HomeMy WebLinkAboutRBPR-06-2016-24084.TIF 3fic:'A THIS IS NOT A PERMIT Case # RBPR-06-2016-24084
4-T All c . p G'- CATAWBA COUNTY HEALTH DEPARTMENT 0 tp
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\r� 4" 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 'Y
1842 Residential Building Plan Review - Manufactured Home 'pro' o
IMPROVEMENT- AUTH_CONST- EXPANSION oy •- ,
Applicant *OAKWOOD HOMES #712 (ELIOBERTO ALFONSO), 1265 70 HWY W,NEWTON NC 28658
B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712 @CLAYTONHOMES.COM
Land Owner BRUCE BERRY, 5912 LEIL RD, HICKORY NC 28602
C:82838I1389
Owner DAVID STUMBO, 4534 ATHENS DRIVE,NEWTON NC 28658
NAME TO APPEAR ON PERMIT
DAVID STUMBO
SITE ADDRESS: 4535 ATHENS DR,NEWTON NC 28658 PIN # 360801499601
NAME of SUBDIVISION: SPRINGDALE Lot# 27 Section/Block B
PROPERTY SIZE: Square Feel Acres 0.42
DIRECTIONS: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR, turn on Athens DR
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Community Well
DESCRIBE WORK:(Revised 6/16/16 -Changed Back Deck to 12x20.
Revised 6/15/1b-Added AC. System is only sized for 2 BdRm. Needs AC to expand to 3 BdRm.
Change Out DW 28x60 Decks: Front 6x18, Back 8x10
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? Yes
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: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF Vacant Lot
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2
PROPS e ONSTRUCTION
NEW STRUCTURE DIM:: DW 28x60, Decks: F 6x1: B 12x20
#OF NEW BEDROOMS:: 3
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
E9-ehapplication 06/16/2016 13:51 Page 1 of 4
• CATA\VBA COUNTY Case 4 RBPR-06-2016-24084
Public Health Department Subdivision SPRINGDALE
01 Environmental Health Division PIN,/ 360801499601
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
/• . su
NAME ON PERMIT: ( DAVID STUMBO),4534 ATHENS DRIVE,NEWTON NC 28658
( DAVID STUMBO)
Site Address: 4535 ATHENS DR,NEWTON NC 28658
Property Size: Square Feet Acres 0.42
Directions: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR, turn on Athens DR
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
LT!FEENAME.! Ills ,ili ilbli,11I:lI ldbufl +u�ll t)I4 ll iillkl�r��I�VIigsDATEutinllFfI VIlL EE.AMOUNT:
Improvement Permit Fee 06/13/2016 $150.00
Authorization to Construct Fee (New/Expansion) 06/15/2016 $150.00
Fee
1 1 0 ..=wTOTAL FEES Illus p njIl' 1tt Ip�III'4A4 h _,v'l�h h1kI I $300100;1+1,
•
'gdIt!, f011ltlihhh porutI tlIV g1'+`�' ,y II9I1IIv.,4 IIUL. It ntir" IHUIIUUIIUUWUnhirroUJIU9UAll111tlrlipllj ' . , !
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-ehappliculion 06/16/2016 13:51 Page 2 of 4
n G THIS IS NOT A PERMIT Case# RBPR-06-2016-24084•
E CATAWBA COUNTY HEALTH DEPARTMENT C •'�`''r f 0
dy
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti i
/842 SM Residential Building-P s r E.•view - Manufactured Home o f•0 o A
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C
. .1
IMPROVEMENT AUTH_CONST- EXPANSION • . { i r CI
Applicant *OAKWOOD HOMES#712 (ELIOBERTOALFONSO), 1265 70 HWY W, NEWTON NC 28658
B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712 @CLAYTONHOMES.COM
Land Owner BRUCE BERRY, 5912 LEIL RD, HICKORY NC 28602
C:8283811389
Owner DAVID STUMBO,4534 ATHENS DRIVE,NEWTON NC 28658
NA E-TO-APPEAR-ON-PERMIT
DAVID STUMBO Th
SITE ADDRESS: 4535 ATHENS DR,NEWTON 8658 PIN # 360801499601
NAME of SUBDIVISION: SPRINGDALE Lot# 27 Section/Block B
PROPERTY SIZE: Square Feet Acres 0.42
DIRECTIONS: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR, turn on Athens DR
PRIMARY CONTACT: Owner EWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUP LY: Community Well—)
DESCRIBE WORK: Revised 6/15/16-Added AC. System is only sized for 2 BdRm. Needs AC to expand to 3 BdRm.
Change Out DW 28x60 Decks: Front 6x18, Back 8x10
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? Yes
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: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF Vacant Lot
EXISTING STRUCTURES
ON SITE(IF ANY)
EXISTINTRUCTURE:
N - S
UMBER OF EXISTING B 00MS: 2 #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: DW 28x60, Decks: F 6x18, B 8x10
#OF NEW BEDROOMS:: 3
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
E9-ehuppleation 06/15/2016 09:12 Page 1 of 4
sy,A CATAWBA COUNTY Case# RBPR-06-2016-24084
•
Public Health Department Subdivision SPRINGDALE
< , Environmental Health Division PIN# 360801499601
� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
/8,2 :.
NAME ON PERMIT: ( DAVID STUMBO), 4534 ATHENS DRIVE, NEWTON NC 28658
( DAVID STUMBO)
Site Address: 4535 ATHENS DR,NEWTON NC 28658
Property Size: Square Feet Acres 0.42
Directions: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR, turn on Athens DR
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 identific lion lab ,ling of all property lines and corners and making the site a e ble so that a co plete s t valuation can b rformed
Date: lc 0 Signature of Applicant or Agent �>f'(14Qn4 �, �1Y O')Ie
An Environmental Health Specialist will contact you within 5 working days of a p cation date.
If you need further information or assistance please call 828-466-7291
AREA2
.olll�IflT g II '!" ` If P( i��slla;t�, , r ui 1111ll! i'.I p ,.b�hR rjl
[FEENAMEIItill I hl'a�t' iti`iII IRA me ,+# tit i hi«r DATE I] FEE�AMOUNT"sA
Improvement Permit Fee 06/13/2016 $150.00
Authorization to Construct Fee (New/Expansion) 06/15/2016 $150.00
Fee
I r� t .�CTOTALUES 1�,Ill i1* iii I _ 111 il111���1111liM.14"'7�a° II1IIHI�J�)IIIIIIIIINNIl?�i�:V9,9I0Q ,(
+o"� I u I�� �,II nI � III
II • li amiulJIILllVi ,,, 'filliiSItil nr:,wnunuii9 aann N�h "Wst'a , ,;•n!auorga!NIWNmiemmnnxnnunW9u
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-ehappiication 06/15/2016 09:12 Page 2 of
41p'A CATAWBA COUNTY
"g •� 100A SOUTHWEST BLVD
i M 7 NEWTON,NORTH CAROLINA 28658 RECEIPT
77rgio PHONE: 828.465.8399
U ,ref • Ni Wednesday, June 15, 2016
1842 sm www.catawbacountync.gov
PAYOR: *OAKWOOD HOMES#712
*OAKWOOD HOMES#712 (Alfonso, Elioberto)
PAYMENTS
TRANSACTION NUMBER: TRC-692223-15-06-2016
PAYMENT DATE : 06/15/2016
PAYMENT TYPE: Credit Card
payment by phone
INVOICE NUMBER FEE NAME FEE AMOUNT
06-16-329454 Authorization to Construct Fee $150.00
(New/Expansion) Fee
TOTAL PAYMENTS : $150.00
RBPR-06-2016-24084
CASE TYPE: Residential Building Plan Review WORK CLASS: Manufactured Home
SITE ADDRESS: 4535 ATHENS DR,NEWTON NC 28658
Applicant *OAKWOOD HOMES#712, 1265 70 HWY W,NEWTON NC 28658
B:(828)217-I862C:(828)464-2662F:828-464-4301 R7I2 @CLAYTONHOMES.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED **
Land Owner BRUCE BERRY, 5912 LEIL RD, HICKORY NC 28602
C:8283811389
Owner DAVID STUMBO,4534 ATHENS DRIVE,NEWTON NC 28658
receipt 06/15/2016 09:11 Page 1 of I
�$A G THIS IS NOT A PERMIT Case # RBPR-06-2016-24084
Q g ti CATAWBA COUNTY HEALTH DEPARTMENT . tiro f O
C j 9I % PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '
1842 sM Residential Building Plan Review - Manufactured Home ..o3rro to
IMPROVEMENT 0 a o r
77--eSEC Applicant *OA WOOD HOMES#712 (ELIOBERTO ALFONSO), 1265 70 HWY W,NEWTON NC 28658
B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712@CLAYTONHOMES.COM
Land Owner BRUCE BERRY, 5912 LEIL RD, HICKORY NC 28602
C:82838I1389
Owner DAVID STUMBO,4534 ATHENS DRIVE, NEWTON NC 28658
NAME TO APPEAR ON PERMIT
SITE ADDRESS: 4535 ATHENS DR,NEWTON NC 28658 PIN # 360801499601
NAME of SUBDIVISION: SPRINGDALE Lot# 27 Section/Block B
PROPERTY SIZE: Square Feet Acres 0.42
DIRECTIONS: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR,turn on Athens DR
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
DESCRIBE WORK: Change Out DW 28x60 Decks: Front 6x18, Back 8x10
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? Yes
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: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF Vacant Lot
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: DW 28x60, Decks: F 6x18, B 8x10
#OF NEW BEDROOMS:: 3
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
E9-ehnpplicauon 06/13/2016 13:09 Page 1 of 4
x,55• • CATAWBA COUNTY Case# RBPR-06-2016-24084
T ' Public Health Department Subdivision SPRINGDALE
Environmental Health Division
�® ^c PIN# 360801499601
PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
1g.2 s.
NAME ON PERMIT:
*OAKWOOD HOMES#712 ( Elioberto Alfonso)
Site Address: 4535 ATHENS DR, NEWTON NC 28658
Property Size: Square Feet Acres 0.42
Directions: Turn Right on 70, turn on Northwest Blvd,turn on NC 10,W C Street,turn on Springdale DR, turn on Athens DR
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
ilin11 ' d P" `•' ' 1�'11 1 1' l I 1.p � 11 1�{ h'a L. , f 19 f
ENAME: 1 6 1•N',III'I,(„lF 1 f i��I 1f�1�i I�iU l �'I�itJbpDATE I L �&FEE_AMOUNT:,i'-
Improvement Permit Fee 06/13/2016 $150.00
�,�TOTALFEES f rPUP, °j1�ill 11� r " a911(!p �1
�t,�ry��ry� i` pt._ �'�tlnl u�h�.hlull� '.`�-!� ��EIIIVIIVI!��illhll�i� �VI�tilE1r�')ill�l�:�l�$tso.00,
91111AI ��1 t�. -a ti ifillialli Ort." t 0;611 W8,O$iI1,I Hop V*,u 7"• iillll00AU U
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-ehappl ieation 06/13/2016 13:09 Page 2 of 4
•
-% • THIS IS NOT A PERMIT Case # RBPR-06-2 0 1 6-240 84
Frot ..
a�� CATAWBA COUNTY HEALTH DEPARTMENT ° , y
o °!°�� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES T �' �� 3i
1842 s^ Residential Building Plan Review - Manufactured Home
'- a lr
IMPROVEMENT •- ` r },
Applicant *OAKWOOD HOMES#712 (ELIOBERTOALFONSO), 1265 70 HWY W, NEWTON NC 28658
B:(828)217-1862 C:(828)464-2662F:828-464-4301 R712 @CLAYTONHOMES.COM
Land Owner BRUCE BERRY, 5912 LEIL RD, HICKORY NC 28602
C:8283811389
Owner DAVID STUMBO,4534 ATHENS DRIVE,NEWTON NC 28658
NAME TO APPEAR ON PERMIT
SITE ADDRESS: 4535 ATHENS DR, NEWTON NC 28658 PIN # 360801499601
NAME of SUBDIVISION: SPRINGDALE Lot# 27 Section/Block
PROPERTY SIZE: Square Feet Acres 0.42
DIRECTIONS: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR, turn on Athens DR
PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
DESCRIBE WORK: 3 bedroom Doublewide
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? Yes
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: Mobile Home OTHER DESCRIPTION:
DESCRIPTION OF
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS:
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 28x60
#OF NEW BEDROOMS:: 3
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES •
Other described:
E9-chapplication 06/13/2016 11:36 Page 1 of 4
c5r� CATAW\BA COUNTY Case RBPR-06-2016-24084
's L ' Public Health Department Subdivision SPRINGDALE
d r r Environmental Health Division , 360801499601
--® w PO Box 389. 100-A Southwest Blvd.Newton.NC 28658 I IN#
NAME ON PERMIT:
*OAKWOOD HOMES #712
Site Address: 4535 ATHENS DR, NEWTON NC 28658
Property Size: Square Feet Acres 0.42
Directions: Turn Right on 70, turn on Northwest Blvd, turn on NC 10, W C Street, turn on Springdale DR, turn on Athens DR
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
FEENAME DATE • FEE AMOUNT •
Improvement Permit Fee 06/13/2016 $150.00
TOTAL FEES $150.00
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)
P9-chappl ication 06/13/2016 11:36 Page 2 of 4
9(foN
•
CATAWBA THIS IS NOT A PERMIT
COUNTY CATAWBA COUNTY HEALTH DEPARTMENT
...e.,.. . Application for Environmental Services Page 1
Improvement Permit Authorization to Construct❑ Septic Repair CI Septic Malfunction❑
Septic Expansion New Well Permit ❑ Replacement Well El Well Abandonment El
Well Repair ❑ Existing System Inspection (Pre-Approval Required) litL
Application is for New Construction ❑ Existing Facility
Property Address —13 3`J -1- -PVi it Subdivision
' _at ,d i , • .- Lot# Acres
Section/Block/Phase
Driving Directions to Property (♦ on 1 (] T t Gce
On NC ( () - c, ) ( S -i-reel -Trg- (iri : pr,‘nsai e i' -t'vC
T(2 nn 2-44k-0.ns Dri tie
NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor
Applicant Contact Information
Name OC..(jThuirYThcka R ncII c\xo S (-4-' k)e�'
n
Address 1 _(.0 ��t_.vt `10 i , 'l — �PC.�.)4 (Th 14 C O� Co T
Phone ag -4 . \.(..0 ( ,a Cell Phone
Owner Contact Information
Name L)c, l ■ A 3-LL Fin bj.)
Address —3_ A-t-k a • - ,_e Y •
Phone R-.?) ( - S-1(C{ Cell Phone
Contractor Contact Information
Name '<<:: rem < CS 0-Cy) I Cc(-1 -
Address
Phone Cell Phone
WHO WILL BE THE PRIMARY CONTACT? ❑ Owner EillApplicant ❑ Contractor
Description of Existing Structures on Site
#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.
fl Yes "194NNo Does the site contain any jurisdictional wetlands?
Yes ' No Does the site contain any existing wastewater systems?
Yes 'No Is any wastewater going to be generated on the site other than domestic sewage?
)(Yes 4i4o Is the site subject to approval by any other public agency?
to Yes / N'o 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? ** Li Yes Val 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 Any
1f
■
11
Z/ I. 9102-01-90 W e9b:9Z:80 ZLOHA l0Eb79
CATAWBA THIS IS NOT A PERMIT
courrrr CATAWBA COUNTY HEALTH DEPARTMENT C c
N,,,��„ . Application for Environmental Services Page 2.--=
Proposed Facility Type 3 _ ex,0
Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t
Project Description 5-r<4- LA.10 nt t. i do 0 *LL)i I C 6iY*1 CC (') cn-n e
Structure Dimensions r S> (Q (1 #of Occupants 2_
Basement El Yes F No Basement Fixtures ® Yes r No
L Accessory Structure(s) Describe
#of New Bedrooms *t if applicable Structure Dimensions
#of Occupants Accessory Dwelling El Yes ❑No
Plumbing ❑ Yes ❑No Describe Plumbing Needed
U Multi-Family Residence#Units #Bedrooms per Unit*t
Total#Bedrooms *t Structure Dimensions
LJ Food Service Specify Type
#Seats Floor Space-Entire Food Service Facility (Sq Ft)
#Employees per Shift #of Shifts Dining Area (Sq. Ft.)
U 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 ❑ Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑Yes ❑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 1, ileglik (1.4 I (kK(r /10- late y( o — v / L fir ' %
Printed Name of Owner or Agent „ripen l Sf. (-4C l f n q✓_ - V (} -L L t i-! 1 es
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Parcel: 360801499601, 4535 ATHENS DR NEWTON, 28658
Owners: BERRY BRUCE EDWARD, BERRY KIMBERLY J
Owner Address: 5912 LEIL RD s�--U IV o
Values - Building(s): $0, Land: $11,200, Total: $11,200
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
06/10/2016
Catawba County Environmental Health
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Parcel: 360801499601, 4535 ATHENS DR tin=50ft
NEWTON, 28658
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
06/10/2016
Parcel Report Page I of 1
Parcel Report - Catawba County NC
Parcel Information: Owner Information:
Parcel ID: 360801499601 Owner: BERRY BRUCE EDWARD
Parcel Address: 4535 ATHENS DR Owner2: BERRY KIMBERLY J
City: NEWTON, 28658 Address: 5912 LEIL RD
LRK(REID): 2248 Address2: null
Deed Book/Page: 3196/1109 City: HICKORY
Subdivision: SPRINGDALE State/Zip: NC 28602-7199
Lots/Block: 27/ B
Last Sale: School Information:
Plat Book/Page: 24/203 School District: COUNTY
Legal: LOT 27 SPRDALE PL 24-203 Elementary School: BLACKBURN
Middle School: JACOBS FORK
Calculated Acreage: .420 High School: FRED T FOARD
Tax Map: 002EJ 01056
Township: JACOBS FORK School Map
State Road #: null
TaxNalue Information: Tax Rates(pdf) Zoning Information:
City Tax District: All in County Zoning District: COUNTY
County Fire District: PROPST Zoningl: R-20
Building(s) Value: $0 Zoning2: null
Land Value: $11,200 Zoning3: null
Assessed Total Value: $11,200 Zoning Overlay: null
Year Built/Remodeled: null/null Small Area: MOUNTAIN VIEW
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 #: 3710360800J
Building Details 2010 Census Block: 4000
WaterShed: null 2010 Census Tract: 011802
Voter Precinct P3 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 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.
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_ CATAWBA COUNTY HEALTH DEPARTMENT
`..>, Telephone (828)465-8270 TDD (828)465-8200 WLS N Oct ' — U 0O 3
IP AC Rpr Prmt. 1 Opr Prmt. Sys Type Well Prmt. Replacement Well _Well Rpr Prmt.
Owner/Agent La�l_s Mc;ndrikvnt4 Phone
Address PO 5e j 1141 1- 14%etce1 *(G fl(,03 - Ey IL Subdivision ,Spr incl.;ac R
Section/Block/Phase Lotf Z,/
Lot Size O clot Directions Ht„/yl0 LJ et e.4- SFr. A`,dnIt ft *.,+ /1-0,4-nJ or.
S- Lo 1' b n �'- __.. I J 1
/ Propert) Address .36080 X499 6e• Or
Facility- blouse Mobile Home V Business Mulu-family Other Pin Number 4535 Abbotns Of-,4
Other Zoning Approval N
N Bedrooms N Seats H Employees Application Rate GPD Flow 360
Hot Tub or Spa yes pectal Fixtures Basement ycs�f 100% Repair ArcaC 'no
Basement Plumbing yes/e) Water Supply- Private Well Public Semi-Public Vi
*****4********************************************************4*********4**************************t*****************R*****
Type of System. Trench Bed Pump Pump/Panel Panel LPP Other
Septic Tank Size I 0 0 0 Pump Tank Size Nitrification Field. Total Square Feet Depth of Stone
Bed Size Trench Width Total Length of All Trenches Number of Trenches
Trench Length / / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well
*D0 NOT INSTALL SEPTIC WHEN WET* WELL RECORD REQUIRED AT COMPLETION*
***************************************************************************************************************************
Topo •o Slope
Texture
Structure • b et 6 ' IM 1- Lns OrtVg—
t
Clay Min. k <
ka.a_lo A ) 1 ro-TS p
Soil Wetn*.s P t
Soil Dep • —. I' 14,,....)
Restric oz at_" 1 1.4„,n.k. z
5 rror, hor+or
Availab e space yes/no y r
Overall Class S PS U IS' 140.,.._ l o` -Po w\ pro p4.r#1 I1 n>LJ
Comments 9 '-p,,.4"
CA 0 . •- - - -0 * P,. np c n CrQS11
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Sgc k P, II w' c,Itgr\
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CI to aC-t✓of^ a a Cft. Via, J
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Filter Required jds O 2 . r t'21 d
q a QXts �tnd r�f�. rn
Riser required when J
tank is more than 3 Do not gr,6.- or I, I '0Jtr
inches deep. 2XIJAt49 drr,4F,CId
"NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH QVTIME 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 thQ .ell by e Health Department staff is to provide protection from known possible sources of contamination. No volume of
water is gua an cal at Ia••sit bt he Health Department. 2
Permit Date - LI a'J- EHS
j Owner/ gent I Septic Tank 1 called By /s/) .'< (}S,Heir r Date a//110 i
I,EHS sc..y I Well Installed By Well Grout Approval Date
Well H d Approval Da( Date Sample Collected
Date of Results Results EHS
White Office Yellow Owner/Agent Pink Building Inspection Authorization to Construct
�.. CATAWBA C< DEPARII eP 4%:-0, 'W/
Lot E�ialuation Improvement Permit Repair Permit Completion Permit
Owner/Agent X61-61,_-44i10. lasu iCe4c4j Phone
Address vision
,S7}.-, - 01 i.0 Section/Block y Lot # g•'7
Lot Size /1 ac2 c' Directions: •. — — %. • '!...1_ •i. _ •.. 1
`, r)�., A.4.E. , . . • c 3 �`1 Si-- Lc,-n A f-h-4�c.� --
Facility: House Mobile Home L—usiness : Other: Zoning Approval yes/no #/ g/7
Multi-family Other : 100% Repair Area yes/no
Bedrooms ;1--Baths / Seats Employees : GPD Flaw2LcApplication Rate e tj
Garbage Disposal Special Fixtures : REPAIR I�TICE: REPAIRS MUSP BE WI'Il-QN 30
Basement yes/no Basement Plumbing yes/no . DAYS OR _ DAYS FRAM LATE OF PERMIT.
Water Supply: Private Public
:*********,t t**#**************rr******##*********r*****#********t**
Type of System: Trench t---fe-d System Other (Specify)
Tank Size: Septic Tank 7 )Gv (j • Q Pump Tank
.�
Nitrification Field: Total Square Feet . Depth of Stone Bed Size
Trench Width 36 Total Length of All Trenches (2 N rber of Trenches ap 4
1
Individual Trench Length 0 i,"/ / Feet on Center' ' Maximim Trench Depth 24'
Distance to Nearest Well 'r 5- ,. Lot Evaluation: Approved Disapproved
********* ** - ********************k************ *****************
Sketch . L 'aluation Site - Systiem Design -final/
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************************************************************************************* **
Permit Date F— jr— 'y (Lot Evaluation and Irnproveme. •-rmit .void a ter 36 mon hs)
Owner/Agent _ 44• & San it. • / L_ ��t
Installed By .yM ffi, Date Cl h)i(/ Sanitar- _ _�- _ ,,.,, ill
(Note any c . ges/information n red or by s - ch on bac ) N.
Togo S PS U Drainage S PS U Depth S PS U Restrictive Hoz. S PS U Space S PS U Soil S PS U
III Loans: Sandy Clay, Silt, Clay, Silty Clay :Y-.4 IVa Clays: Sandy, Silty, Clay .4-.2
WHITE-OFFICE COPY YELLOW-OWNE RAGE NT COPY