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HomeMy WebLinkAboutEHPR-05-2016-23867 (2).TIF 44..\Z3A • THIS IS NOT A PERMIT Case # EFIPR-05-2016-23867 G `� y CATAWBA COUNTY HEALTH DEPARTMENT 0 o f 0 4.11 ` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES } 1 1842 sM Environmental Health Plan Review - OSWP }o_ i3 13 r 't r IMPROVEMENT 0 o , ' C : Applicant *COBBLE CREEK CUSTOM HOMES LLC (SHAWN PATTERSON ), 1658 MAGGIE ST, CATAWBA NC 28609 B:8282414150 C:7043699856F:704-323-7161 COBBLECRKHOMES @YAHOO.COM Owner COBBLECREEK CUSTOM HOMES LLC& RUG INVESTMENTS LLC, 1658 MAGGIE ST, CATAW■ NC 28609 B:704-369-9856 NAME TO APPEAR ON PERMIT *COBBLE CREEK CUSTOM HOMES LLC (Shawn Patterson) SITE ADDRESS: 1098 SHILOH RD, CATAWBA NC 28609 PIN # 368901092292 NAME of SUBDIVISION: Lot# 3 Section/Block PROPERTY SIZE: Square Feet 49,484.16 Acres 1.136 DIRECTIONS: Hwy 16 to IGA, Left onto Buffalo Shoals Rd, Right onto Shiloh Rd, Lots will be on the Right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60 #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: 09-ehapplication 05/16/2016 08.48 Page 1 of 4 CATAWBA COUNTY Cased EHPR-05-2016-23867 a .0 � ,/, Public Health Department Subdivision 'C Nigi ei '4 Environmental Health Division PIN# 368901092292 '=d1- PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 is.2. ,, 7 NAME ON PERMIT: *COBBLE CREEK CUSTOM HOMES LLC (SHAWN PATTERSON), 1658 MAGGIE ST, CATAWBA NC 286( *COBBLE CREEK CUSTOM HOMES LLC ( Shawn Patterson) Site Address: 1098 SIHILOH RD, CATAWBA NC 28609 Property Size: Square Feet 49,484.16 Acres 1.136 Directions: Hwy 16 to IGA, Left onto Buffalo Shoals Rd, Right onto Shiloh Rd, Lots will be 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 d labeling of all property lines and corners and making the site accessible o that omple e ite evaluation can be performed. Date: /(,z/y"/v 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•iiii F.ENAMEiIf 11 )1I r,l1�lrrir. t ;l�111i .'Pi l;i IV'i91„lu!f n1t 111III�llllW 't Ittli ,..�;ir10111FEE1IAMOUNT II 21 . illut 1 h rlu .�i,l?IlJ1liie � *�Ilr,LliJI�;11: @III I , ��1I„ Improvement Permit Fee 05/16/2016 5150.00 P T 7� ht r,i { iw I i� f_ I 11 III 1"- qi1' li i� ii i i t"� hr l l�iI I If1 NI ,��i,TOTAU gEES ) �Y l t•„ti ,I:�INII���llludln 11 ti bl6 ! _ ��ill I� I li�l�`�,ISiso ooh .i I 11„,,„,,„,.... .,.„,..,r,i �t(iiiiii w a1,... t ;.Ninrl O5IlLvW�?-.'r MtifE - da,l6liiltllthll9l x'fllilrtl 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) F9-chapplicati n 05/16/2016 08:48 Page 2 of 4 C eTAI\ BA THIS IS NOT A PERMIT ��covnTr c�Y ii'.. CATAWBA COUNTY HEALTH DEPARTMENT „o; „o;;:� Application for Environmental Services Page 1 Improvement Permit Authorization to Construct n Septic Repair n Septic Malfunction ❑ Septic Expan on New Well Permit❑ Replacement Well _ Well Abandonment Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application is fore New Construction 0, Existing Facility r Property Address 'l i:(V5 ` )�i tin f<O( Subdivision Lot# 3 Acres /,/.317 Section/Block/Phase \V Driving Directions to Property `3v Al2 AP” 16th fS /2 719 — 6-----12- `f" U,--' 51-;'e /a/r /2C) /> .<---' fi %f l7*- NAME TO APPEAR ON PERMIT? ❑ Owner Applicant n Contractor Applicant Contact Information Name (oWr rezett/K;./.ts / mac/ 1'C C Address /(P 5-y nit f c r l"- Phone -7 c2 y 36?pert Cell Phone Owner Contact Information s(. Name rrLek OtPwit & ihts - (lc 12( C Jj44,€¢1 ii 1614.yiel y Address Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site VUCO41f 1 c+ # of Bedrooms *t 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 in question. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes up No Does the site contain any jurisdictional wetlands? ❑ Yes fi1 No Does the site contain any existing wastewater systems? ❑ Yes 7 No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes ® No Is the site subject to approval by any other public agency? ❑ Yes it No 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? ** r' Yes 7 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other �p Any A rrA 7B A THIS IS NOT A PERMIT _ COUNTY , 'L?"l-� CATAWBA COUNTY HEALTH DEPARTMENT .. North Oo,,,,n, ` Application for Environmental Services Page 2 Proposed Facility Type\ Primary Residence New Residence Addition to Residence # of New Bedrooms 41. t�� Project Description ll �pUiP Structure Dimensions 40X620 ' # of Occupants I Basement ❑ Yes I.No Basement Fixtures ❑ Yes V No ❑ Accessory Structure(s) Describe # of New Bedrooms *j if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing ❑ Yes Li No Describe Plumbing Needed n 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 n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well n Semi-Public Well n Community Well Abandonment Type n Drilled n Bored ❑ Dug ❑ Unknown Well Repair Requested n 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. 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. � 4Signature of Owner or Agent JM ( 7 /1 Date 57/ 4 Printed Name of Owner or Agent Shies v /A Kru Catawba County Environmental Health Are,.SJ I 4 0' (,>/�J 17 (212) rn `tiye\ 8 / f Ts- 2� / / ?pp� e i 7 * 7 63 . LO • • Gt c`oGG1O 9(0I ry 0 ilf. 0,11\V ` _ Foy iiii CO X53) cv (181} ` lic.... • / (172) / i t ' _9/ Gli / '—...—...-..e.--sssa-s.....eassi . . Ell(1p5) 213.:as / e 3.97 / / Parcel: 368901092292, 1173 BUFFALO SHOALS 1in=100ft RD CATAWBA, 28609 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 05/16/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 368901092292 Owner: COBBLE CREEK CUSTOM HOMES Parcel Address: 1173 BUFFALO SHOALS RD LLC City: CATAWBA, 28609 Owner2: RLG INVESTMENTS LLC LRK(REID): 23238 Address: 1658 MAGGIE ST Deed Book/Page: 2854/0090 Address2: null Subdivision: City: CATAWBA Lots/Block: / State/Zip: NC 28609-8249 Last Sale: $155,000 on 2007-07-30 School Information: Plat Book/Page: School District: COUNTY Legal: 1173 BUFFALO SHOALS RD Elementary School: CONTACT SCHOOL Calculated Acreage: 3.340 DISTRICT Tax Map: 023 Y 04004 Middle School: MILL CREEK Township: CATAWBA State Road #: 1003 High School: BANDYS School Map 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: $95,200 Zoning2: null Land Value: $36,300 Zoning3: null Assessed Total Value: $131,500 Zoning Overlay: WP-O Year Built/Remodeled: 1947/null Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: null Building Details 2010 Census Block: 4011 WaterShed: WS-IV Protected Area 2010 Census Tract: 011402 Voter Precinct: P5 Agricultural District: Proximity 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 infomration 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. 1S4 \qer6 Nk Gt� http://gis.catawbacountync.gov/nomap/parcel_report.php?key=368901092292&typ=P 5/16/2016