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HomeMy WebLinkAboutRBPR-07-2014-19642.TIFOwner THIS IS NOT A PERMIT Case # RBPR-07-2014-19642 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New IMPROVEMENT JESSE GODIN, 1353 CLINTON CT, IRON STATION NC 28080 C:7047287506 NAME TO APPEAR ON PERMIT Jesse Godin SITE ADDRESS: 5120 GATES DR, DENVER NC 28037 NAME of SUBDIVISION: PROPERTY SIZE: Square Feet Acres 0.79 'f 0 0 PIN # 369603327734 Lot # 6A Section/Block DIRECTIONS: Hwy 16 to Grassy Creed Rd/turn righ ton Grassy Creek/drive approx 1 mile/turn right on Gates Dr/5120 is on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 34 x 44 Three bedroom Doublewide 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 APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF none EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: NEW STRUCTURE DIM:: 34 x 44 # OF NEW BEDROOMS:: 3 BASEMENT? No # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT FIXTURES? No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: PLUMBING REQUIRED? Yes CONVENTIONAL: ANY: 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. Date: 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 ************************************************************************************************************ E9 - chapplication 07/31/2014 16:54 Page 1 of �$A CATAWBA COUNTY Case # RBPR-07-2014-19642 Public Health Department Subdivision d �� Environmental Health Division PIN# 369603327734 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig42 SM NAME ON PERMIT: ( JESSE GODIN), 1353 CLINTON CT, IRON STATION NC 28080 ( Jesse Godin) Site Address: 5120 GATES DR, DENVER NC 28037 Property Size: Square Feet Acres 0.79 Directions: Hwy 16 to Grassy Creed Rd/turn righ ton Grassy Creek/drive approx 1 mile/turn right on Gates Dr/5120 is on right MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit Fee 07/31/2014 $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 - chapplication 07/31/2014 16:54 Page 2 of 4 7/23/2014 1:04 PM FAX THIS IS NOTA PERMIT I �R� aU 14- �001/0002 CATAWBA COUNTY HEALTH -DEPARTMENT Applieatipn for Environmental ServIices Page i .mit Autborization to Construct Septic gcpair [] Septic Malfunction. ❑ ansion ❑ New Well Permit ❑ Rcplacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction;. Existing Facility ❑ Property Address 5120 GATES 17 R 1 V.E.. _ Subdivision —b a V 1= R 1 isi C Lot # 3, 00,,3 Q'7 7.3 q Acres -_7 Section/131ock/Phase Driving Direcdons to Property t ut�..r 4 6Aj 1-4 1 &+_tri.1_IL_O ^PAgsy TUR0 Qt6"T Dhp a >S CRE_F_APJt"? bRtt(C— AEMOU AIEL—YI Ad.LE. Tu R N l� gr &Aj 1,-ATss ?b R tv F_ , S-1 D- ©; 6A7 -as; i -S btJ _7W 9- Z' t !jr IMOD D 1=EF_7` N,kW, TO AI�PPI:,AR ON PERMIT? ROwncr [[3 Applicant ❑ Contractor Applicant Contact Information Na.mc Address Phone Cell Phone Owner Contact Information Name J JIZ4A0 Phoneys x'35-3 CLI ri�r1J COtia . ...1 f DN S 'i"101J N C A9-0,qd Cell Phone 704 'Z a � Z5"e� (o. Contractor Contact Information Name Address I Phone Cell Phone BE THE PRIMARY CONTACT? (,Owner [DApplici.nt nContractor WHO WILD Des# opt,Be ooins *�s Structure oil StStructu��Diimensiotts � I , I.V ,of Occupants .. Basement ❑ Yes ❑ No Basement Fixtures Yes No 1'h� A lira It sltiall notif the to department upon submittal of ipp i „ � y � he following apply pp t} y cal h��z►Ith pa this lrcation if an of to the property in question, I r the answer to any question is "yes applicant must attach supporting documentation. ® Yes JNo ; Docs the site contain any jurisdictional wetlands? ,, Yes 83 No; Does the site contain any existing wastewater systems? 0 Yes JKNO i Is any wastev✓ater going to be gcneratedj on the ,site thcr than domestic sewage? '� JrNo; is the; :vitt: subject to approval by any other public ag ney? ® Yes )(No; Are there any easements or right of ways on this pro erty? Describe Existing; wat supply in use + Individual Wel! Community W lfi u Semi -Public Well ❑ Cou�hty/C:ity/Township Water Line Is a public water supply available? '"" Yes No +1J)N.SVJ t.,.. Y t ❑ ❑ R.l�. (systems cb fbelrankcd in order of our car Aath} rization to Construct, Please Iadicatc Desired syst � ypc .s nim rovement Permit em T (): Accepted 13 Alternative IQConventional O Innovative cr ..... Oth�. 0 Any 07/23/2014 1:05 PX FAX II C(7j 0002/0002 r A THIS IS NU? ' A PERMIT C Wc�nA COUNTY , HJE;ALTIH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility.Type Primary Residence ❑ New Residence. ❑ Addition to RtNidcnce # cof Ncw Bedrooms Project Description tJ�l�-a�' P-Eb � Struct re bimcnsion " x 1(kt' ' # of Occupants BasemFnt! ❑ Yes No ; Basemtnt Fixtures Yes No U Acccssory Structures) Describe # of Bedrooms *t if applicable ! Structure Dimens ons # Of' Wcupants Accessory Dwelling Q Yes ❑ 1,10 Plumbing! ❑ Yes ❑ No ; Describe Plumbing; Needed U Multi -Fa 7y bteiidence # Unitsl fIBedroolns per Unit""1 .y — Total #k3edrooms Structure Dimensions Food Se lieei Specify Type # Sea .4 Floor Space -Entire Food Servicei Facility :(Sc FI) # Employees per Shift # of Shifts Dining Area (Sq. Ft_) B (� usiness f5pccific Type of Bus'i yes's _ 'keltail Floor Space _ # ofBmploym; % per Shift # of Shifts LJ Other >Facality Type Spec'i'fy if Church! # of Scats Kitchen ❑ Yes ❑ No If Daycar, Specify Occupancy _ Application fir Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair R ryuested ❑ Yes ❑ No Describe „ . g er f Additional information may be required to dei Calculated 1i1 Desi a Flaw, Commercial ati-- crmznc design flow from certain facilities. This value will be determined during-^onsultation with ort -site staff. Any room that willfor sleeping at the time of construction for for future consideration should be noted as a ' + ' , be intended f bedroom and counted on all alppltcations. The number iof bedrooms will be confirmed 1by rooms identified on house plans as a bedroom at the time of building pe tt issuance. This may prevent the need for septic system sire increase in the future. If structure i , plumbed but no bedrooms, calculated design flow is rcqutrcd. If No, a well, permit must be issued with the Authorization to Construct. SYSTEM RIEDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvementmics issued as a result of this information are valid for S years or may be non -expiring under certain specified conditions. An�uthorization to Construct issued by this department is valid for (5) five years from the date issued And is not transferable, Iniprpvcmcnt Permits and Well Permits are transferrable. Permits may b: 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 issue, complete and correct. Authorized county and state officials arc granted right of entry to conduct necessary inspections to determine comlPliance with applicable laws and rulcc. I understand thA I am solely responsible for the proper identification and ilabcling of all property lines and corners and making the site acccssiblo sot at u complete site evaluation can be performed. Signature of Owner or Agent Printed Name t f Owner or A Date 7--1o"L-9-01 q 07/30/2014 13:55 FAX 7043771897 RAYBURN COOPER & DURHAM 14002/002 Geospatial �. Informatlon Services Real Estate Search N W E 5 Parcel: 369603327734, 5120 GATES DR DENVER, 28037 Owners: GODIN JESSE RYAN, Owner Address, 1353 CLINTON CT Values - Building(s): $54,600, Land: $10,300, Total: $64,900 1 in=75ft - his map/report product was prepared from the Catawba County, NC Geospabal 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 recomlmAnds 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 cons"uentlal which arises or may arlse from this map/repos product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 07f30/2014 CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (704) 465-8200 NjoC/ a 9 31 9,0 Improve. Permit _y�A'uthorization to Construct L- Ii epair Permit_Oper. Permitl "System Type Owner/Agent 1i-Uy) b a M q-L,Q_C' Phone '%QY_ R.;./ - 7/ Address / .2 r,/-lug./, Lr L:R-oUF' Subdivision [�t� �P•7-p,y /�Lju, �, Section/Block/Phase Lot# Lot Size ,- , f,�Gn �" dire_ctions:_// S' /S Facility: Ho ,, Mobile Home_,L.�Business Other: Tax Map # _[�7t 1 - ay.iliYf/OF Multi- family L. Other Zoning Approval # -5lj # Bedrooms # Seats # Employees Application Rate GPD Flow Hot Tub or Spa yeso Special Fixtures 100% Repair AreaCje�yno Basement yes Basement Plumbing ye� Water Supply: Private Well / Public aaaaaaaaaaaaa,waaaaaaaaaaaa*a+aaaraataw*aaaaaa*ataaa+a,►,raaataaaaaaaaaaaaaaaaaaaaaaasaasaaaaaaaaa Type of System: Trench_kf!!"`Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size /Q"' Pump Tank Size Nitrification Field: Total Square Feet FO-ZF- Depth of Stone ed Size Trench Width ` Total Length of All Trenches Number of Trenches 18 i r. Individual Trench Length�✓' v o o//oci//6 d / / Feet on Center_ Maximum Trench Depth Distance of Nearest Well Sa -f- *DO NQT INSTALL WHEN WET* aaaa*aaaa.ot;v'*aaa*saaataaaaataaaaa*raaaaaaaatawa***�*wwaa.,ra.*.a�aaw,rt,taaa,raaasa*aaaaa t ' . Topo.. , ��, %, Slope Texture sp 1+ ;Struc`tureiV ` v L c11C1 ,I Clay Min. Soil Wetness " Soil. Depth Res tric...Hoz:. a. f-�1 Available `space ,ye /no Q2ar` 2 t NGiG S Overall Class PS U Ix 3 F Comments : r / i ,yam �-a 7R,13� i l -G2 :� 00 -----> a t ' T=4 +,V1' It's **NO GUARANTEE OR W TY IS IMPLIED OR GIVEN AS TO HE P, -R40 R LENGTH OF TIME THIS SYSTEM WILL FUNCTIOI M aaaaaaa _________------ v ............------. aaaa *Improvement Permit has no expiration date and is transferabl u y be revoked if site plans or intended use changes for the proposed facility. An Au orization to Construct is valid for (5) five years fr. date issued and is not transferable Permit Date dwner/Agent V 1 A Sanitarian-��, Installed By & k,, C, � K.r- /.SE-61 Y Date /- %'� � Sanitarian .,-" IeZ5, White - Office Blue - Building Inspection OPeration Permit Yellcw - Owder/Agent Green - Building Inspection Authorization to Construct • '� CATAWBA COUNTY HEALTH DEPARTMEN r OSk d Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS # J609- 0/,5�i-9 IP AC Rpr. Pgnt.pr. Prmt.)VSys. Type ;ZIA- Well Prmt. Replacement Well Well Rpr. Prmt. Owner/Agent ZT Phone Address -51, PO 44— Subdivision mil C/L Ale, Section/ lock/Phase Lot# Lot Size o ? /y[ Directions: /�� (� al- Y11e/G /1y Property Address. Facility: House Mobile Home Business Multi -family . Other: Pin Number Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate `i GPD Flow} Hot Tub or Spa yes/no Special Fixtures Basement yes/no 100% Repair Are,(!3t/no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public #####*##*#*##*#########################*#*############################*****####*#**######*######*###***#*#*#***#######*#*# Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size 4e"Xi5,1-�—Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone t► Bed Size Trench Width Total Length of All Trenches Number of Trenches Trench Length _//,/// Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo % Slope Texture Structure Clay Min. Soil Wetness Soil Depth Restric. Hoz. at Available space yes/no Overall Class S PS U Comments: 1 I k /i ,��•Is1'1R't� ,v�P^^' tl �T Filter Required I' Riser required when tank is more than 6 inches deep. **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before an , portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known po e s urces of contamination. No volume of water is guarant�jd at, any-Ve by the Health Department. Per C"J C— EHS! Owner/Ant Septic Tank nstalled�t�", Date E t �p Well Installed By Well Grout Approval Date Well' ead Ap royal Date` Date Sample Collected Date of Results Results EHS white - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct • 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 snap 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: 3696-03-32-7734 1 inch = 50 feet Prepared for: 'S ---�_ 20.0 J', '8-8-3 THIS IS NOT A LEGAL DOCUMENT \ b-1 01� (-6B) ti 1* Date Saved: 6Y1.1�014 Time' --4 L� 003 Pl� CATAWBA COUNTY NC - Parcel Report Informethon Rbgarding Selected Parcel(s) Parcel ID:, 3696-03-32-7734 Name: GODIN JESSE RYAN Name2: Address: 1353 CLINTON CT Address2: City: IRON STATION State: NC Zip: 28080-6786 Account: Calc Acreage: 0.79 Tax Map: 016DX 01038 LRK: 17500 Deed Book: 3212 Deed Page: 1322 Subdivision Name: Subdivision Block: Lots: 6A Plat Book: 37 Plat Page: 157 Building Number: 5120 Street Name: GATES DR Site Zip: 28037 Township: MOUNTAIN CREEK Fire Dist: SHERRILLS FORD City/Tax: State Road: Total Bldgs Value: $54,600 Land Value: $10,300 Total Value: $64,900 Year Built: 1986 Year Remodeled: Last Sale Date: 9/1/1998 Last Sale Amount: $78,000 Neighborhood: 129 Watershed: WS -IV Critical Area Watershed Split: YES Voter Precinct: P41 E911 District: COUNTY Zoning: R-30 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: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011504 Census Block 2010: 4061 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Wednesday, July 23, 2014 04:19 PM ck,dc 4� bvk5; I 3bit boYJ