - ehapplication 07/24/2014 09:22 Page 2 of 4 ,CATAWBA nTHIS IS NOT A PERMIT cO�UNTY�� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit El Authorization to Construct 17 Septic Repair ❑ Septic Malfunction Ej Septic Expansion F-1 New Well Permit 0 Replacement Well 0 Well Abandonment ❑ Well Repair El Existing System Inspection (Pre -Approval Required) D Application is for New Construction ❑ Existing Facility ❑ Prop" Address VA -Ile,, f:r�a Subdivision Lot 9 Acres Sect ionfBIock/P h ase Driving Directions to Property 141" 1,27 S,', L, 4 T.:,(. #IN L c ICF &11 4 I/p, Ile,, /=' -e Q A,c,c5t, 2 9 0 el 469W r�A �jJ NAME TO APPEAR ON PERMIT? E.]Owner El Applicant VContractor Applicant Contact Information Name Address Cell Phone L Phone (v(2 Owner Contact Information Name5L, -e- Address 2 Ula I k , I Phone (92 5 V 1� 'i Cell Phone Contractor Contact Information Name Address Phone Cc) I Phone WHO WILL BE THE PRINURY CONTACT? ROwricr FlApplicant 2ontractor Description of Existing Structures es on Site I 0 4." 4Q, # of Bedrooms *t '3 Structure Dimensions —3q' 4 50 1 V of Occupants Basement ��Yes F1 No Basement Fixtures F� Yes 7"N"o The Applicant shall notify the local health department upon submittal of this application if ariy of the following apply to the property in question. If the answer to any question is "ves", applicant must attach supporting documentation. 1-1 Yes EX10 Does the site contain anv,jUrisdictional wetlands? &(Yes is Does the site contain any existing wastewater Systems? 0 Yes Is any wastewater going to be generated on the site other than domestic Sewage? IZ/Yes ko Is the site subject to approval by any other public agency? 0 Yes �Xo Are there any easements or right ofpys on this property? Describe . I Existing water supply in use F-1 Individual Well Community WeIf' ns Semi -Public Wet WCounty/City/Township Water Line IS 3 public water supply available? ** R Yes 7 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 0 Conventional Cl Innovative 0 Other 0 Any C�r THIS IS NOT A PERMIT cotanrY F.,+�;',,,M` CATAWBA COUNTY HEALTH DEPARTMENT "F PPF IK9C^'tFA'P e'+M•.' Application for Environmental Services (Proposed Facility Type Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Dec- (L re k'k (A. lad K —) t-{ Structure Dimensions # of Occupants Basement ©`Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes []No Describe Plumbing Needed Multi -Family Residence # Units #Bedrooms per Unit*t Total # Bedrooms *� _ 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/Abandontnent/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 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. "chis 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. .w 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 frorn 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. 1 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 Milt 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. Signawre of Owner or Agent14 Ale 1'e,� Date Printed Name of ONvner or Agent (1-)A.TL*e LATA VBA Geospatial Information Services VALLEY FIELD RD Real Estate Search N W +E 5 Parcel: 279010369910, 5629 VALLEY FIELD RD HICKORY, 28602 Owners: WAGNER JERRY LYNWOOD, Owner Address: 5629 VALLEY FIELD RD Values - Building(s): $84,900, Land: $13,000, Total: $97,900 1 in=50ft This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends the independent verification of any data contained on this map/report 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 maptreport product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 07/24/2014 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 2790-10-36-9910 Name: WAGNER JERRY LYNWOOD Name2: Address: 5629 VALLEY FIELD RD Address2: City: HICKORY State: NC Zip: 28602-5587 Account: Calc Acreage: 0.34 Tax Map: 163H 13011 LRK: 55621 Deed Book: 1935 Deed Page: 1142 Subdivision Name: HOMESTEAD Subdivision Block: C Lots: 11 Plat Book: 14 Plat Page: 103 Building Number: 5629 Street Name: VALLEY FIELD RD Site Zip: 28602 Township: HICKORY Fire Dist: MOUNTAIN VIEW City/Tax: State Road: 2559 Total Bldgs Value: $84,900 Land Value: $13,000 Total Value: $97,900 Year Built: 1977 Year Remodeled: 2005 Last Sale Date: Last Sale Amount: Neighborhood: 77 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P24 E911 District: COUNTY Zoning: R-20 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: 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: 2008 Small Area Plan: MOUNTAIN VIEW Agricultural District: Proximity Printed: Thursday, July 24, 2014 09:01 AM GATAWBA CC►UNTY HEALTH DEPARTMENT "A $20.00 SEPTIC TANK INSPECTION FEE MUST BE PAID BEFCRE TEE UM LETION 9R IMPROVEMENT PERfitlli CAN BE iS,�►IEC.OMPLETION PERMIT FOR SEPTIC TANKS (Ground Absorption Sewage Disposal System — G. S. 130-13'C) N o OWNER OR CONTRACTOR Ar.�. 4w� J ADiDIR,ES.1� LOCAT�IION .��.7. o�Fti—. PERMIT 2657 DATF It '12 - 71 SUBDII:V.IISI'ON, NA+MF �-e7,,A i, UOT ,NO. H S-ECTI. 1\11 OAR BLOCK NO HOUSE (. , MOBhLE HOME (—) BUSTNESIS ( ) NO. ;BE;DIROO,MS ( ) -NO. BATHIRO.OIMS GAIR'BAIGE 131S$POSAL U`N,IT: Yes (_) No. OS,) SIZE,OF TANK j6nc7 Total Gallons Nil TIRIiFIICATIC)N:,FI,ELD `f00 `('53 ` X /7 k2 )Ft. WATER SOPPILY: IPiRIVATE (_) PUSEJ.I` c CNSTAULED &Y CERTIIPI,CATE OF COMIPLE,T10WB.Y DATE :INSTALLED 'i - 7 - 17 I I I 1 i Health Department " i HD 2-74 N° 02765 C ATJiW E3 COUN ki II H�EPAI2Tfl�E Lot Eval. mprove. Permit epair Permi Cert. of Comp. Permit Oper. Permit Owner/Agent Phone a ��/ Address Subdivision rntie Sle" Wcka v /l/C. a (oo Section/Block Lot Lot Size Directions: - �t/�r �r1mZ/.L�.!.�.t� 5.� .sv. 1)tLQ�.��c1-�/ �i3'. .� l Said► `Lc�Z�-f �J�1 %�, Facility: House Mobile Home Business .,Other: Zoning Approval yes/no # Multi -family Other 100% Repair Area yes/no Bedrooms .3 Seats Employees GPD Flow Application Rate t Y Hot Tubo a yes/no Special Fixtures REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes o Basement P1 ng yes/'o 30 DAYS OR DAYS FROM DATE OF dater Supp y: Private Public PERMIT. Type of System: Trench Bed - -Pump :7PUMP/Panel—Panel—LPP Other rdSize Tank Size: Septic Tank X lS �10 Pump Tank 1Qd6 Nitrification Field: Total Square Feet--rDepth of Stone 1r) IP B Trench Width Total Length f 1 r n hes r �U Number f Tr:�4n UCiV-lPc4 r��0 �D �jJ u a e5 Meed S ` �' IndividualTrench Length////Feet on Center Max Tepth Distance of Nearest Well hivn Lot Evaluation: Approved /17:�X/no (Void After 24 months)� Topo % Slope I Sketch of lc_t Evaluation Site - System Design - Final - Texture - - -- -1 -- ' - - -t'k IN6, Structure �G�ftle Gia"�" (Gku,�e� ie Clay Min. j 9�IUv PO o i e Soil Wetness D ply Soil Depth Restric. Hoz. at Available space .yes/nol " Overall Class S PS U Comments: I Prop 1W 1 : en��. J, 1 6 �S JU vQ tteV +t' e,t 4 I7�, **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date 36) 9 (Improvemen ermit avioid aftq 60 months) Owner/Agent Rout �i . . /�Uca-r,�,C3 anitarian� v • Installed B % 0� D to 41 S it a10-4 y a an an : J , 6 M (Note any c ges/informat on.kn rem or by sk tch on_back) —