HomeMy WebLinkAboutEHPR-10-2015-22595 (2).TIF a,,tliA • THIS IS NOT A PERMIT Case # EHPR-10-2015-22595•4 � ` CATAWBA COUNTY HEALTH DEPARTMENT 4
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" to PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES t
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Applicant FOUNDATION REAL ESTATE (TIM SCAER), PO BOX 1450,NEWTON NC 26858
C:8286120776
Owner SARAH LYTTON TATE, 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
NAME TO APPEAR ON PERMIT
SARAH LYTTON TATE
SITE ADDRESS: 1317 KNEBWORTH LN, CATAWBA NC 28609 PIN # 461901294697
NAME of SUBDIVISION: OLD MILL SUBDIV Lot# 13 Section/Block
PROPERTY SIZE: Square Feet 22,651.20 Acres 0.52
DIRECTIONS: Mollys Backbone from Mumbo Rd, Left on Rowe St, Right on Knebworth Lane & lot is on the Right.
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
DESCRIBE WORK(Revised 4/19/16 -Chan ed the house dimensions to actual home that was staked 32x63)
Revised 4/11/16 -Added Well Abandonment. equireprior to issue ofIP.
IP for sale of home*
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? No
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: House OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 32x65
#OF NEW BEDROOMS:: 4
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Drilled
G9-ehapplication 04/19/2016 08:54 Page 1 of 8
rpA —11•••\ CATAW13ACO,UNTY Case# EHPR-10-2015-22595
ti � Public Health Department Subdivision OLD MILL SUBDIV
�TT 10 Environmental Health Division PIN# 461901294697
°err PO Box 389, 100-A Southwest Blvd. Newton,NC 28658
g42 a.
NAME ON PERMIT: (SARAH LYTTON TATE), 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
( SARAH LYTTON TATE)
Site Address: 1317 KNEB WORTH LN, CATAWBA NC 28609
Property Size: Square Feet 22,651.20 AC1es 0.52
Directions: Mollys Backbone from Mumbo Rd, Left on Rowe St, Right on Knebworth Lane& lot is on the 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 understa1hd that I am solely responsible for the
proper identification and labeling of all property lines and corners and making the site accessible so that . complete site evaluation can bestir-form-if
S- 2 n/6,
Date: 4— I Signature of Applicant or Agent - c _
An Environmental Health Specialist will contact you within 5 working .ays of application date.
If you need further information or assistance please call 828-466-7291
AREA1
*.....**..**..**.***.******....**........*****...*.*.*.*..***.....************..**..**...****..*...*..*.*...
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TFEFNAME IL `"i dhkI i u :14, ,. hiL&1iikbi r.w: DATEa r1! ftIFEEIAMOUN ,I
Improvement Permit Fee 10/22/2015 $150.00
Well Abandonment Fee 04/11/2016 $100.00
P1il;1�l't Iilli I1l II;TOTALIFEESii 6 i Iii a m,r ti t' AAa_ �'lUhili 111.1 'Pl9IllIlr 11IPf Ii1IY, S250 00 'a'•
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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-ehappli cairn 04/19/2016 08:54 Page 2 of8
s1�A •G THIS IS NOT A PERMIT Case # EHPR-10-2015-22595
`fi t a CATAWBA COUNTY HEALTH DEPARTMENT 0; , o•; "1 D
0 Mr:i- PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES t : t
1842 sm Environmental Health Plan Review - OSWP i r U •k
IMPROVEMENT- ABANDONMENT
0 .' �. ' :
0,n\Do LII Iq ( o d InVittrit
Applicant FOUNDATION REAL ESTATE (TIM SCAER), PO BOX 1450,NEWTON NC 26858
C:8286I20776
Owner SARAH LYTTON TATE, 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
NAME TO APPEAR ON PERMIT
SARAH LYTTON TATE
SITE ADDRESS: 1317 KNEBWORTH LN, CATAWBA NC 28609 PIN # 461901294697
NAME of SUBDIVISION: OLD MILL SUBDIV Lot# 13 Section/Block
PROPERTY SIZE: Square Feet 22,651.20 Acres 0.52
DIRECTIONS: Mollys Backbone from Mumbo Rd, Left on Rowe St, Right on Knebworth Lane& lot is on the Right.
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
DESCRIBE WORK Revised 4/19/16 - Chan•ed the house dimensions to actual home that was staked 32x65)
Revised 4/11/16 -Added Well Abandonment. -equired prior to issue ofiP.
IP for sale of home'
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? No
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: House OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5
_ PROPOSED CONSTRUCTION
(NEW STRUCTURE DIM:: 32x65
#OF NEW BEDROOMS:: 4
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Drilled
09-chap l iccn ion 04/19/2016 08:54 Pau I of 8
\\A CATAWBA COUNTY Case EHPR-1 0-20 1 5-22 5 95
Public Health Department Subdivision OLD MILL SUBDIV
4 L.lS-� " Environmental Health Division
! ®i mc' PIN# 461901294697
wf PO Box 389. 100-A Southwest Blvd.Newton,NC 28658
1.42 +.
NAME ON PERMIT: ( SARAH LYTTON'FATE), 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
( SARAH LYTTON TATE)
Site Address: 1317 KNEBWORTH LN, CATAWBA NC 28609
Property Size: Square Feet 22,651.20 Acres 0.52
Directions: Mollys Backbone from Mumbo Rd, Left on Rowe St, Right on Knebworth Lane& lot is on the 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 accessible so that a complete site evaluation can be performed.
Date: Signature of Applicant or Agent
An Environmental Health Specialist will contact you within 5 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA1
FIIIEIEN IuME, ' f4jf II-�;Tip lm IihIDATE „,A lip" FEE AMOUNTM;Gr
Improvement Permit Fee 10/22/2015 $150.00
Well Abandonment Fee 04/11/2016 $100.00
[IF; `mju�� ITOTAL'iFEES � ir ! !iP'III!I�IVilllllll!iliilllHllillllhlllCikt ii!ii;�lilU(ilad:' ' Ifl;S25O.Oo
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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)
L9-ehapplicatinn 04/19/2016 08:54 Page 2 of8
�gA THIS IS NOT A PERMIT Case # EHPR-1 0-20 1 5-22 5 95
Nit Q pry, CATAWBA COUNTY HEALTH DEPARTMENT o.'{'•1 CI
'!Z2 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • ti• ' it
84 sM Environmental Health Pla 1 ' • •• S • ' a a a X
, IMPROVEMENT ABANDONMENT off
Mow r
-- - - -
Applicant FOUNDATION REAL ESTATE (TIM SCAER), PO BOX 1450, NEWTON NC 26858
C:8286120776
Owner SARAH LYTTON TATE, 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
NAME TO APPEAR ON PERMIT
SARAH LYTTON TATE
SITE ADDRESS: 1317 KNEBWORTH LN, CATAWBA NC 28609 PIN # 461901294697
NAME of SUBDIVISION: OLD MILL SUBDIV Lot# t3 Section/Block
PROPERTY SIZE: Square Feet 22,651.20 Acres_ 0.52
DIRECTIONS: Mollys Backbone from Mumbo Rd, Left on Rowe St, Right on Knebworth Lane & lot is on the Right.
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
DESCRIBE WORIRevised 4/11// -Added Well Abandonment. Required prior to issue of IP.
IP for sale of home'
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? No
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: House OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 80x40
#OF NEW BEDROOMS:: 4
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
APPLICATION FOR WELL ABANDONMENT
ABANDONMENT TYPE: Drilled
E9.ehapplicarion 04/11/2016 10:46 Page 1 of 8
� CATAWBA COUNTY Case a EHPR-10-2015-22595
V::" y Public Health Department Subdivision OLD MILL SUBDIV
7", Environmental Health Division PIN# 461901294697
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
NAME ON PERMIT: ( SARAH LYTTON TATE), 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
( SARAH LYTTON TATE)
Site Address: 1317 KNEB WORTH LN, CATAWBA NC 28609
Property Size: Square Feet 22,651.20 Acres 0.52
Directions: Mollys Backbone from Mumbo Rd, Left on Rowe St, Right on Knebworth Lane& lot is on the 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 d lab ling of all property lines and corners and making the site accessible.so that a complete site evaluation can be pe ormed.
Date: — \I — 2c 1 w Signature of Applicant or Agent t L>5
An Environmental Health Specialist will contact you within 5 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA1
°_,,`
i• FEENAMEL= , ' air,`,6gDATE L n ,LFEE AMOUNTTpd
Improvement Permit Fee 10/22/2015 $150.00
Well Abandonment Fee 04/11/2016 $100.00
ka atl RPg t,.TOTAL FCESx c}: i A.' ",il.��h1.
k_..r!iil,I a r.u „;G ..a,._'_ _2.,..E.R i.,.0 ., 1F2 MRREN ,...,.h re to __...,.,.:I2a'.";.,.. rn
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-ehapplicatiou 04/11/2016 10:46 Page 2 of 8
gyp' C CATAWBA COUNTY
,00A SOUTHWEST BLVD
NEWTON. NORTH CAROLINA 28658 RECEIPT
U "711. 1 ,,� PHONE: 828.465.8399 Monday, April 11, 2016
"]la
1842 sM www.catawbacounwnc.gov
PAYOR:
TATE, SARAH LYTTON
PAYMENTS
TRANSACTION NUMBER: TRC-653252-11-04-2016
PAYMENT DATE : 04/11/2016
PAYMENT TYPE: Check 424
INVOICE NUMBER FEE NAME FEE AMOUNT
04-16-327050 Well Abandonment Fee S 100.00
TOTAL PAYMENTS : $100.00
EHPR-10-2015-22595
CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP
SITE ADDRESS: 1317 KNEB WORTH LN, CATAWBA NC 28609
Applicant FOUNDATION REAL ESTATE. PO BOX 1450, NEWTON NC 26858
C:8286120776
Owner SARAH LYTTON TATE, 1790 SW POWDER SPRINGS RD, MARIETTA GA 300644154
** NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 04/11/2016 10:45 Page 1 of I