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HomeMy WebLinkAboutEHPR-03-2016-23339 (2).TIF .h$A THIS IS NOT A PERMIT Case # EHPR-03-2016-23339 [Tito /4,1 CATAWBA COUNTY HEALTH DEPARTMENT i is } i 0 Tiny' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • �'8 2 Environmental Health Plan Review - OSWP • o o IMPROVEMENT ' . a {'moo ¢E Applicant CLAYTON HOMES (VINNIE NATHANIEL),2026 NORTH SIDE DR, STATESVILLE NC 28625 H:7048732547 C:7046778903 HOME:7048732547 V1NNIEN26 @YAHOO.COM Owner YARENIS ANGLIN, 1425 20TH AV NE, HICKORY NC 28601 C:8283085384 NAME TO APPEAR ON PERMIT Yarenis Anglin SITE ADDRESS: 2604 23RD AV PL NE, HICKORY NC 28601 PIN # 372306382743 NAME of SUBDIVISION: CLEARVIEW ACRES PL 9-49 Lot# 17-20 Section/Block D PROPERTY SIZE: Square Feet 61,855.20 Acres 1.42 DIRECTIONS: 140 West, Right on McDonald Parkway SE, Right on Springs Rd NE, Left on 28th St NE, Left on 23rd Ave Ct NE, Lot is on the Left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: IP - Preliminary 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: Vacant Lot NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Modular 25x64 w/Decks: front& back 10x10 #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: H9-ehapplication 03/07/2016 13:54 Page 1 of 5 $ CATAWBACOUNTY case# EHPR-03-2016-23339 Public Health Department Subdivision L CLEARVIEW ACRES PL 9-49 Q :fir®°{ Environmental Health Division PIN# 372306382743 ras PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 IA 42 , NAME ON PERMIT: (YARENIS ANGLIN), 1425 20TH AV NE, HICKORY NC 28601 ( Yarenis Anglin) Site Address: 2604 23RD AV PL NE, HICKORY NC 28601 Property Size: Square Feet 61,855.20 Acres 1.42 Directions: 140 West, Right on McDonald Parkway SE, Right on Springs Rd NE, Left on 28th St NE, Left on 23rd Ave Ct NE, Lot is on the 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 t o W !e e lu e performed. Date: 3- 7- 201 6 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 w rking days of application ate. If you need further information or assistance please call 828-466-7291 AREA2 ...................................................................................................................... f ,mi N L 8 - 114 t' ; fl q`Ir"n aF 1:v tp �+u� ,�^ n �.{ry +w"<' '"F �'21'Ei�aas�x�c �� a s� � �ar 4 FEENAME �'la5 r�r r sli innF ea ,{" v(rl ,ar l,�iE DATET ;I"FEE AMOUNT/ Sda��d��e„ 3._.1 L.'_�$�€� , ee°°i„,�s.�,....�.NaU ..,a:,.,t:,�s Improvement Permit Fee 03/07/2016 $150.00 � uIC `i t�"s `N 44;`61 P 7 wi t itt 3aa`f a� d' TOTAL}FEES a°h eatL 1.a. _ ' A p"a8 c aah,, '� S63a, 0 00 , I!-?.a.+:S tnv.,,m.Aa,°,»k','L s i01fimsn E"�-x 'm'rom o- 3 Y s i ..,u6.a.$iao.a`:Y}A"asRngeM qhlad 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 03/07/2016 13:54 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT `coc-s�i C �o i ��l�, CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit V/ 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�ispfor Ad /1/ F! Existing Facility ❑ /� Property Address 23 AJ- Ad / 2 'de Subdivision gel(cj;e,.,) &res. T L- 9-Lice t( rc, it 2f 60/ Lot# 17- 20 /0 Acres r Section/Block/Phase �'���� Driving Directions to Property x 10 446 X' ON ,� JDAJq(U(�C✓ 5^f — ' -- OA) Qr,,J Lk 10 G.- - I-4-1- 06 2°041-, S1 NE - IcS4 & 23 TO Atic CI tOt - Ld 1 v..) Le-S+ NAME TO APPEAR ON PERMIT? 'Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name erg -/m) �''E7Ak S flocricsty 1 (t Address 20�/Y� /Oat c1 i ae S-f of (k k 286tr Phone / 7 - g? K _ 2��7 Cell Phone_e7 7 ipo S Owner Contact Information Name 14re4 i c g•4r(e/1e c n Address /4 2S 20-A ,bey /le fe-koity eQ 2B(UD( - 2t '�3 Phone Celt Phone g20 -- ?,vg -- S354 Contractorr�Contact Inform tion 1 Name CIA Ai �> 4,9 S G.St;c ac Address ,tLoi Sldt T' OC_ sinittsx}I (`UL� ES gzar Phone �ley, � j73 _ 75,17 Cell Phone 70T —G77—M9dS WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑✓Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *1' Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property ipyquestion. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes o Does the site contain any jurisdictional wetlands? ❑ Yes Ca" o Does the site contain any existing wastewater systems'? ❑ YY`°s l o Is any wastewater going to be generated on the site other than domestic sewage? C#'Yes ❑O Nj Is the site subject to approval by any other public agency? ❑ Yes nelCo Are there any easements or right of w3ys on this property'? Describe Exist�in water supply in use Li Individual Well a. . Community Well ❑ Semi-Public Well LACounty/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 your fercnce) 0 ❑ Accepted ❑ Alternative at onventional ❑ Innovative ❑ Other ❑ Any COUNTY A 7 CATAWBA COUNTY N TY HEALTH DEPARTMENT Application for Environmental Services Page 22 Pro sed Facility Type 3—(1 so [" rimary Residence ❑ New Residence ❑ Addition to Residence #of New,Bedrooms *f � Project Description 6� °„ Coal Structure Dimensions / 2SX b k' #of Occupants - • DX Basement ❑ Yes a No Basement Fixtures ❑ Yes ❑IC) U Accessory Structure(s) Describe • # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Lf Multi-Family Residence# Units #Bedrooms per Unit*t Total#Bedrooms *'i Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) L) Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well Community Well • Abandonment Type ❑ Drilled ❑ I3ored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes ❑ No Describe g 4/cec y a.) s;+C_ Calculated Design Flow, Commercial fi 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. 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 he 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; hmprovement 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 � —� Date 3— t 20/C.• Printed Name of Owner or Agent «fit Catawba County Environmental Health • LCiTcn !.. i N Z m 23RD AV PL NE F 190 00 05 I 1 I r 1 9 i I biL 5 I 1 I • II! T ,D 1 I f 1 70 1 e2 X 64/ 1 3E, I I . , 9" I i, 9 SD ioei y, I S I--/ I l _ 1 I 9 I I S , 1 1 I 1 1 3594 "+�._. 1 I 1 1 1 I 1 • I w I I I 201.6 1 ' ` 9 Parcel: 372306382743, 2604 23RD AV PL NE 1 in=50ft HICKORY, 28601 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 03/07/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372306382743 Owner: BOGER RAYMOND CHARLES SR Parcel Address: 2604 23RD AV PL NE Owner2: City: HICKORY, 28601 Address: 209 SECTION HOUSE RD LRK(REID): 53802 Address2: Deed Book/Page: 2197/0334 City: HICKORY Subdivision: CLEARVIEW ACRES PL 9-49 State/Zip: NC 28601-9381 Lots/Block: 17-20/ D Last Sale: School Information: Plat Sale: age: 9/49 School District: COUNTY Elementary School: CLYDE CAMPBELL Legal: Middle School: ARNDT Calculated Acreage: 1.420 High School: ST STEPHENS Tax Map: 155H 15002 Township: HICKORY School Map State Road #: 2303 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: HICKORY County Fire District: ST STEPHENS Zoningl: R-2 Building(s) Value: $0 Zoning2: Land Value: $22,800 Zoning3: Assessed Total Value: $22,800 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 #: 3710372300J Building Details 2010 Census Block: 1031 WaterShed: 2010 Census Tract: 010303 Voter Precinct: P30 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=372306382743&typ=P 3/7/2016 i A CATAWBA COUNTY G 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT dOitl PHONE: 828.465.8399 U�t747t Monday, March 7, 2016 /842 sm www.catawbacoungmc.gov PAYOR: Clayton Homes Clayton Homes(NATHANIEL, VINNIE) PAYMENTS TRANSACTION NUMBER: TRC-633321-07-03-2016 PAYMENT DATE : 03/07/2016 PAYMENT TYPE: Check 1538 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325905 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23339 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2604 23RD AV PL NE, HICKORY NC 28601 Applicant CLAYTON HOMES, 2026 NORTH SIDE DR, STATESVILLE NC 28625 H:7048732547C:7046778903 V INNIEN26 a YAHOO.COM **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner YARENIS ANGLIN, 1425 20TH AV NE, HICKORY NC 28601 C:8283085384 receipt 03/07/2016 13:54 Page 1 of 1