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HomeMy WebLinkAboutEHPR-08-2016-24538 (2).TIF • s1,A \ THIS IS NOT A PERMIT Case # EHPR-08-2016-24538 r`�' ��G CATAWBA COUNTY HEALTH DEPARTMENT D, l o �. .� -tea I .,,,,;. 1 v +l'!'� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES , 1842 sM Environmental Health Plan Review - OSWP o 0 IMPROVEMENT �� o r g Applicant JACOB LONDON,2763 FARMSTEAD LN, CATAWBA NC 28609 C:8282448019 Contractor CLAYTON HOMES (BOBBI *LASAGE), PO BOX 132,TAYLORSVILLE NC 28681 C:8282173168 JWHOLDERaHOTMAIL.COM Land Owner MINNIE SHOOK, 2763 FARMSTEAD LN, CATAWBA NC 28609 NAME TO APPEAR ON PERMIT Jacob London SITE ADDRESS: 2763 FARMSTEAD LN, CATAWBA NC 28609 PIN # 367802859801 NAME of SUBDIVISION: Lot# 2 Section/Block PROPERTY SIZE: Square Feet 87,163.56 Acres 2.001 DIRECTIONS: Right onto Southwest Blvd, Left onto W E St, Left onto Buffalo Shoals Rd, Right onto Little Mountain Rd, Left onto Farmstead En, Before the road curves to the Right. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing of Property* 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Modular 30x66, Decks: front& back 6x6 #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: E9-ehnpplication 08/18/2016 16:48 Page 1 of 4 as ,. CATAWBA COUNTY Case 4 EHPR-08-2016-24538 7 ti Public Health Department Subdivision , " Environmental Health Division PIN# 367802859801 �" wa: PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 i8 2 w NAME ON PERMIT: (JACOB LONDON),2763 FARMSTEAD LN, CATAWBA NC 28609 ( Jacob London) Site Address: 2763 FARMSTEAD LN, CATAWBA NC 28609 Property Size: Square Feet 87,163.56 Acres 2.001 Directions: Right onto Southwest Blvd, Left onto W E St, Left onto Buffalo Shoals Rd, Right onto Little Mountain Rd, Left onto Farmstead Ln, Before the road curves to 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 identificatio labeli g of all property lines and corners and making the site accessi a so that a complete site evaluation can be performed. Date: g�IB ILe Signature of Applicant or Agent 111 An nvironmental 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 Y' limit 11riipi' 1 {Tpunil1 1j 9 r�f'Tt k aa:,,i � �ll'Nlkll -77-11777777-777-71 E1IFEENAME ,1 11 u ,1illi 1� i l !ii DATEi, 1IIFFE.AMOUNT, � ILLL 1!S -i,Cu�l�rll �, 1 � n � G '. t ._`Jlw�tl� I� ui1L11 (�Im{ provement Permit Fee 08/18/2016 $150.00 11 711i1111J1iJ_0Y13 ITOTALFEES j Li: y : 1'1(fI i��111llll digit!" Ig1Iiiii"v �IG�ii6i n150 00 u thisadiiik,1,Iiiii. Im_,,,a iminiinkihev>'...,. - -• : • •Liiilill1ti9W9LLu 2 "IIInIW- dliirk.J'IEL', 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) 119-ehapplication 08/18/2016 16.48 Page 2 of4 ��r"-' �' THIS IS NOTA PERMIT -�\\ �� CATAWBA COUNTY HEALTH DEPARTMENT cou �v -- Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair E. Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) Application is for New Construction ❑ Existing Facility K+� ❑ Property Address_TT(&I fziwa 1 ctEz Lana_ Subdivision ma. Ct.. ;DA Lot# .2 Acres 1, 00 Section/Block/Phase _ `�/� �it Driving Directions to Property �,� a ,111 .. _ - /I - Q • Dara ;Lin: o ALM Y wun1►�t ,A� Rck , -6.) TA o,4t cmi► ySLN p4“ A-a'7/D34• . NAME TO APPEAR ON PERMIT? X1 Owner ❑ Applicant ❑ Contractor tie Cum. e›.ttl'e, Le-FL Applicant Contact Information �ECotrlylc-r Name C laybN i-1-n✓ —S k 81 �xldo( La.se25-e 828-24 ? -311,05. Address (0_30 Ccenovvet Riad l.0 COnoVP.c. MC- .3&31 Phone ' ZE344(4-315q Cell Phone ��-21-7-311aS Owner Contact Information NameAicob LOvlritivl Address crib?3 F-A- 3lrj 1 arra , 7)9-�h4At•• Phone 222 -2L4L.( � X0/9 �CellPhone 8Zg Zir..I-So 19 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner W Applicant n Contractor Description of Existing Structures on Site SAM 1/ 1 nt., # of Bedrooms *j' Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes (E,]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 fiNo Does the site contain any jurisdictional wetlands? ®Yes No Does the site contain any existing wastewater systems? Yes paNo Is any wastewater going to be generated on the site other than domestic sewage? D Yes 4 No Is the site subject to approval by any other public agency? C Yes Iii11No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ individual Well (l Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n Yes tNo 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 0 Alternative 0 Conventional 0 Innovative 0 Other t/ Any TAwBA THIS IS NOT A PERMIT "'c`ouNt CATAWBA COUNTY HEALTH DEPARTMENT NonApplication for Environmental Services Page 2 ,�gi '_ Proposed Facility Type ? 111 Primary ResidenceTz New Residence L Addition to Residence # of New Bedrooms *1,- J Project Description 36 X(.p(p (Dericil Structure Dimensions_3(1X cc Co # of Occupants p2 Basement n Yes No Basement Fixtures ® Yes No - I I Accessory Structure(s) Describe #of New Bedrooms *1* if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No, Plumbing n Yes n No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions n 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 ❑ Yes Lf No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled Bored n Dug C Unknown Well Repair Requested In Yes 7 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 depai huent 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. /' itt: Signature of Owner or Agent l c= C� J4'*L aatte ?/i7//fr Printed Name of Owner or Agent ,g6/s t r (J - II . ti.. ''M r& .'. �t�.� 'tI' "-.y5+ :i h_�'n,v. Fi Zw\^g C < $Y 3.17 SCP �, F g4 *et ip ;' �'fa tt9® y I S -t 3}tl4 �. • t.41 t b ,�, Al/.y i tp `7 a�4 '. 1 <it '-:( l /. x'\ I 'flIiis - S,,,,,,...-c,.. '� : / \ a f 3 s` i e \I 'e a / F € a / . �_— SI s .. ... 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Ar,...:-.4“ > ".*: e2) 2acm `, o q -•r L i'S v j j 5 •- d a { o„n tO ooNm o'o � $¢ 'iV \ 7. � a oS ^� �` see a 06:,,,„:"..,° 1C " 8,H, o n�CO as itit 't U?' x c' 3N y mm no. 2 �2I O as ext m > "f .f Catawba County Environmental Health / • 7 . • e>y, 0. °o ,///:: a • ,• L • \ . .1, C , ,) , (1 • •1p • yo , :40/ 41H CI , .3. two h 1� (497) Q • Parcel: 367802859801 , 2763 FARMSTEAD LN 1in=100ft 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 08/18/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367802859801 Owner: SHOOK MINNIE LOU LEE Parcel Address: 2763 FARMSTEAD LN Owner2: City: CATAWBA, 28609 Address: 2763 FARMSTEAD LN LRK(REID): 2683 Address2: Deed Book/Page: 2642/1915 City: CATAWBA Subdivision: State/Zip: NC 28609-8130 Lots/Block: / School Information: Last Sale: School District: COUNTY Plat Book/Page: Elementary School: BALLS CREEK Legal: Middle School: MILL CREEK Calculated Acreage: 4.270 Tax Map: 003 K 02028A High School: BANDYS Township: CALDWELL School Map State Road #: Tax/Value 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: $49,100 Zoning2: Land Value: $26,100 Zoning3: Assessed Total Value: $75,200 Zoning Overlay: WP-O Year Built/Remodeled: 1984/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710367800J Building Details 2010 Census Block: 2018 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P1 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=367802859801&typ=P 8/18/2016 g'A CATAWBA COUNTY O�� 100A SOUTHWEST BLVD I.la 0 , NEWTON, NORTH CAROLINA 28658 RECEIPT v * Aar • PHONE: 828.465.8399 Thursday, August 18, 2016 is 42 st www.catawbacountync.gov PAYOR: Clayton Homes Clayton Homes(*Lasage, Bobbi) PAYMENTS TRANSACTION NUMBER: TRC-789161-18-08-2016 PAYMENT DATE : 08/18/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331777 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24538 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2763 FARMSTEAD LN, CATAWBA NC 28609 Applicant JACOB LONDON, 2763 FARMSTEAD LN, CATAWBA NC 28609 C:8282448019 Land Owner MINNIE SHOOK, 2763 FARMSTEAD LN, CATAWBA NC 28609 Contractor CLAYTON HOMES, PO BOX 132, TAYLORSVILLE NC 28681 C:8282173168 JWHOLDER@HOTMAIL.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/18/2016 1647 Page 1 of 1