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HomeMy WebLinkAboutEHPR-03-2016-23301 (2).TIF \3A �� THIS IS NOT A PERMIT Case # EHPR-03-2016-23301 ti 'a CATAWBA COUNTY HEALTH DEPARTMENT o n" t El !� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r- }r {y r '.*•r .t 1g42 sM Environmental Health Plan Review - OSWP .o CIO-1 • o r• • IMPROVEMENT • • ' ci - C -, • ■•; Applicant KEVIN COX,2107 OKLAHOMA CT, LINCOLNTON NC 28092 C:7046340219 Owner DAVID COX, 2791 DAVID COX RD,MAIDEN NC 28650 C:7046340218 NAME TO APPEAR ON PERMIT Kevin Cox SITE ADDRESS: 2737 DAVID COX RD, MAIDEN NC 28650 PIN # 365604738470 NAME of SUBDIVISION: Lot ft 2 Section/Block PROPERTY SIZE: Square Feet 66,211.20 Acres 1.520 DIRECTIONS: From Buffalo Shoals Rd, Left onto David Cox Rd. Property is 500 feet on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing* 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? Yes Property Easements Description: Road ROW APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Barn EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 24x20 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 70x53 #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: E9-chapplication 03/02/2016 10:26 Page 1 o14 �� • CATAWBA COUNTY Case# EHPR-03-2016-23301 flL Public Health Department Subdivision d v--^% p `' Fpvironmental Health Division PING 365604738470 ® PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 144 NAME ON PERMIT: (KEVIN COX),2107 OKLAHOMA CT, LINCOLNTON NC 28092 ( Kevin Cox) Site Address: 2737 DAVID COX RD, MAIDEN NC 28650 Property Size: Square Feet 66,211.20 Acres 1.520 Directions: From Buffalo Shoals Rd, Left onto David Cox Rd. Property is 500 feet 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 acces ib e so that a complete sitp.Rvaluation can be performed. Date: 3 -2 -e.(7/ ' Signature of Applicant or Agent katrl.(. 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 q EN %'a°x� Uj5 �t t i 3ir . v DATE' '�a'&t9FEE AMOUNT d d'°FEENAME * ' .�.:a..�[�.�.�, -., ...,.eta �±„ ,-� Improvement Permit Fee p 03/02/2016 S150.00 � f 1 '.+>KTOTALEFFJ `( ..�c �i�{ t {":r .J 3 3': kR S4�p�0 4. $150iffN vY t" ttl k �' t E uS s,€ -rv,t . RU'°a„.x}n mNu.t.ailifft.,3 k y,'�..a°;�P ..✓ l�.EY.aue. a",;.,vi .>' _ _.-mwt'3�ia.�i 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 03/02/2016 10:26 Page 2 of 4 CATJWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT s °"- N.,0,7;;;;;;-;... Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair n Septic Malfunction n Septic Expansion n New Well Permit n Replacement Well n Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) n Application is for New Construction �9 Existing Facility n j_Property Address a 73 7 ,pa 00,, _ 0e/ Subdivision _,/41�40 t'Ltc O Lot# Acres I ,Th20 // / Section/Bloc_k1 phase i � Driving Directions to Property (rLYpz ju /o 5Lti7E2 5 4 i/ !GU/"/t O/c t� �6. vrdt Oak Rorl Aro� r S)O / r 'Ea/ / r NAME TO APPEAR ON PERMIT? ❑ Owner n'Applicant n Contractor Applicant Contact Information Name g_/!& 'O _ Address a/o 7 uA/4 kez,,t A (Ooa r[ Zin o /.td TJit, /L/C 250512 Phone Cell Phone 767&7.3 0.277 d �V Owner Contact Information Name �a 1,,,,d daft J / Address ,,2 79/ )76I via,/ Rd ecie i 1 if //,,t_ NC _2_er ,_5 O Phone Cell Phone 70/ S� 4i O.2/ g' Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner n Applicant n Contractor Description of Existing Structures on Site a . S # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes f l No Basement Fixtures n Yes No 7 The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in estion. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes NN Does the site contain any jurisdictional wetlands? ❑ Yes C3 Noo Does the site contain any existing wastewater systems? ❑ Yes a1 Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 0. No Is the site subject to approval by any other public agency? 2 Y`es ❑ No Are there any sements or right of ways on this property? Describe , aUo/ Existing water supply in use F-----Individual Well ❑ Community Well n Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n Yes o If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): J(systems can be ranked in order of your preference) � ID C� Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other 'Any C ^TAwBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT ew,�—,o, a- Application for Environmental Services Page 2 Pr osed Facility Type Primary Residence n New Residence ❑ Addition to Residence #of New Bedrooms *t -3 1 / Project Description y Structure.Dimensions ( X) -YE'S #of Occupants ca- Basement ❑ Yes ❑/No Basement Fixtures ❑ Yes [-N ❑ Accessory Situ ture(s) Describe #of New Bedroom ' if applicable 3 Structure Dimensions' -Xj3,0 #of Occupants 9 -_.. I - t • Yes n No Plumbing [Yes to Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j 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 n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored n Dug n Unknown Well Repair Requested ❑ Yes IT 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 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 ed�,-C-72--- Date 3-1,2 Printed Name of Owner or Agent A /7y1Gf _b. 6a Catawba County Environmental Health 22928-_ r. — liki••••"-- ,.��r � gs` i.spy • 117 0.V. , 73r 111 ir 1;1c lt lh r� �C3 toy; �►� ,`. A cg \ ir ear II Q II )it { f I *a\ \\___ . .' 964~Th p� 2y pry PG V/ �y7OG � 1 '. Parcel: 365604738470, 2791 DAVID COX RD 1in=300ft MAIDEN, 28650 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 03/02/2016 Parcel Report Page 1 of 1 , , Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365604738470 Owner: COX DAVID EDWARD Parcel Address: Owner2: COX JUDY D City: MAIDEN, 28650 Address: 2791 DAVID COX RD LRK(REID): 201220 Address2: Deed Book/Page: 2227/1271 City: MAIDEN Subdivision: State/Zip: NC 28650-9645 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: 2813 DAVID COX RD Elementary School: TUTTLE Middle School: MAIDEN Calculated Acreage:a^ High School: MAIDEN Tax Map: Township: CALDWELL School Map State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $293,900 Zoning2: Land Value: $147,000 Zoning3: Assessed Total Value: $440,900 Zoning Overlay: Year Built/Remodeled: 2000/ Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710365600J Building Details 2010 Census Block: 4013 WaterShed: 2010 Census Tract: 011600 Voter Precinct: P9 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. ■.._, . ---xp unNy soms 01a52O Oq PI .�3� ibl '���4 ttp: s cat wbacountync.goy/nontati7parce_report.php?key=365604738470&typ=P 3/2/2016 C % CATAWBA COUNTY :� 100ASOUTIIWESTBLVD uagp _i ,-] NEWTON,NORTH CAROLINA 28658 RECEIPT 016e PHONE: 828.465.8399 iojs/, C Wednesday, March 2, 2016 -it--- 842 sM www.catawbacountync.gov PAYOR: Cox, Kevin PAYMENTS TRANSACTION NUMBER: TRC-630286-02-03-2016 PAYMENT DATE : 03/02/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325759 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-03-2016-23301 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2737 DAVID COX RD, MAIDEN NC 28650 Applicant KEVIN COX, 2107 OKLAHOMA CT, LINCOLNTON NC 28092 C:7046340219 ** NO PEOPLESOFTACCOUNTASSIGNED ** Owner DAVID COX, 2791 DAVID COX RD, MAIDEN NC 28650 C:7046340218 receipt 03/02/2016 10:25 Page 1 of 1