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HomeMy WebLinkAboutEHPR-02-2016-23264 (2).TIF $A '\ THIS IS NOT A PERMIT Case # EHPR-02-2016-23264 d H CATAWBA COUNTY HEALTH DEPARTMENT . D .r D \ ''a' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Environmental Health Plan Review - OSWP . 13 • • bin ' ry IMPROVEMENT AJ'. o, a 12/1S-C - -`^ tls -ir • I Contractor CLAYTON HOMES (VINNIE NATHANIEL),2026 NORTH SIDE DR, STATESVILLE NC 28625 H:7048732547 C:7046778903 HOME:7048732547 VINNIEN26 @YAHOO.COM Owner AARON SHOOK, 1928 SIOMON DAIRY RD,NEWTON NC 28658 C:8284463765 NAME TO APPEAR ON PERMIT Clayton Homes (VINNIE NATHANIEL) SITE ADDRESS: 1853 DISNEY LN, NEWTON NC 28658 PIN # 363914236941 NAME of SUBDIVISION: MRS EMMA L KILLIAN ESTATES Lot# 37-40 Section/Block PROPERTY SIZE: Square Feet 14,810.40 Acres 0.34 DIRECTIONS: 321 Business South, Right on Hwy 10 West, Left on Sigmon Dairy Rd, Left onto Lutz Dr, Left on Disney Rd, Lot is the 3rd empty lot on Left. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only* New Modular 25x52 w/ Decks: front& back 6x6 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Modular 25x42, Decks: front& back 6x6 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: IN-ehapplication 02/23/2016 12:53 Page 1 of 5 4en CATAWBA COUNTY Case# EHPR-0 2-20 1 6-23 264 Tint t, Public Health Department Subdivision MRS EMMA L KILLIAN ESTATE :-T, ,, Environmental Health Division PIN# 363914236941 �'e PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /842 su NAME ON PERMIT: CLAYTON HOMES ( VINNIE NATHANIEL),2026 NORTH SIDE DR, STATESVILLE NC 28625 Clayton Homes ( VINNIE NATHANIEL) Site Address: 1853 DISNEY LN,NEWTON NC 28658 Property Size: Square Feet 14,810.40 Acres 0.34 Directions: 321 Business South, Right on Hwy 10 West, Left on Sigmon Dairy Rd, Left onto Lutz Dr, Left on Disney Rd, Lot is the 3rd empty lot on Left. 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 Wet 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 t".eP.W P iti t "L_T -�.-.^'^'.Y ' k "%"" C s t rteEr t 3a` „ k,� � � C � a z.,r. 't � r >F (dG FEENAME /, ,.,:m,_xls'i?sE"*atY'" '.,r%us'w�`:?r_.��z... v.Ill.ia .;a.DATE._V SkZFEE AMOUNT,:fI Improvement Permit Fee 02/23/2016 $150.00 117 OTAL FEES a t e t ` I° .C...., 5 i -. -S]50"00 l giiiiii r aft T w r o tet _.. ^i 92111e196111112100461, u,...-;>.k.E,_ 1.P - -o..9 !"21/2' x.. ,eel aa. 1x, - -c. 44 FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 02/23/2016 12:53 Page 2 of 5 //$A • THIS IS NOT A PERMIT Case # EHPR-02-2016-23264 Q CATAWBA COUNTY HEALTH DEPARTMENT 0 0.7, . 0 °17 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' 4 -./8 411 sM Environmental Health Plan Review - OSWP L ' S. 1y , IMPROVEMENT DI • • Contractor CLAYTON HOMES (VINNIE NATHANIEL), 2026 NORTH SIDE DR, STATESVILLE NC 28625 H:7048732547 C:7046778903 HOME:7048732547 Owner AARON SHOOK, 1928 SIGMON DAIRY RD, NEWTON NC 28658 C:8284463765 NAME TO APPEAR ON PERMIT Clayton Homes (VINNIE NATHANIEL) SITE ADDRESS: , PIN # 363914236941 NAME of SUBDIVISION: Mrs Emma L Killian Estates Lot# 37-40 Section/Block PROPERTY SIZE: Square Feet 14,610.40 Acres .340 DIRECTIONS: 321 Business South, Right on Hwy 10 West, Left on Sigmon Dairy Rd, Left onto Lutz Dr, Left on Disney Rd, Lot is the 3rd empty lot on Left. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only* New Modular 25x52 w/ Decks: front& back 6x6 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Modular 25x42, Decks: front& back 6x6 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: £9-ehappliication 02/23/2016 11:38 Page I of 5 �,�$ CATAWBA COUNTY Case# EHPR-02-2016-23264 Public Health Department Subdivision L Mrs Emma L Killian Estates 79> Environmental Health Division PINE 363914236941 °+3® PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 Ig.2 sM NAME ON PERMIT: CLAYTON HOMES (VINNIE NATHANIEL), 2026 NORTH SIDE DR, STATESVILLE NC 28625 Clayton Homes ( VINNIE NATHANIEL) Site Address: , Property Size: Square Feet 14,810.40 Acres .340 Directions: 321 Business South, Right on Hwy 10 West, Left on Sigmon Dairy Rd, Left onto Lutz Dr, Left on Disney Rd, Lot is the 3rd empty lot on Left. 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 s that a co plete sialuatio e performed. Date: 2-23- ZD/(, Signature of Applicant or Agent An Environmental Health Specialist will contact you within world g days of application da If you need further information or assistance please call 828-466-7291 AREA1 ker<calali57 ` s sk4 '*.:��� r''tic '-ire v ` @ 1 i f :4Mr�Y A FEENAME ' r $ E , DATE 5 _ rk FEEAMOUNT I., Improvement Permit Fee 02/23/2016 $150.00 rj# y"ra TOTAL'FEES ,,,T11d/ r....-`u jrr. X515000 `( ��)yr r- tom` •�- `{',€ fa lS tr.atti.:ar.i F1u.,,at,d:iu« rt ,a_i..i.,«tuMa a,V 44:641 .1.,....i;,L +* _ FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) F.9-ehapplication 02/23/2016 11:38 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT COUNTY 1 CATAWBA COUNTY HEALTH DEPARTMENT --- Q5, . F Application for Environmental Services Page 1 Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ ' Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ Property Address lea 0r5^Joy LAOc. Subdivision Akio 4-aa t At 1 2°o('S8 Lot# Acres Section/BI ck/Phase Driving Directions to Property 321 5ws.Oeu ga..t4 A . 0.J--wr,.J1i /o w..c7z- Lerl 00.0 5,444 A.O Da rr id 14+ eho L ..It Dr LcW A D;s ricy LA*+e • !-.off- a, le& gold 5;de. NAME TO APPEAR ON PERMIT? n Owner ❑ Applicant R td'Contractor Applicant Contact Information Name C147 �o...es/ off' 3'$t%s.J.14. 0;/1/I.C.�, 26 P AAoo. Cow. Address 2d 2!0 /(/or f s'de Dr;Jc. 404ler0: t(e 'tic t$6zf- Phone 70y 87J- ZS/7 Cell Phone ?goy- 677- 9903 - i%ne7e_ Owner Contact Information Name Agra') SA..t �/ Address 1et te 5 , , ,,,� A;e-y to/. /14,4,7 At 28 Cot$ Phone ,,, Cell Phone 5Z t— We -3765 Contractor Contact Information Name C/4s,40 644 ea- el .Hider,/,'/l_ License# Address / 20 2 6 tin A s;4 £nLr_ se.,-Ieru;t'je. AL ZS6 z.f Phone 'jpy- en _ ecV7 Cell Phone 704 —(o7-7- g}Qo3 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant [✓Contractor Description of Existing Structures on Site 25W.ra # of Bedrooms *t 3 Structure Dimensions # of Occupants 3 Basement ❑ Yes nis< Basement Fixtures ❑ Yes D o The Applicant shall notify 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. ❑ Yes 13'4o Does the site contain any jurisdictional wetlands? ❑ Yes ErNo Does the site contain any existing wastewater systems? ❑ Yes 2'No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes ErNo Is the site subject to approval by any other public agency? ❑ Yes [610 Are there any easements or right of ways on this property? Describe Existing water supply in use ❑"Individual Well ❑ Community 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 Desired System Type(s): (systems can be ranked in order of youryreference) ❑ Accepted ❑ Alternative Rtonventional ❑ Innovative ❑ Other ❑ Any . CATAWBA THIS IS NOT A PERMIT ,CO - CATAWBA COUNTY HEALTH DEPARTMENT Nort(q,o„ny Application for Environmental Services Page 2 Proposed Facility Type E3 Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t .3 Project Description A✓ Afeeh he w•X /Av t-ell rf Stp7�e Structure Dimensions Z X sZ ' # of Occupants I Basement ❑ Yes [-o Basement Fixtures ❑ Yes R-<o ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure'Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing ❑ Yes n No . Describe Plumbing Needed . . ❑ Multi-Family Residence# Units #Bedrooms per Unit*,t Total # Bedrooms *t 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 n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair '. . • Proposed Well Type . I 4dividual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n 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 applicaiions. 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. j 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 r/7/ Date Z z?- tote Printed Name of Owner or Agent" (/.;Poo-1./ AAihfri• e/ Catawba County Environmental Health `~ti J , J J r r r J r J gi ° r / / d -- J I IJ /I J I J l J I J J l J / d s' O J I $ $ J J J 1p9"/J cab I / J J J --1: I I / I i J J J J i / I ,. J IQ t- - -_ : I 00 J ((9. J J J 1$d J VI Y • Ca J -- / ix J / I J $ 00 I J I J I / - / -' I r I a I $ J -- .. J I J J / J — I I J 0 J r 1$ J J I -- I 2,- ° I -- C - J _ ./ ' � r J oo \5 • J J° I J ° / I l I 970 --- J ' J ° J / J y' J 30000 J J Parcel: 363914236941 , NEWTON, 28658 1in=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 map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 02/23/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 363914236941 Owner: SHOOK AARON SCOTT Parcel Address: Owner2: DESSERT DEANNA MICHELLE City: NEWTON, 28658 Address: 1928 SIGMON DAIRY RD LRK(REID): 39188 Address2: Deed Book/Page: 3327/1028 City: NEWTON Subdivision: MRS EMMA L KILLIAN ESTATES State/Zip: NC 28658-8606 Lots/Block: 37-40/J Last Sale: School Information: Plat Book/Page: 10/96 School District: COUNTY Legal: LOT 37-40 37 40 J PL 10-96 PL 10-96 Elementary School: STARTOWN Calculated Acreage: .340 Middle School: MAIDEN Tax Map: 076N 10005D High School: MAIDEN Township: NEWTON State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: NEWTON County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $0 Zoning2: Land Value: $7,200 Zoning3: Assessed Total Value: $7,200 Zoning Overlay: Year Built/Remodeled: / Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710363900J Building Details 2010 Census Block: 2054 WaterShed: 2010 Census Tract: 011701 Voter Precinct: P34 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report 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 map/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=363914236941&typ=P 2/23/2016 ys�'A �. CATAWBA COUNTY �' Ci 100A SOUTHWEST BLVD iti LP t 14 NEWTON, NORTH CAROLINA 28658 RECEIPT ' z*. PHONE: 828.465.8399 s°. Tuesday, February 23, 2016 \ ^ 1842 sM www.catawbacountync.gov PAYOR: Clayton Homes Clayton Homes(NATHANIEL, VINNIE) PAYMENTS TRANSACTION NUMBER: TRC-625859-23-02-2016 PAYMENT DATE : 02/23/2016 PAYMENT TYPE: Check 1530 INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325531 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 CASE TYPE: WORK CLASS: SITE ADDRESS: , receipt 02/23/2016 11.38 Page 1 of I