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HomeMy WebLinkAboutRBPR-03-2016-23454.TIF O� THIS IS NOT A PERMIT Case # RBPR-03-2016-23454 6 .. td. CATAWBA COUNTY HEALTH DEPARTMENT _;� , sTe � A PLAN REVIEW APPLICATION LICAFION FOR ENVIRONMENTAL SERVICES .F� ti �i 1842 Sm Residential Building Plan Review - Building New T IMPROVEMENT - AUTH CONST- NEW WELL '' ' �'r ` 'f Applicant MAX STEVE HOVIS (MAX STEVE HOVIS), 4005 SPRINGVIEW DR, DALLAS NC 28034 B:704-913-8169F:704-922-1957 Contractor JOHNSON REAL ESTATE GROUP, INC . (ROBERT JOHNSON),711 E MAIN ST, CHERRYVILLE 28021 B:7044605087 OTI-IER:70444500022I RJOHNSON aJOHNSONANDASSOCIATES.NET Owner PHILLIP XION, H:3366680851 C:7044605087 HOME3366680851 Parcel Owner JOHN FOX JR. 1855 WATERFALLS DR. LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT Johnson Real Estate Group, Inc. (Robert Johnson) SITE ADDRESS: 4617 CHARLOTTE ST, CONOVER NC 28613 PIN # 373305092370 NABAIE of SUBDIVISION: Lot N Section/Block PROPERTY SIZE: Square Feet Acres 3.87 DIRECTIONS: Startown RD - McDonald HWY right on Springs RD NE, Right Charlotte ST(lot on right with sign 4621) PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: I story single family dwelling w/attached garage 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: _ #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50x53 #OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: REPLACE WELL?: NO E9-ehapplicotiou 03/23/2016 09:44 Page 1 of 4 ,aA CATAR'BACOUNTY Case# RBPR-03-2016-23454 ‘5," �c Public Health Department Subdivision 4 zcp;, ,�; Environmental Health Division PIN/I 373305092370 �" PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 18.2 su NAME ON PERMIT: JOHNSON REAL ESTATE GROUP, INC. (ROBERT JOHNSON), 711 E MAIN ST, CHERRYVILLE NC 28021 Johnson Real Estate Group, Inc. ( Robert Johnson) Site Address: 4617 CHARLOTTE ST, CONOVER NC 28613 Property Size: Square Feet Acres 3.87 Directions: Startown RD- McDonald HWY right on Springs RD NE, Right Charlotte ST(lot on right with sign 4621) 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 AREA2 ,: arf a r« ,a , 1 ��I�r „�+7 [ r� ( : 1 �.,<- .3 (dpdra I rFELNAMEr=;�,� ,+W, �" ks.._�, z � v 3;yP� DATE �...s; _,_ FFF AMOUNT ".. Authorization to Construct Fee (New/Expansion) 03/22/2016 S300.00 Fee Improvement Permit Fee 03/22/2016 $150.00 Well Permit& Inspection Fee 03/22/2016 $300.00 575o 00 irl L,.,.,{.,v_x ... 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-ehapplieation 03/23/2016 09:44 Page 2 of4 THIS IS NOT A PERMIT Case # RBPR-03-2016-23454 r.7( itlitti n CATAWBA COUNTY HEALTH DEPARTMENT 0�r '' 1 El K PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES t` :r, t 1842 M Residential Building Plan Review - Building New _U 4G o r 1• .r , * 1: r IMPROVEMENT- AUTH CONST- NEW WELL :IOWA 0 Applicant MAX STEVE HOVIS (MAX STEVE HOVIS),4005 SPRINGVIEW DR. DALLAS NC 28034 B:704-913-8169F:704-922-1957 Contractor JOHNSON REAL ESTATE GROUP, INC. (ROBERT JOHNSON), 711 E MAIN ST, CHERRYVILLE 28021 B:7044605087 OTHER:70444500022I RJOI-INSON @JOHNSONANDASSOCIATES.NET Owner PHILLIP XION, 1:3366680851 C:7044605087 HOME:336668085I Parcel Owner JOHN FOX JR. 1855 WATERFALLS DR, LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT Johnson Real Estate Group, Inc. (Robert Johnson) SITE ADDRESS: PIN # 373305092370 NAME of SUBDIVISION: Lot# Section/I3lock PROPERTY SIZE: Square Feet Acres 3.87 DIRECTIONS: Startown RD- McDonald HWY right on Springs RD NE, Right Charlotte ST(lot on right with sign 4621) PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: ! story single family dwelling w/attached garage 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF 1 vacant EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50x53 it OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: REPLACE WELL?: NO E9-chapplication 03/22/2016 16:56 Page 1 of4 4gA • CATAWBACOUNTY Case# RBPR-03-2016-23454 if f Public Health Department Subdivision < _ Environmental health Division „t, PIN# 373305092370 PO Box 389, 100-A Southwest Blvd.Newton,NC 28658 28.2 . NAME ON PERMIT: JOHNSON REAL ESTATE GROUP, INC. ( ROBERT JOHNSON),711 E MAIN ST,CHERRYVILLE NC 28021 Johnson Real Estate Group, Inc. ( Robert Johnson) Site Address: Property Size: Square Feet Acres 3.87 Directions: Startown RD-McDonald HWY right on Springs RD NE, Right Charlotte ST(lot on right with sign 4621) 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 labelin of all property lines and corners and making the site acces`Ale so that a complete site evaluation can be performed.• Date: 3(z2 a /�/4 Signature of Applicant or Agent -A1� 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 AREA2 EEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 03/22/2016 $300.00 Fee Improvement Permit Fee 03/22/2016 $150.00 Well Permit & Inspection Fee 03/22/2016 $300.00 TOTAL FEES 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-chapplication 03/22/2016 16:56 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY r ae CATAWBA COUNTY HEALTH DEPARTMENT 1 rc- ..,4„"„- °` Application for Environmental Services Page 1 Improvement Permit Authorization to Cons ruct Septic Repair❑ Septic Malfunction ❑ Septic Expansion New Well Permit Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ ApAlication is for New Construction k Existing Facility ❑ _ Property Addressl' /n 'JAN W S. Subdivision Lot# Acres / 1 Section/Block/Phase 1\<,Driving Directions to Property Clio,C- G r '/ ft v N �d ^ , i c d6r�a (d /9 Ni y le? 2 q 11 -/-- pr- AisS Id Il/ F /? i5A +' GAAr /o7474C 5-9-/ 6t.o-i dN r t'g hf w , fk set, 49 of fl 21 ) NAME TO APPEAR ON PERMIT? n Owner ❑ Applicant ['Contractor Applicant Contact Information Name _'-?l.e v C 7/U v is Address El 0 O6 9/- Jy u / o - bp ,' ✓e 4G. /1 (4.5" N " C . Phone Cell Phone 4/ 97 3' ' /67 Owner Contact Information & Name Ph; f 2 i X % d Ate Address Phone 3s 6 to Q Q' 51 Cell Phone 24 Y .1l4'0 Co g 2 Contractor Contact Information Name ±R Ober+ SQ A,N Se n/ License # .95 7 f Address GaE 4ea,/ env Jitee* C1 erry Ili // 42 c_. Phone 2 6 L/ Lf y s ,0 v0 -e ir' 1 2 / Cell Phone WHO WILL/BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site MULU (Dili # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑Yes n No Basement Fixtures Li Yes in No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in uestion. If the answer to any question is"yes", applicant must attach supporting documentation. El Yes M o Does the site contain any jurisdictional wetlands? ❑ Yes L��J l� Does the site contain any existing wastewater systems? ❑ Yes L�J'N�o Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes I-tQo Is the site subject to approval by any other public agency? ❑ Yes D-Nti Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well In 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 your preference) 4❑ Accepted ❑ Alternative R-Conventional ❑ Innovative ❑ Other ❑ Any cATA�'( BA THIS IS NOT A PERMIT l_ ;vr couv VV 17 CATAWBA COUNTY HEALTH DEPARTMENT „,M. o Application for Environmental Services Page 2 Proposed Facility Type P• rimary Residence ew Residence n Addition to Residence # of New Bedrooms *t it Project Description S e n..:5 l e Fa rr.r, `r,7 /I G nn C . Structure Dimensions tic, yt ,S #of Occupants 02_ Basement n Yes [ r Basement Fixtures ❑ Yes a.-No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑Yes No Plumbing ❑ Yes n No Describe Plumbing Needed n Multi-Family Residence # Units #Bedrooms per Unit*t Total# Bedrooms *t Structure Dimensions ❑ F• ood Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area(Sq. Ft.) ❑ B• usiness Specific Type of Business Retail Floor Space # of Employees per Shift #of Shifts ❑ O• ther Facility Type Specify If Church# of Seats Kitchen n Yes No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Ns. Individual Well n Semi-Public Well n Community Well Abandonment Type n Drilled n Bored ❑ Dug _ Unknown Well Repair Requested f l Yes n 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. 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 ncan�be performed. 7 Signature of Owner or Agent /� /L / 1�� J�>^/`" Date �4), �J Printed Name of Owner or Agent Sl e ✓ e //v ✓iS Catawba County Environmental Health rt \\ \ vie: "i1-44:4 i (3y t, c c en 1 nr i 1055 L m r\ _ P$ V A . a k 10511 _.--- / rn I v yr ji r Ni -i 41 S C)c.KK tS II f 315 f d7 1i (2 7) Parcel: 373305092370, CONOVER, 28613 1 in=80ft 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 03/22/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373305092370 Owner: FOX JOHN CHRISLEY JR Parcel Address: Owner2: null City: CONOVER, 28613 Address: 1855 WATERFALLS DR LRK(REID): 63449 Address2: null Deed Book/Page: 3267/1765 City: LINCOLNTON Subdivision: null State/Zip: NC 28092-8528 Lots/Block: null/ null Last Sale: $24,000 on 2000-12-13 School Information: Plat Book/Page: 21/26 School District: COUNTY Legal: PLAT 21-26 Elementary School: SNOW CREEK Middle School: ARNDT Calculated Acreage: 3.870 High School: ST STEPHENS Tax Map: 2108 02007B Township: CLINES State Road #: null Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: ST STEPHENS Zoning1: R-20 Building(s) Value: $0 Zoning2: Land Value: $33,000 Zoning3: Assessed Total Value: $33,000 Zoning Overlay: Year Built/Remodeled: null/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710373300J Building Details 2010 Census Block: 2004 WaterShed: null 2010 Census Tract: 010303 Voter Precinct: P29 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. \t (1- ,SD ',91r) ChcribW [(i2m (-180 day http://gis.catawbacountync.gov/nomap/parcel arcel_report.php?key=373305092370&typ—P 3/22/2016 1jciCZoUb-os' CATAWBA COUNTY HEALTH DEPARTMENT pD • Telephone: (828)465-8270 TDD: (828)465-8200 N0 8888 - IP N AC Rpr. Prmt. Opr. Prmt. Sys. Type Well Prmt. Replacement Well Well Rpr. Prmt. Owner/Agent —7-,:t, • ay Phone ?.6-y 70 Address Pc r.e_ C0L11, C. Subdivision Section/Block/Phase Lott/ Lot Size -c. R Directions: c Q.o T 4;ac ^-�clZ. S 1" c Tf =/l C u J — — O w [ o r'f r Property Address 8(y>, j / PP Facility: House NI Mobile Home Business Multi-family . Other: Pin Number 1330• 39 Z3 7 0 Other . Zoning Approval N H Bedrooms t-{ / Seats ll Employees . Application Rate e ')$- GPD Flow [No Hot Tub or Spa yes/69S ecial Fixtures Basement&no . 100% Repair Are );. no Basement Plumbing 4r i(?j Water Supply: • ate Well Public Semi-Public ***************** ****** *******************************************************,****************************************** Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank SizeJO�_ Pump Tank Size Nitrification Field: Total Square Feet f 37) Depth of Stone /4)■"‘ Bed Size Trench Width Total Length of All Trenches Number of Trenches Trench Length / / / / / Feet on Center - Maximum Trench Depth Distance of Nearest Well •DO NOT INSTALL SEPTIC WHEN WET* WELL RECORD REQUIRED AT COMPLETION* ************************************************************************************** *********************************** Topo % Slope a� L Texture nn Structure ST) • a Clay Min. i : l • <-fit-r l. rrt; S'rreer _ . Soil Wetness 4.' " 573- Soil Depth 1.4c " q •\ _ Restric. Hoz. at Cif ))7 Available space0/no t• • I 5 elpTI C, Overall ClassU �O Comments: r' ,I /� 52f i-lc -,v -5! .. OSGf , . I c'S row". O"e. o FT c.kp .. I.1,11 . • s^ :X. " r, iii �GkfG iNA ����. ; Lr . • LA.A5�,Yw101e . . • S o 4 Filter Required S)p • Riser required when tank is more than 6 inches deep. . **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** . *************************************************************************************************************************** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. . The siting of the well by-the Health Department staff is to provide protection from known possible sources of contamination. No volume of D" water is guarani‘•d at any site by the Health Department. 1 Permit Date_ ,: —S •`� EHS d _ __ _ . - . Owner/Agent d. r . Septic Tank Installed By it Date EHS Well Installed By Well Grout Approval Date , Well Head Approval Date Date Sample Collected Date of Results Results . EHS White-Office Blue- Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct