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HomeMy WebLinkAboutEHPR-11-09-2621 (2).TIF ~A Cpl THIS IS NOT A PERMIT Case # EHPR-11-09-2621 CATAWBA COUNTY HEALTH DEPARTMENT U Plan Review Application for Environmental Services 142 sM Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR MARY SIMPSON MARY SIMPSON 4221 HERTER RD 4221 HERTER RD LINCOLNTON NC 28092 LINCOLNTON NC 28092 828-320-1341 828-320-1341 NAME TO APPEAR ON PERMIT MARY SIMPSON Pin#: 362703108982 SITE ADDRESS: 4221 HERTER RD, Lincolmon, NC DIRECTIONS: STARTOWN RD S TO 321/ CROSS 321 & GO APPROX 1.5 MI/ RT ON BLACKBURN BRIDGE/ GO APPROX 1 Ml/ LT ON HERTER RD/ 4TH DRIVEWAY ON RT INSIDE GATE & BLACK WOOD FENCE NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 3.15 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:Yes No. in Family 2 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: Has any grading, removal, or addition of soil been done to this property? If so, describe Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well X Community Well Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a nor-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Dater 611. 10 Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 work' a s of application dat If you need further information or assistance please call 828-466-7291 AREA2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 80 -FEE NAME DATE AMOUNT Side Existing Tank Check Fee 11/10/2009 $80.00 Rear 30 TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/10/09 14:17 Catawba County, North Carolina T This map product was prepared from the Catawba Cowny, NC, Geographic L formation SYslem. 1 V Caicnrba Cou t has made subsimuial efforts to ensure the accm'acv of location and labeling Mformation conained on this map, Catawba Count- promotes and recommends the independem verification of am data contained on this map product by the user. The Comity of Caimrba, its emplopee.s, agents and personnel disclaim. and shall mat be held liable for a qv and all damages, loss or liability, whether direct, indirect or conseguemial which arises or nnm" arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3627-03-10-3932 1 inch = 100 feet Prepared for: s ,µbr r ~f ► 726') Z 17, Iv t ~ r 'o _ - 3.15A o N ti cY O 8982 o 00 11 678.93. 0 r` r THIS IS NOT A LEGAL DOCUMENT Tuesday, November 10, 2009 01:33 PIVI CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3627-03-10-8982 Name: SIMPSON WILLIAM H Name2: SIMPSON MARY JANE Address: PO BOX 543 Addre'ss2: City: DENVER State: NC Zip: 28037-0543 Account: 63876000 Calc Acreage: 3.15 Tax Map: 011 J 03003 LRK: 11163 Deed Book: 2670 Deed Page: 1329 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 4221 Street Name: HERTER RD Site Zip: 28092 Township: JACOBS FORK Fire Code: MAIDEN RURAL City Code: COUNTY State Road: 2022 Total Bldgs Value: $105,200 Land Value: $23,400 Total Value: $128,600 ; Year Built: 1976 Year Remodeled: A Last Sale Date: 6/17/2005 Last Sale Amount: $126,000 (l-- Neighborhood: 113 Watershed: Watershed Split: Voter Precinct: P34 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED-O,DWMH-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1):0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MAIDEN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011702 Census Block 2010: 1040 Small Area Plan: STARTOWN Agricultural District: PROXIMITY Printed: Tuesday, November 10, 2009 01:38 PM THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check © New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit M A12Y ,)Ax1E SC. k Pi _ J 2. Permit Requested By A e E CAP o&J Business Phone &,g ).3 z~ -•i.3 4 Address q 01 ( Je. l.J:,„AP Li ~,JUL.OT-oO f,.Jc- P-& Home Phone) ±28 -Of S-) 3. Property Owner 0_# :J_AiYe_ Business Phone Address L)L_( I.~C~c ~1Ty~.J NC. ,~-Home Phone 4. Name of Subdivision ✓ o Nf✓ Lot # Section/Block/Phase Property Address Directions to Property: o1-1?z S _ /4D _,;CZ o I rC 3a t o I1 OCA. (An A v + A tri V-e~ A O l V.$ .S~lev~tn~ ell e~ ~Oc>d 5. Property Size: Square eet Q W 5F Gres 3.2. A02e~4_ Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home_ Dimension of Structure 30 k (,,Q Bedrooms* *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 application:;. 'Ihe number of bedrooms will be confirmed by rooms identified on house plans as~a bedroom at the time of building perini~'i nuance. Tllis inay,prevent the need for system size ' Icrease in the future. Basement: yes/ o Water Using Fixtures in Basement: e /no No. in Family 2 Whirlpool yes/no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Oc /No If so, describe: X 90 CUr'~EJ6. dp rC_,, 8. Has any grading, removal, or addition of soil been done to this property? Yes o If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes 10. Is a public water supply available on or adjacent to the above property? Yes Check type that is available: [ ] Comn unity well [ ] Semi-public well [ ] County/City/Township water line **IfNo, a Well Permit must be is ed with the Septic Permit.** 11. Well Type Applying For: [ ndividual well [ ] Community well [ ] Semi-Public well I understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE" Date ► • fQ , ,WC)Signature of Owner or Agent