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Home My WebLink AboutEHPR-10-09-2202 (2).TIF BA C THIS IS NOT A PERMIT Case # EHPR-10-09-2202 CATAWBA COUNTY HEALTH DEPARTMENT v ''C Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP IMPROVEMENT - AUTH CONST AR P LJ CANT OWNER CONTRACTOR Hugh Rudisill Hickory Hollow LLC 1922 Wilson Ridge 211 Fairway DR Maiden NC 28650- Fayetteville NC 28305 (828)428-31-)8 NAME TO APPEAR ON PERMIT Hugh Rudisill Pin 376013148152 SITE ADDRESS: 3612 OLE COUNTRY LN, Claremont, NC DIRECTIONS: HWY 10 E/ RT BETHANY CH RD/ LT INTO COUNTRY VALLEY/ RT HANOVER LN/ RT OLD COUNTRY LN/ LOT 33-A ON LEFT NAME of SUBDIVISION: COUNTRY VALLEY PH 2 PL50-98 Lot # 34 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.64 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home Dimension of Structure 24 X 50 Bedrooms 3 Basement: Water Using Fixtures in Basement: No. in Family 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? 0 Type of Water Supply: Individual Well 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 non-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 t applicable setbacks. Date: Z S~74 Signature of Applicant or Agent Z~ % ~v~~ ~ .G✓ An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks AMOUNT Front 30 FEE NAME DATE Side 15 Authorization to Construct Fee (New[10/19/2009 $150.00 Rear 30 Improvement Permit Fee 10/19/2009 $150.00 Max Hght $300.00 TOTAL FEES *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/24/09 13:12 THIS IS NOT A PERMIT WLS # ~ Jr R- 0_ 0 -a a Oa • ` CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services IP AC S. T. Rpr. Exist. S. T. Well Prmt. Replacement Well 1. Name to Appear on Permit 2. Permit Requested By a(4 1.` 12 %s I Business Phone 'off 3 41 - 0 V/S- Address I a a- I,J ; 1 S o Y. (1: d k i d C Home Phone 3. Property Owner P Ivy Business Phone Address r-)- 7 0 S k4 d 7 4/ e y Lk -e C 14 re o. k , nJ C Home Phone 4. Name of Subdivision C o V c , l / e !Z /K f4 Pa Lot # Section/Block/Phase Property Address 3 6 1.~_ 0(e t. i~L-F - ar a ~tf NC Directions to Property: c,; , 1 c E ~Z; 4 G.f c,~-(o i4L~y LG urcG~ 12d- Le-Ff 1-e C0 LLv,-f'r...r L0 0J"\. L,.-C+- 5. Property Size: Square Feet Acres a (o Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure 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 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 system size increase in the future. Basement: yes Water Using Fixtures in Basement: yes/(9 No. in Family Whirlpool Tub yes/ foo 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? Yes / If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes 10 10. Is a public water supply available on or adjacent to the above property? ) / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Monitoring Well Request? Yes / No # of wells _ Name of Site 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 non-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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $50 CHARGE." Date 0 / g Signature of Owner or Agent j /L.. (FOR OFFICE USE ONLY) Please Contact between 8 am and 9 am Phone I have confirmed that no municipal water line exists adjacent to the above property if well permit is being issued.** Signature Date 1 CATAWBA COUNTY, NC - Parcel Report Informatic.n Regerdirtg Selected Parcel(s) Pa;rcel ID: 3760-13-14-8152 Name: HICKORY HOLLOW LLC Name2: Address: 211 FAIRWAY DR Address2: City: FAYETTEVI LLE State: NC Zip: 28305-5571 Account: 159745320 Calc Acreage: 0.64 Tax Map: LRK: 301058 Deed Book: 2929 Deed Page: 0287 Subdivision Name: COUNTRY VALLEY PH 2 PL50-98 Subdivision Block: A Lots: 34 Plat Book: 50 Plat Page: 98 Building Number: 3612 Street Name: OLE COUNTRY LN Site Zip: 28610 Township: CATAWBA Fire Code: CLAREMONT RURAL,NEWTON RURAL City Code: COUNTY State Road: Total Bldgs Value: Land Value: $10,300 Total Value: $10,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P5 E911 District: COUNTY Matrix: STD 1 Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-0,WP-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: CATAWBA Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 2032 Recorded Date: 4/24/2000 Lot Type: Small Area Plan: BALLS CREEK Printed: Monday, October 19, 2009 10:56 AM Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification ofany data contained on this map 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3760-13-14-8152 1 inch = 60 feet Prepared for: ,R-20 Ora .95 _ _ 110 COUNTRY ___7T 10. 7 MOI"]T'- FIRE .54A CIRF~,✓10fJT ~fJ FIFA ~KURAL FIRE -61A CLAAREMOivT~ _ J RURAL 'F i-R,E i O~3A fJEV TOf~J FIRE 03A !aEWTON F1RE - .y- LO J 71- r' 01 x:144 R-20 . N 9163 152 34 1- J J D E f - - - - ~V PQ f ' R 30,' f THIS IS NOT A LEGAL DOCUMENT Monday, October 19, 2009 10:55 AM t~ ! ~ d f t t ! l~ f J ~ A CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE Newton, NC 28658- 0 (828)465-8399 Monday, October 19, 2009 18 42 sM www.catawbacountync.gov Plan Case: EHPR-10-09-2202 Invoice Number: INV-10-09-256348 Environmental Health Plan Review Invoice Date: 10/19/2009 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 10/19/2009 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 1 ulanmniu ;cd 7dcac-u> 2-=]blot-8c8G-h638b12t131C)'; rpt 10/19/2009 11:30