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Home My WebLink AboutRBPR-07-2014-19618.TIFTHIS IS NOT AP0RMIT Came# l0BPR-07-20/4-19610 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � Residential Building PKanRmview-AuummmmryStructumu IMPROVEMENT Applicant BILLY IS0K4, 5876 LE|LRC\ HICKORY NC 28602 11:704- 325-3822 C:8283080969 H0ME:704-325'3822 Owner BILLY |SOM. 5876 LEI LRD, HICKORY NC 28602 8:704-325'3822 C:8283080969 B0MG:704-325'3822 NAME TOAPPEAR ONPERMIT BILLY USOM SITE ADDRESS: 5876LEILRD, HICKORY y4C28602 NAME w[SUBDIVISION: pROPSTACRES PROPERTY SIZE: Square Feet Acres 2.91 PIN# 269917107360 3 bu4 8ucbvn8B(ovk DIRECTIONS: 127S0mmigh 1O.take right, go1!4mile and turn right onLei/Rd 1stHome onright PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 21 x23 nneba/ carport SITE INFORMATION Dnany ofthe following apply 0uthe property for h hthioapp|ioadonioapp|ied? If the answer to any of the questions below is "YES", then supporting documentation is required.- Doesthiuoiteountainonyjuriudictiona|wodondm? 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 |sthe site subject hoapproval byany other public agency? Yea Are there any easements orhght-of-woyaonthis property? No APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORYSTRUCTURE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF I House -ranch (modular) EXISTING STRUCTURES OMSITE (IF ANY) | DIM EXISTING STRUCTURE: 84x43 NUMBER UFEXISTING BEDROOMS: 3 #OFOCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE 0K8:: 21x22 BASEMENT? No BASEMENT FIXTURES? PLUMBING REQUIRED? Desired system types(Improvement Permit orAuthorization VmCunutruut): accEp/Eu: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: oY-vmw,b^mion 07o9o014 D:oz Page /v/^ CATAWBA COUNTY Case # RBPR-07-2014-19618 Public Health Department Subdivision PROPST ACRES < s> Environmental Health Division PIN# 269917107360 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1842 s NAME ON PERMIT: ( BILLY ISOM), 5876 LEI RD, HICKORY NC 28602 ( BILLY ISOM) Site Address: 5876 LEIL RD, HICKORY NC 28602 Property Size: Square Feet Acres 2.91 Directions: 127S to roight 10 , take right, go 1/4 mile and turn right on Leil Rd - 1st Home 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 identificati n arid labeling of ta!l/l) property lines and corners and making the site accessi so that a complet site evaluation can be performed. Date: — — T Signature of Applicant or Agent %lam prs�,v� An Environmental Health Specialist will contact you witlfih 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEI NAME- DATE FEE AMOUNT Improvement Permit Fee 07/29/2014 $150.00 TOTAL FEES -$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 07/29/2014 12:02 Page 2 of 4 VN CTHIS IS NOT A PERMIT 61 , 1 � �CATAWBA COUNTY HEALTH DJEPAR'� M ENT v T' Z Z� Application for Environmental Services JV Page 1 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 F. Existing Facility ❑ Property Address -5976 Le it i d- Subdivision IVG. Vi i, 0 oZ Lot # Acres 3 Driv ing Directions to Property Irl o i'VI p- U N R I M -F - NAME TO APPEAR ON PERMIT? L-- w'ner Applicant Contact Information Name Address Phone Section/Block/Phase CL— lZ QL� L 1�� l s f ❑ Applicant ❑ Contractor I Cell Phone Owner Contact Information -r— Name 1j Ie 11 .i--- DI ft- NC' -1-SD M I Address 5! 7 to Lem L- 2d.. N -L-Ko R y, N C 2-!K (o (>2 Phone '7 U Ll- 9-S— 3 �- Cell Phone Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? er ❑ Applicant ❑ Contractor Description of Existing Structures on Site -P-0- 1 — D C # of Bedrooms *� Structure Dimensions # of Occupants o- Basement es Yes 010 �� The AppliBaseiccant sent hall notify Yes 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. kyes - -.-Does the site contain any jurisdictional wetlands? es �Fo� Does the site contain any existing wastewater systems? 0 Yes [UNo Is any wastewater going to be generated on the site other than domestic sewage? Yes ��Is the site subject to approval by any other public agency? In Yes Fl/o Are there any easements or right of ways on this property? Describe Existing water supply in use ii ual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No If applying46r an Improvement Permit or Authorization to Construct,Jed System Please Indicate Desir ._ y T .. • .v�,.....,...... .. Type(s): (szectced an be ranked in order of your preference) 0 Alternative 0 Conventional ❑ Innovative ❑ Other CAny CATAWBA THIS IS NOT A PERMIT COUNTY -- L:_---_ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 F9o�n Cmotno Prdposed aEility Type Pfimary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *j' Project Description Structure.Dimensions # of Occupants B ❑ ❑- [I No - Basement Yes -uL_ No Basement Fixtures _Yes .,,,• .`W,L „` , _ i_.=.- ..._..� ,..,....._ Lj Accessory Structure(s) Describe Me A- G A 2 DD # of New Bedrooms *t if applicable f A. Structure Dimensions # of Occupants /u o A, Accessory Dwelling ❑ Yes 9-N6--- Plumbing -3t!Plumbing ❑ Yes ElNo— Describe Plumbing Needed N i 4 - ❑ Multi -Family Residence # Units #Bedrooms per Unit*j' Total # Bedrooms *j Structure Dimensions Food Service Sp ecify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) Specific usiness ,BS ❑ p ypeofBusiness Retail Floor Space # of Employees per Shift # of Shifts Other Fac"Type" Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandor ment/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. • • _ i.ii . _,i.. .. ._.0 .u.,. .. _.. is _. i.r_. u. +_____. .•_.. _... ii. ..m ii .. .. i•aci•.,___ ..... .. r_,.. .ii.... .. .unla—. ... ..i. ......._..i•o.. _. ri iics.+.. .. iu _._I *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 corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent "12) £, ,v N�,f,��p_ ,gate_ �u. LY ,20 / Ll Printed Name of Owner or Agent -1 (" A:,' TH DEPAXIMEW Lot Evaluat n rrprovenent Permit Repair Permit Completion Permit Owner /Agent % t y E i�.,-,. �S O m t ,,Phone Address "Subdivision Section/Block 1 Lot # 1 Lot Size C j P_S' Directions: q-1.,t.� l[/%�,/ail_' f i�:�f �-#— '' �1 ''L � J' �—' s;/ of � � •`�—_+_. Facility: Housey Mbile Homey Business Other: Zoning Approval Yes/no # I,.Lee)ff Multi-family Other ; 100% Repair Area rs: o Bedrooms Baths 2- Seats Employees ; GPD F1ow�OApplication Rate Garbage D sposal Special Fixtures ; REPAIR NOTICE: REPAIRS musT EE NITIIIN 30 Basement yes/no Baserre ' Plumbing yes/no DAYS OR DAYS FROM DATE OF PERMIT. Water Supply: Private Public ; Type of System: Trench Bed System Other ( Specify ) Tank Size: Septic Tank %/'2 f 'i 6) Pump Tank Nitrification Field: elTotal Square Feet (,i Depth of Ston "Bed Size Trench Width 5J Total Length of A11 Trenches !:�-V 0 Number of Trenches Individual Trench Lengt,``�0 ="" Feet on Center � Maximun Trench Depth Distance to Nearest Well Lot Evaluation: Approved Disapproved Sketch of Lot Evaluation Site - System Design - Final t I Permit Date (Lot Evaluation and Improvement Pe. Owner/Agent ,L� >�� Sanitarian_ Installed By ��'�� U},r Date 9_;I_o RySanitarian,� (Note an changes/information in red or by sketc t1void after 36 months) back) Togo S PS U Drainage S PS U Depth S PS U Restrictive Hoz. S PS U Space S PS U Soil S PS U III Loams: Sandy Clay, Silt, Clay, Silty Clay .6-.4 IVa Clays: Sandy, Silty, Clay .4-.2 WHITE - OFF -ICE COPY YELLOW - OWNER/AGENT COPY N -1 inch = 80 feet 4A inns _ U 1.48A 5460 o� �t 65- �o 1 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 ofany 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: 2699-17-10-7360 Prepared for: '-7S --, 7> 4B 2.91 A ® 7360 4s r191V1 1, Z t4 E -Le \ 2 0 ; 0 3 9130 1 THIS IS NOTA LEGAL DOCUMEN at v 7/29/2014 Time: 11:40:30 7 ,77q 1.82A 026 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID:- 2699-17-10-7360 Name: ISOM BILLY DARRELL Name2: ISOM DIANE M Address: 5876 LEIL RD Address2: City: HICKORY State: NC Zip: 28602-7161 Account: Calc Acreage: 2.91 Tax Map: 005AB 01003 LRK: 5210 Deed Book: 1605 Deed Page: 0061 Subdivision Name: PROPST ACRES Subdivision Block: Lots: 3 Plat Book: 15 Plat Page: 166 Building Number: 5876 Street Name: LEIL RD Site Zip: 28602 Township: BANDYS Fire Dist: PROPST C ity/Tax: State Road: Total Bldgs Value: $66,300 Land Value: $21,400 Total Value: $87,700 Year Built: 1990 Year Remodeled: Last Sale Date: 3/1/1988 Last Sale Amount: $11,500 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): Split Zoning Dist(2): 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: 2000 Small Area Plan: PLATEAU Agricultural District: Proximity Printed: Tuesday, July 29, 2014 11:40 AM 381z 3405Pd