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HomeMy WebLinkAboutRBPR-07-2016-24363.TIFApplicant Land Owner Owner THIS IS NOT A PERMIT Case # RBPR-07-2016-24363 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT 'AC dansl'lvthot ne6e.d r-ff364 lElf Mol *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 BOBBY DAVIS, 159 DAVIS TRAIL LN, TROUTMAN NC 28166 TODD MANNING, 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 C:8287816186 Paid By *ELIOBERTO (AL) ALFONSO, 1265 HWY 70 W, NEWTON NC 28658- C:8282175480 R712@CLAYTONHOMES.COM NAME TO APPEAR ON PERMIT Todd Manning SITE ADDRESS: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 PIN # 363611654963 NAME of SUBDIVISION: MAIDEN WOODS Lot # 37 Section/Block PROPERTY SIZE: Square Feet Acres 1.14 DIRECTIONS: HWy 70 towards 321, Right onto Hwy 321, right onto South Main Ave, Right onto Salem Ch Rd, Left onto Maiden Wood Circle. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Revised 9/13/16 - Changed to 3 BdRms. 360 GPD New Modular 28x72 w/ Decks: Front & Back 6x6 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: STRUCTURE TYPE: FACILITY TYPE: Mobile Home DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28x72 w/ Decks: Front & Back 6x6 # OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: CONVENTIONAL: ANY: YES E7,9 - chapplication 09/26/2016 16:25 Page 1 of 4 9 CATAWBA COUNTY Case# RBPR-07-2016-24363 n t Public Health Department Subdivision MAIDEN WOODS Environmental Health Division PM# 363611654963 >w PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 NAME ON PERMIT: ( TODD MANNING), 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 ( Todd Manning) Site Address: 1498 MAIDEN WOOD CK MAIDEN NC 28650 Property Size: Square Feet Acres 1'14 Directions: HWy70 towards 321, Right onto Hwy 321, right onto South Main Ave, Right onto Salem Ch Rd, Left onto Malden Wood Circle. Improvement Permits Issued as a result of this Information are valid for 5 years or may be non -expiring under certaln 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 transferable. Permits maybe 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 ru ndersland that I am solely responsible for the proper Identifieslabelin all property lines and comers and making the site accessi o that as mylate site evaluation can be performed. Date: �_SignatureofApplicant orAgent irQ/dof 1' — An E virZmental Health Specialist will contact you within working pplication date. If you need further information or assistance please call 891 AREA1 sora+a++rararrrrraaaa+taraaraafaararaa+t+arrarrarataaaarraasaarare+a+rrrrarrrrraaraaraaarraaaaaaraarrraaaaaa E9 - chappiicatlon Authorization to Construct Fee (New/Expansion) 07/25/2016 $300.00 Fee Improvement Permit Fee 07/25/2016 $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) 09262016 16.25 Page 2 of 4 ihhsd Applicant Land Owner Owner THIS IS NOT A PERMIT Case # RBPR-07-2016-24363 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTH CONST - EXPANSION 19 *OAKWOOD HOM S #712 (ELIOBERTO ALFONSO ), 1265 70 HWY W, NEWTON NC 28658 B:(828)217-1862 C:(828)464 -2662F:828-464-4301 R712@CLAYTONHOMES.COM BOBBY DAVIS, 159 DAVIS TRAIL LN, TROUTMAN NC 28166 TODD MANNING, 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 C:8287816186 Paid By *ELIOBERTO (AL) ALFONSO, 1265 HWY 70 W, NEWTON NC 28658- C:8282175480 R712@CLAYTONHOMES.COM NAME TO APPEAR ON PERMIT Todd Manning SITE ADDRESS: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 PIN # 363611654963 NAME of SUBDIVISION: MAIDEN WOODS Lot # 37 Section/Block PROPERTY SIZE: Square Feet Acres 1.14 DIRECTIONS: HWy 70 towards 321, Right onto Hwy 321, right onto South Main Ave, Right onto Salem Ch Rd, Left onto Maiden Wood Circle. PRQMARY CONTACT: Applicant SEWER TYPE: Septic Tank ALLONS PER DAY- 360 WATER SUPPLY: Private Well DESCRIBE WORK( Revised 9/13/16 -Changed to 3 BdRms. 360 GPD New Modular 28x72 w/ Decks: Front & Back 6xb 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: STRUCTURE TYPE: FACILITY TYPE: Mobile Home DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW_ STRUCTURE DIM:: 8x72 w/ Decks: Front & Back 6x6 C# F NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: CONVENTIONAL: ANY: YES F"9 - eiiapplication 09/13/2016 08:49 Page 1 of 4 8284644301 MHC712 09:26:12 a.m. 09-13-2016 2/2 a CATANVBA COUNTY Case # RBPR-07-2016-24363 `C Public Hcallh Department Subdivision MAIDEN WOODS Q Environmental Health Division PINd 363611654963 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 w NAME ON PERMIT: ( TODD MANNING), 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 ( Todd Manning) Site Address: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 Property Size: Square Feet Acres 1.14 Directions: HWY 70 towards 321, Right onto Hwy 321, right onto South Main Ave, Right onto Salem Ch Rd, Left onto Maiden Wood Circle. 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 Weil 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 torrulhorize�! county and stale officials are granted right of entry to conduct necessary Ins ections to determine compliance with applicable laws a)*rules. I understand that I am solely responsible for the proper identification and la lln of ro erty lines and corners and making the site acres ' Is so that to site evaluation can be performed. Date: Signature of Applicant or Agent i An E ironmental Health Specialist will contact you within 5 works . days of application date. If you need further information or assistance please Il 828-466-7291 AREA1 j��,�atnauw;lt�ml;�.. -� tT�!ti,..' It,„�;r�N,+m�tiiiii>3�ati�!iiail'{ �FF.NA�MEIp��,�c�` DATE f t FEE AMOUrIT�I�� Authorization to Construct Fee (New/Expansion) 07/25/2016 5300.00 Fee Im rovement Permit Fee 07/25/2016 $150.00 PAL%FEES S45ffj%( ` 7AirpRNfi�7Sllttll!t6dIBIPBRL:N!111!110i!'rs^' i”'�71Yp!IIIIIHkIIt�-'�.!uNflICr1•_I;enrmlm. 'r .••;►� 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) Eo - chappticasion 09/13/2016 08:49 Pagc 2 of 4 Applicant Land Owner Owner THIS IS NOT A PERMIT Case # RBPR-07-2016-24363 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTH CONST - EXPANSION `&KWOOD HOMES #713 (ELIOBERTO ALFONSO), 1265 70 HWY W, NEWTON NC 28658 B:(828)217-186' C:(828)464 -2662F:828-464-4301 R712@CLAYTONHOMES.COM BOBBY DAVIS, 159 DAVIS TRAIL LN, TROUTMAN NC 28166 "TODD MANNING, 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 0:8287816186 Paid By *ELIOBERTO (AL) ALFONSO, 1265 HWY 70 W, NEWTON NC 28658- C -8282I75480 R712aCLAYTONI-IOMES.COM NAME TO APPEAR ON PERMIT Todd Manning SITE ADDRESS: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 PIN # 363611654963 NAINIE of SUBDIVISION: MAIDEN WOODS Lot # 37 Section/block PROPERTY SIZE: Square Feet Acres 1.14 DIRECTIONS: HWy 70 towards 321, Right onto Hwy 321, right onto South Main Ave, Right onto Salem Ch Rd, Left onto Maiden Wood Circle. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: New Modular 28x72 w/ Decks: Front & Back 6x6 SITE INFORMATION Do any of the following apply to the property for which this application is applied9 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: STRUCTURE TYPE: FACILITY TYPE: Mobile Home DESCRIPTION OF vacant EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28x72 w/ Decks: Front & Back 6x6 # OF NEW BEDROOMS:: 4 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTEDALTERNATIVE. OTHER. INNOVATIVE' Other described. CONVENTIONAL' ANY: YES F9 - rhnpphe,itu,ii 07/25/2016 16 54 Page I of 4 8284644301 MHC712 09:26:12 a.m. 09-13-2016 2/2 a CATANVBA COUNTY Case a RBPR-07-2016-24363 Public Health Department Subdivision MAIDEN WOODS Environmental Health Division FINN 363611654963 W PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 NAME ON PERMIT: ( TODD MANNING), 1498 MAIDEN WOOD Cl R, MAIDEN INC 28650 ( Todd Manning) Site Address: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 Property Size: Square Pcct Acres 1.14 Directions: HWv 70 towards 321, Right onto Hwy 321, right onto South Main Ave, Right onto Salem Ch Rd, Left onto Maiden Wood Circle. Improvement Permits issued as a result of this information are valid for 5 years or may be nonexpiring 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 hereln Is true, complete and tort uthonzeil county and state officials are granted right of entry to conduct necessary Ins ections to determine compliance with applicable laws an ales. I understand that I am solely responsible for the identification and la IlnV47royart Imes and corners and making the site acces to so that to site evaluation can be performed. proper Date: 47 S / C� y Signature of Applicant orAgent 7_ An Er ironmental Health Specialist will contact you within 5 worki days of application date. If you need further information or assistance please II 828-46G-7291 AREA1 •{t tYYYIHtYH1YYYt tttYRf YY�Y{ii iiYNi N4YYiYHf {YlYYYY4YN YYiYtYti{Y{NiYiYNYtYYYtiiiY iYi tYYY1 HiitHi HY• 'L� ,,Fixrililllw� fl�liWt. q hF;lW - :+S'il^'ii"'An.:�''� � r' I��u� p I�''��nllh• � I�M�i111r�'UIIIiIAIIIYIIIPI' ,FFNA•MF�pa-"Np;�x��('IIIiIR)f i,.' -x' °E.('(8'Ik+"IBu1IPlll III�t'DATEII!III!!�'l'n18FEE•AMOUNTiII Authorization to Construct Fee (New/Expansion) 07/25/2016 $300.00 Fee Improvement Permit Fee 07/25/2016 S 150.00 liIM17'OTA�L�FE .... m �����1�f1�� nlilil�.i .1•]I'.�i����� f�Coe= id:w��y�l�r(tl�3.1d4�5450r00� �� tl °--vncmnninMmm.—.; �uxiircr�.tnurnnml. � a¢ 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-drapplmnu011 09/132016 08:49 PaEc2 of Applicant Land Owner Owner THIS IS NOT A PERMIT Case # RBPR-07-2016-24363 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTH_CONST - EXPANSION *OAKWOOD HOMES 4712 (ELIOBERTOALFONSO), 1265 70 HWY W, NEWTON NC 28658 B.(828)217-1862 C:(828)464 -2662F:828-464-4301 R712@CLAYTONHOMES.COM BOBBY DAVIS, 159 DAVIS TRAIL LN, TROUTMAN NC 28166 TODD MANNING, 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 C:8287816186 Paid By *ELIOBERTO (AL) ALFONSO, 1265 HWY 70 W, NEWTON NC 28658- C:8282175480 R712@CLAYTONHOMES.COM NAME TO APPEAR ON PERMIT Todd Manning SITE ADDRESS: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 PIN # 363611654963 NANIE of SUBDIVISION: MAIDEN WOODS Lot # 37 Section/Block_ PROPERTY SIZE: Square Feet Acres 114 DIRECTIONS: x PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: Install 28x72 manufactured home. 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? APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Moble Home DESCRIPTION OF I vacant EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 28 x 72 # OF NEW BEDROOMS:: 4 Desired system types (Improvement Permit or Authorization to Construct), ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: CONVENTIONAL: ANY: F9 - ehapphcanon 07/25/2016 15.39 Page I of 4 �e CATAWBA COUNTY Case # RBPR-07-2016-24363 G Public Health Department Subdivision y MAIDEN WOODS Environmental Health Division PIN# 363611654963 PO Box 389, 100-A Southwest Blvd, Newton. NC 28658 Ig :M NAME ON PERMIT: ( TODD MANNING), 1498 MAIDEN WOOD CIR, NIAIDEN NC 28650 ( Todd Manning) Site Address: 1498 MAIDEN WOOD CIR, MAIDEN NC 28650 Property Size: Square Peet Acres 1 14 Directions: x Improvement Permits issued as a result of this information are valid for 5 years or may be non-expuing 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 an t s I understand that I am solely responsible for the proper identification and labeling o all property lines and corners and making the site acces e s hat a complete site evaluation can be performed Date: � / �� Signature of Applicant or Agent f An--nvironmental Health Specialist will contact youIth' rking days of application date. If you need further information or assistance ple se call 828-466-7291 AREA1 r �FEENAME DATE FEEAMOUNT� Authorization to Construct Fee (New/Expansion) 07/25/2016 $130000 Fee Improvement Permit Fee 07/25/2016 $150.00 r TOTAL FEES $450.00 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) E9 - ehapphcauon 07/25/2016 15 38 Page 2 of 4 5 644301 ,MHC71Z Ko CATA� ♦ LA p COUNTY ' T NmA Gd4� k y 3�3 12.35:59 p.m, 07-16-2016 1/4 THIS IS NOT A PERMIT 1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit [f/ Authorization to Construct Septic Repair ❑ Septic Malfunction ❑ Septic Expansion New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) Application is for New Construction El Existing Facility E:1Property Address 1 1 i( M ,o I�P �1t j1tL�( lrr.�P Subdivision ;hC I a ; C(c:2r1 A ) C— .':�U Lot # Acres / Section/Bloc Phase Driving Directions to Property n - 0 (,, 'Gr S �� ( , TI n , , -� a I _ % u O q :�N..�k VY)Gtin 4X. —IR nn EH- --7-L a'-\ Mack, WCCC4 C1'rG(e- NAME TO APPEAR ON PERMIT? *Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name1P,� t�-V Address I-)(6cl E �l.Jul -7() (_�- Qejl l < AJ(- ni Qis�� Phone $,J 3 Co U qi I Cell Phone Owner Contact Information Name r0rlr% i'n0 Address l�k r)r�.'rlPr,� I . kY)rA ('. t f -r Ir-_ _ IYI -'c(e , Ili( 2.6, C11 Phone `�� g , I - (n I CP _ Cell Phone I Contractor Contact Information + Name �C.ory P (2 Address Y Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner E4pplicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *j' 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. El Yes Does the site contain any jurisdictional wetlands? Yes o Does the site contain any existing wastewater systems? O Yes o Is any wastewater going to be generated on the site other than domestic sewage? )(Yes 40 Is the site subject to approval by any other public agency? 13 `I�y ways on this property? Describe Ex1sh❑ngCou ty/Citysupply /Township Whter Line individual Wen t Is Yes o Are there an easements o gh Il U Community Well LI Semi -Public Well a public water supply available? ** E] 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) ❑ Accepted ❑ Alternative 0 Conventional 0 Innovative 0 Other 0 Any 8284644301 . MHC71,2 12.36:19 p.m. 07-16-2016 2/4 CATA"A THIS IS NOT A PERMIT coua-ry CATAWBA COUNTY HEALTH DEPARTMENT k Application for Environmental Services Page 2 Pr posed Facility Type Lf Primary Residence ❑ New Residence ❑ Addition to Residence --''#ofNew lBedrooms *t Project Description SCk .( I . V-\PA) Structure Dimensions �' 4 a # of occupants n Basement LJ Yes K�No Basement Fixtures ® Yes ® No 1pop {� rat d (Cetide&5 ❑ Accessory Structure(s) bescribe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions U Fomd 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/AbandonmenURepair 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 maybe 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent n d l lcxII �Pl l �II�uS/� Printed Name of Owner or Agent 1 t"'G.l1lrY-C'--) --�Ca� CA`,iAWBA Geospatial Real Estate Search Information Services 227.95 NA w+E 15 S Parcel: 363611654963, 1498 MAIDEN WOOD CIR MAIDEN, 28650 Owners: DAVIS BOBBY G, DAVIS LAURA J Owner Address: 159 DAVIS TRAIL LN Values - Building(s): $0, Land: $11,700, Total: $11,700 1 in=75ft This maplrepart Product was prepared fmm the Catawba County. NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling Infomsation contained on this map or data on this report. Catawba County promotes and recommends the independent verification of any data contained on this maptreport product by the user. The County of Catawba, its employees, agents, and personnel, disclaim, a^d shall not be held gable for any and all damages, loss or liability, whether direct, Indimct or Consequential which arises or may arise from this maptreport product or the use thereof by any person or entity. Copynght 2014 Catawba County NC 03/19/2016 E/£ 910Z -$l -L0 'W'e OE:6£:1,l Z:LDHN t0£71,0818 Catawba County Environmental Health 150.00 MAIDEN WOOD CIR _sa IN Parcel: 363611654963, 1498 MAIDEN WOOD CIR MAIDEN, 28650 AV 75.00 1 i n=50ft 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 07/18/2016 Parcel Re}iort . Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 363611654963 Owner: DAVIS BOBBY G Parcel Address: 1498 MAIDEN WOOD CIR Owner2: DAVIS LAURA J City: MAIDEN, 28650 Address: 159 DAVIS TRAIL LN LRK(REID): 900769 Address2: null Deed Book/Page. 3023/1425 City: TROUTMAN Subdivision: MAIDEN WOODS State/Zip: NC 28166-8759 Lots/Block: 37/ null Zoning3: null Assessed Total Value: $11,700 School Information: Last Sale: $14,000 on 2010-04-30 Small Area: null Current Tax Bill School District: COUNTY Plat Book/Page: 38/33 Zoning Agency Phone Numbers Elementary School: MAIDEN Legal: LOT 37 MAIDEN WOODS PL 38-33 Middle School: MAIDEN Calculated Acreage 1.140 High School: MAIDEN Tax Map: null School Map Township NEWTON State Road # 2111 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District MAIDEN County Fire District: MAIDEN RURAL Zoningl: R-20 Building(s) Value: $0 Zoning2: null Land Value: $11,700 Zoning3: null Assessed Total Value: $11,700 Zoning Overlay: null Year ButtlRemodeled: null/null Small Area: null 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 #: 3710363600J Building Details 2010 Census Block: 4040 WaterShed: null 2010 Census Tract: 011702 Voter Precinct: P20 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report Page 1 of 1 This map/report product was prepared from the Catawba County, NC Geospabal 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 y 31z L http://gis.catawbacountync.gov/nomap/parcel_report.plip'?key=363611654963&typ=P 7/18/2016 TAWBA COUNTY . STH DEPARTMENT Telephone: (704) 465-6270 TDD: (704) 465-8200 No 0 1 4 5 Improve. Permit 'Author lization to constructKRepair Permit_Oper. Permit System Type /i Owner/Agent I�ef kip A -c+ (-e . Phone Address /°ice , //( //1i// 12r✓ Subdivision rLlM4E/� wGt7�S iiJPwim l Section/Block/Phase Lot#d 2 Lot Size li/y we Directions: E' %ZGb . (�G7 fin -enc+.., Facility: House_ Mobile Home X Business_ Other: Tax Map 4671V -S- e Multi -family_ Other Zoning Approval # xttmj OL <ua-/LAN # Bedrooms 3 # seats # Employees Application Rate Flow �f X _ Hot Tub or Spa yeses Special Fixtures 100k Repair Area yes/no Basement yes/0 Basement Plumbing yes/no Water Supply: Private Well Public ••farraaaaaaaaaaraara rararaaaaaaraara ansa•waraaaaaaaarraaaaaraarraaaaraaaararaaraaaaaaaawraraa• Type of System: Trench_Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size Pump Tank Size / C Nitrification Field: Total Square Feet Depth of Stone / Bed Size ! / Trench Width c3� Total Length of All Trenches .10C) Number of Trenches 7 Individual Trench Length/ %� / r / /_ Feet on Center C7 Maximum Trench Depth z Distance of Nearest Well �� *DO NOT INSTALL WHEN WET* arsaau saarasnaaranaaaraarrannraasnnnwannnsaaaaan♦a♦aaaaaaatarrrraaarwnrsnnnsnsaaraarnsnnaaasrs Topo 4 k Slope Text 7GcJ/Qz,s t y I Stn%ture, Clay Mir? - Soil Wetness l Soil Depth l Restric. Hoz. at Available space yes/nol Overall Class S PS U l �h Comments: p i 4l /4159' lz-7"Vo,� z,,�jz r,2 **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** ♦rannnrarnnrasr rnnaaan•nnarrsraww wasraaar wraaaaaranssaaawssssssasrnrrsrraaaananrnwrranaaawann sa *Improvement Permit has no expiration date and is transferable, but may be revoked if site plana or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) fi%e �jear,C from date issued and is not transferable. Permit Dae/'r��i� /� Owner/Agent -/ ,r z R Sanitarian S, _ Installed By ,li1tO� Date p7-L�j/-h,/A Sanitarian White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct