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HomeMy WebLinkAboutCBPR-08-2016-24554.TIF Sl$A �G THIS IS NOTA PERMIT Case # CBPR-08-2016-24554 �dif CATAWBA COUNTY HEALTH DEPARTMENT Jg'o r • f I. •r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Commercial Building Plan Review - Building Alteration 4, G .x IMPROVEMENT :—moZ • riP a VOWS--7:1) (40 Applicant OSBORNE HEFNER, 5500 LEE CLINE RD, CONOVER NC 28613 C:8283205650 Owner JEWELS LLC, 1839 12TI-1 AVE NE, HICKORY NC 28601 NAME TO APPEAR ON PERMIT OSBORNE HEFNER SITE ADDRESS: 6610 N NC 16 HWY, CONOVER NC 28613 PIN # 375501086378 NAME of SUBDIVISION: Lot 14 Section/Block PROPERTY SIZE: Square Feet 141,570.00 Acres 3.25 DIRECTIONS: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N (MARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: 1100 WATER SUPPLY: Public Water DESCRIBE WORK: Revised 9/8/1§ - Mr. Hefner said the fire marshall gave him a 200 person occupancy for events. He wanted to increase his guests from 175 to 200 with 5 employees. 1100 GPD* No Food Service. Catered in only* 8/25/16 *NO FOOD SERVICE, food will be catered 175 guests and 5 employees per Mr Hefner* 975 GPD per MM* EH SEPTIC CHECK ONLY FOR SAFETY INSPECTION * Sapphire Hills Event Center- rental for special occasions 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? Does this site contain any existing wastewater systems? Is any of the wastewater going to be generated on the site other than domestic sewage? Is the site subject to approval by any other public agency? Are there any easements or right-of-ways on this property? Yes Property Easements Description: WELLAND SEPTIC APPLICATION FOR: Existing Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Other OTHER DESCRIPTION: EVENTS BUILDING DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: 5 SEATING CAPACITY: 200 TOTAL FLOOR SPACE (SQ FT): 3,600 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: E9-ehapplicaGoo 09/12/2016 10:18 Page 1 of 4 11) • CATA\1BA COUNTY Case a CBPR-08-2016-24554 Public Health Department Subdivision 2 IRO. K Environmental Health Division PIN# 375501086378 -.Or PO Box 389. 100-A Southwest Blvd, Newton,NC 28658 /g.2 ,q NAME ON PERMIT: (OSBORNE HEFNER), 5500 LEE CLINE RD, CONOVER NC 28613 ( OSBORNE HEFNER) Site Address: 6610 N NC 16 HWY, CONOVER NC 28613 Property Size: Square Feet 141,570.00 Acres 3.25 Directions: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N 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 II11 i d(P Gane I{ I l�°i u 1111 , i I n 1 IIITii5rll�!�Ill il�����Iip �;� , �� 1I11111k. III""ru,il.t .1311 I,FEENAME �i, Il��itl1.11a�d�I4 �� �LJ�GI DATEI ;IM ; IFEE-AMOUN7hth Improvement Permit Fee 08/22/2016 S 150.00 1 i'11a . "TOTALt1FE ES its bH1.;1611IIIl��illll�h�NIU,l1'f I,aa ln'!�I'lt'$IIIIIi��l��lll�'llllllhhnn��.�'iU�I�H�II/1 �.$I50 00(�III�� .iti dill L���ll1pp luIfllillill .. GnIl1lII11niuIatuaiifMI itY . . W4t dN a c�91 ANN ”fn111NIIInl WlII1W 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-ehapplication 09/12/2016 10:18 Page 2 of 4 IgA 0G THIS IS NOTA PERMIT Case # CBPR-08-2016-24554 :cc mad x,hitt CATAWBA COUNTY HEALTH DEPARTMENT a �• �l:1 ��'�" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 ski Commercial Building Plan Review - Building Alteration ` o 'IU Tai0 IMPROVEMENT RNISed Applicant OSBORNE HEFNER, 5500 LEE CLINE RD, CONOVER NC 28613 C:8283205650 Owner JEWELS LLC, 1839 12TH AVE NE, HICKORY NC 28601 NAME TO APPEAR ON PERMIT OSBORNE HEFNER SITE ADDRESS: 6610 N NC 16 HWY, CONOVER NC 28613 PIN # 375501086378 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 141,570.00 Acres 3.25 DIRECTIONS: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY• WATER SUPPLY: Public Water DESCRIBE woF 25/16 *NO FOOD SERVICE, food will be catered 175 guests and 5 employees per Mr Hefner* 975 GPD pe) M 4* EH SEPTIC CHECK ONLY FOR SAFETY INSPECTION * Sapphire Hills Event Center- rental for special occasions 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? Does this site contain any existing wastewater systems? Is any of the wastewater going to be generated on the site other than domestic sewage? Is the site subject to approval by any other public agency? Are there any easements or right-of-ways on this property? Yes Property Easements Description: WELL AND SEPTIC APPLICATION FOR: Existing Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Other OTHER DESCRIPTION: EVENTS BUILDING DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION EMPLOYEES PER SHIFT: , NUMBER OF SHIFTS: TOTAL EMPLOYEES: 0 SEATING CAPACITY: 175 TOTAL FLOOR SPACE (SQ FT): 3,600 Desired system types (Improvement Pe or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: E9-ehapplication 08/25/2016 11:25 Page 1 of 4 CATAWBA COUNTY Case# CBPR-08-2016-24554 2 Public Health Department Subdivision Lt Health Division PIN# 375501086378 PO Box 389, 100-A Southwest 13lvd, Newton, NC 28658 Ig. :w NAME ON PERMIT: (OSBORNE HEFNER), 5500 LEE CLINE RD,CONOVER NC 28613 ( OSBORNE HEFNER) Site Address: 6610 N NC 16 HWY, CONOVER NC 28613 Property Size: Square Feet 141,570.00 Acres 3.25 Directions: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N 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 I• hri .r 11ris.°,5 —m 1r Ir:hflz 'f• 7311 F? r�tJp r!t B FEENAME it ,i,al a ,yay �t,., , ' Wft xrDATF' reNFEE1AMOUNT'fi Improvement Permit Fee 08/22/2016 $150.00 11310'.4';;4; .r- 4a� TOTA EfFEESay* t36 a t . .N t_".........k.JO#.i�I?a:P'1r4 fi 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-ehapplicauon 08/25/2016 11:25 Page 2 of 4 • Julia English From: ozhefner@gmail.com on behalf of Oz Hefner[oz@ozsjewelers.com] Sent: Wednesday, August 24, 2016 3:12 PM To: Julia English Subject: Re: Certified Operators List Julia, for 175 she said it would take 5 people On Wed, Aug 24, 2016 at 12:58 PM, Julia English <JENGLISI-t acatawbacountvne.gov> wrote: S1p,ts, 2o5Pa (ep too = q7s p ?" Julia English Administrative Assistant It Environmental Health Catawba County Public Health 100A Southwest Blvd Newton NC 28658 828-465-8270 828-465-8276 fax Confidentiality Statement: The infomtation comained in electronic nansnn5sions is confidential and ntay be subject to protection under the law,includine the Health Insurance Port tbilii; and Accountability Act(1-11PAA).An electronic transmission is intended Ihr the sole use of the individual or entity to whom it is addressed. If you are not the intended recipient,you are notified that any use,distribution orcopyinu of the message is strictly prohibited. it you received a message in error,please contact the sender immediately he replying to the e-mail and delete the material from any computer 1 Catawba County Environmental Health 7141- ,s5 oo L° 513.o./ H 170.84 0 I a, ' oy 704 o. I .\i613 42.59 p0 \ll;PO s0 vQ5' �3 �A ( 111 l � , !�It, v Vt.., :III 1ii I �i .1',126:' 61 '7- 294.67 I l)I'i a .: ' N. _ — �� (f,if t, r, , hlp,l -1'0 - Id ry I"Il' Ilii ,. / ii1 ; IIIll l 8'. 4 spa \NC)01\ 'ca 0 '.....N-N.N.N. co N111:61.13- i \ t• 2 \ Parcel: 375501086378, 6610 N NC 16 HWY / 1 in=80ft CONOVER, 28613 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 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375501086378 Owner: JEWELS LLC Parcel Address: 6610 N NC 16 HWY Owner2: City: CONOVER, 28613 Address: 1839 12TH AVE NE LRK(REID): 91411 Address2: Deed Book/Page: 3323/0730 City: HICKORY Subdivision: State/Zip: NC 28601-3184 Lots/Block: / School Information: Last Sale: Plat Book/Page: 28/112 School District: COUNTY Legal: PL 28-112 Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: 3.250 Tax Map: 0300 00021 D High School: BUNKER HILL Township: CLINES School Map State Road #: 16 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: RC Building(s) Value: $202,500 Zoning2: Land Value: $91,500 Zoning3: Assessed Total Value: $294,000 Zoning Overlay: WP-O Year Built/Remodeled: 1991/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710375500J Building Details 2010 Census Block: 1004 WaterShed: WS-IV Protected Area 2010 Census Tract: 010101 Voter Precinct: P27 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=375501086378&typ=P 8/25/2016 • • . .. N2 3242 - 'CATAwsA COUNTY HEALTH DEPARTMENT i_-.J' . (704) 465-8270 -7�/�e 344 �J Lot Eval. Improve. Permit //Repair Permit Cert. of Comp. Permit_Oper. Pe4init_ .�56 - 754 st i Owier/Age,�F ,ft /� ._ _AI! Phone t] -2..56 - TT'S 'I Address dai ' .ti' ,tel g Subdivision 1j C, -a. _dit. eC o2?b/3 Section/Block Lott_ Lot SizeS,.2SA 4'i,/4-oa:a6,7,n._ ++1L"-. ions: f� ■n.��t�_ ,, . . �J. /�.n�_.t / / . _s.As. J !I Ri e."-6"-CI ,11en.dI aM.,ci s JSP-4 `2 vCdlr v (r//� 4 Facility: House_ Mobile Home_ Business/` . Other: Zoning Approval yes/no 4/ // ) Multi-family_ Other . 100% Repair Areae no Bedrooms Seats „sa ee.Qe Employees . GPD Flow t00 0 Application Rate 0, o�.�-{�-2 Hot Tub or Spa yes/no Spe�Jial Fixtures . REPAIR NOTICE: REPAIRS MUST BE iiI77� Basement yes/no Basement Plumbing yes/no . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private t/ Public . PERMIT. Type of System: Trench /Bed Pump _ Pum•/Pas - Panel LPP_Other/J Tank Size: Septic Tank 3 95,.E ! . Ekell5i a26OPWap� Tank _Is 9.5 q,�X , Nitrification Field: Total Square Feet 750 0 Depth of Stone /a Bed Size // Trench Width , Total Length o All T enches 510 0 Number of Trenches /b 2 Ft` 1cPs � - R , Individual Trench Length �l/�/ / Feet on Center cit Maximum Trench Depth:ll-30 Distance of Nearest Well /DA 1 + Lot Evaluation: Approve es no (Void After 24 months) Topo '8 % Slope Sketch /of lot /n�Evaluation Site /-) System-� Design - Final Texture ' C 'T 07-04 .Q ,. I # • I,/ Allati rki, ad.- �" Structurest44944c 1 ems( p vv // �*"� TTS-,� e"^1) ,/ 6/3¢-,, Clay Min. /1/ N �NjfA/i uNi l el e_r f. �� r1___. Soil Wetness Soil Depth SS" " s . ,4'Vd .L ys ow c5-.5 4, Restric. Hoz. at --- " Available spac= *g/no J 1 Overall Class S 4P' u -226are,•iyriy, / G-�tse_ TN A. (ki`(Z/.P.u:?Im-i-J.rcw 6,J ly-e ��II 3395,4 .; , SR,, T� ,,4 3 75 �"l� �:/ clA-npT . .may , • �11R'� ('�> Al-�- 4k, p �'',..,K, s�o'I.so�,cQ,�/l�Q, Q.K � ill, �'# ivv (*- r Fa 41..-4 S, 1 H ;:c• 6 fu.,...p- sµ _ -1-c:-‘12- a-•i v4-1ves, 17,8 Toil a" ,A + J - $ Ti,4 .- 7, /56 . s75, f 4 o \9 i hl .z, ;: it.,.l ,.2/1;3 TDil4t4' 9,4' ,. NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT • Permit Date T(w...a_ 02.5 ( / ?/ (Improvemeennt/Permit �v�oid after 60 months) OOmer/Agent ._:4;10i. ( J Sanitarian le -aa J / HJGy:r f/R-S, • . Installed By AnnAck , Date Sanitarian (f to any cha{Ages/information in red or by sketch on hack) Nsks) :' White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp:I.P. • :1C. CreaiOS tits fr• ret 4.-c aL viryr s... k--f. s 1 a rr w + ,I ”i x- '6 C. ,...rd .;...41143:.,... ..f. r,,,ue . ...w :a 2..�.,A,.:;;•.:.e, ..tie.:-.._.. .. T, " . .I . L ,1, '.::::tir"y8, 9 't" .n I,d1,717 PAL[ 67 ;+'` +L; "PREPARED BY: Robert A. Mullinax - Waddell, Mullinax d Childs, Attorneys, %, 0.'no Newton, NC _* NORTH CAROLINA t 9 1 J DEED OF EASEMENT :L CATAWBA COUNTY r This deed, made this IJ day of May, 1991, by and between Billy C. Little and Alice H. Little, parties of the first part; end Billy C. Little and -_ ,y:,� Alice H. Little, parties of the second pert, whose mailing address is Route 4, ;t;`j Box 225, Conover, North Carolina 28613; *ti WITNESSETH[ ;iI. ll; That whereas the said partite of the first part are the owners of a laY certain tract of land located in Catawba County, North Carolina, the sane AA being property conveyed to them by deed recorded in Deed Book 960 at Page "., ?k; 639, Office of the Register of Deeds of Catawba County; end whereas, the said 244 oXs parties of the second part are the 'mars of a certain adjoining tract {; illustrated in Plot Book 26. Page 150, Catawba County Registry, and being ■ i= e` tract of land consisting of 3.25 acres, more Or less, which deed and plat ?d• f reference is given for greater certainty of description ; and whereas, the Il�f .i' sc )4 parties of the second part have indicated a desire o place a septic tank "s..' drain field to service the property of the partlirnithe second part and that ESQ q: the placement of the septic tank drain field fld necessitate a portion of the ; . -i- drain field to extend onto the property of,thp4partiee of'the first part; and •LA 6 li' the parties hereto desire to execute this fifigreeaant aod ebsnnent to allow the rg. i " said drain field to extend upon the pro erryv'ot t✓he: trtiees'O/L) the first part; 4 S4e Nov, therefore, said parties of'.the first part for in consideration ' of the aum of Ten Dollars to them4d' end paid, do{harabyf'give, grant and 1„ Pie convey unto the said parties O4 * attend Wirt a serpEt eal right and easement ff '' to construct and maintain acroes�'and upo�leiid land ofvthe parties of the y .0 W. first part a septic tank drit'foral ¢te lna o., described and upon the +.: conditions as hereinafter nes fortA�•4°' Sb yf+ N M4111 res BEGINNING et an old iron pin located' n Che aortheaet corner of that certain Sin 3.25 acre tract owned] y Billy',y7 Little d'A11ce N. Little as shown on Plat `^ ill. Book 26, Page 150, Cat,w •SoouuncyyReglstry�` and runcing thence from said N beginning point withVitt he eaete bine of Little, South 1' 09' 20" East 304.11 feet to en old,., ron pini the ee runcing North 80° 44' 46" East 60.89 feet to a A^ Ilk ;5°: point; thenca'Sdo.¢th��11"\ 3l' 30" Eae[#118.56 feet to a point; thence North 75'P‘PEeF to5" 30'a2point;tthence�'So t�88'1a19'iEastnt; t62nfeetce otohalpoint; thence 6' 43' 45" °North 21°t 102.09 t 21' Cb f Y,.:.�r. :a3'. ft West 293.42 feet to a po et;Ththence South 89' 55' West 176 feet to the point A of Beginning, containing"1 V.7 acres, more or less, and being that certain . area designated as Septic Field Easement Area on a plat entitled "Billy C. 11.4. ' Y Little Pro." prepared by Sem Rowe, Jr., Registered Surveyor, dated May 2, Y % 1991. eti That the parties to this agreement specifically agree that in ".'� % % consideration of this agreement, the parties of the first part do hereby give, ` .; grant and convey unto the said parties of the second part, a perpetual right 11 i5sand easement to construct said septic tank drain field upon the property as I bereinabove described, and to go upon said lands whenever the same is �' - ,',: reasonably necessary for the purpose of inspecting, maintaining and repairing b 74 said septic tank drain field; provided, that said septic tank drain field '1.1 shall be placed within the confines of the boundary of the property as 14:' pr: hereinabove described, and that in constructing and repairing said field, the b�j said parties of the second part and/or their agents shall interfere as little ,p. as is reasonably possible with any plants, fences or other improvements upon the land of the parties of the first part. 111 '' ; To have and to hold said right and easement to them; the said parties offel y; the second part and their successors in title, it being agreed that the right A PF: and easement hereby granted is appurtenant to and runs with the land nov owned FF;; 'j0 by the parties of the second part and hereinabove referred to and subject to the conditions as hereinabove sat forth. $7' ' . Vi x : - .�,i-'3 " '=',Sarre ..� t• " tap. - no r i .49 V'+:+m S. r4 r.•4;vq x .cl3)J a a "'+C',A ii,f,t+ yn� 'rS '. :: a Y }i,A,,, �1)i,,, ,,,....:. stAc �- ..:-.r.,4%y_ 1 • i4`r'0. k,7 �.(k i '^5! p2 a"-txn kel in"Sa�•A Dud t i. 7.epP ; wi 1' „.fr1§ �zi9 7lY,3.X w.t a or w a P ^:. Y•� nc41717PILE 68 ;. ^: IN TESTIMONY WHEREOF, said parties of the first pert have hereunto set their hands and seals the day and year first above written. ^1 .- Ce a to le (SEAL) L( e.t `.� Litt a Alice H. ![tie [SEAL) 'b; J ? ( S.• ______ ___ — -- b•; STATE OF NORTH CAROLINA - COUNTY OF CATAWBA. 1' 'i I. Whale m• `n(,4N s Notary Public. do kerebg';,, r +� '•. �' c'.5 certify that Billy C. Little and Alice H. Little personally appeared deo o..a0'i):;': sr ?'i: this day and acknowledged the due execution of the foregoing Snetrtrotth ;i4fr�¢�''-j.�:>..11 a'. 1: the purposes expressed herein. `��-,, • 1 Witness ay hand and notarial seal, this theisiE ��day of' . 'y- Ir ,4/: '+,• 1991. O 11' FHy Commission Expires: 9,4,..C;(13 TiQl1fJQD-+ � � tS1< .......:,•,r . p}', Notary Public ill 41 c STATE OF NORTH CAROLINA - COUNTY OF CATAWBA ''' ��Lftawba County, N.C. Oenisee Eads " `� 4.0 The foregoing certificate of `t�1� s„D,z�"Jlotany;#P.ubl tc of is vY certified to be correct. This instrument vatZpreuented fotttee iatration this :,}: 15 day of May . 19 9+1Vat 12t`4OZ Y .A. and duly '�' rP recorded in the office of the Reg r of heeds cfOatavb 'Count North 3` l't Carolina, in Book 1717 , Pag`' it` y, '�'') H This the 15 day of , May A.D., 19 91 r, ty�t ,, 'V}sT y. 1y Regis f-oDeeds ' 'Asel ant, Deputy Register of Deeds y"k' ,yy� �( tizt, MN Y�lit •4�1 9D91/dee 1 " 1• N xj a Me '1 '= h' x„ W N W T:ro c,E n {G. Yet 1L S In L: 4y. STA ¢ , w a ��b(DE D.9. -4 D:' odie 04. ? 4. Vilf_ Pf- T^ i+K i;. ti. .. 9ht t'a: :pc br rte+ 41 z<E al %e.tt lC1 kir:://P141:41(64‘4 Df s, DP1. i`64' 4 rt- trq y��& a 1 ytgal' D ...Lai, 'x i +P`Y:i."„n }}y h: . y} c '11g.t45•t 1t,#, 114,:a ct iJ Y. ti 'are t,,.1.u'C'f +. ' T>f(5:>g D.FaFAA'. 4'tY`ab...?i` F ..41.lra .^ r i4i'i 1 rr • NENA 4 K tI WE.ATHEo--04mF Co...T ILOL %ow W/ LIG1+-r A-40/OR-. EL_L• ZIseFc tS SERLEn RT TANK sEP0•0• TE &.t2.tut-TS aun A-r Eurr -rovers Fern FOR- ALAQM -% -Du'AP J -CH{ SUPPLY LUTE AUD WI RNCI ti)O E.LEC TRICPL. SUuc7.o.iS 1..1 ?UMP TR..1K ( ' � . • _� its „AOE • 6 n A3ovE CrRAOE --� _ uuo:a.Gee .n E..a c -. C4SL.¢� H 111_n 2/ PVC • . ;- TH0.F/OCO CNE C • • : • } r I ,-.4 , f0' > gr > ? arP J ! .- W I D . U d• � d tri R „,.., .. J >_, ,..,, 0 , N ' W D a I p i W F r_ • s;N N g h VTP 0 ? c J . W a r { N J Q /1 f v W O 4t 4.1 UN J - F 7'7" • py m rt o ; r 1 i- LU ni 144y •m N1N _, w to p. W 2. in W O XI- u a W ' > ^i w0\ r W • 7 V a CC -- Z 8 03J v P Q tr o 0 ,A S i la Ew^ L - II tu cc rkd7 � u . x o c w • W j �� I J7 W i er V; . _ - N 7 ___ >a p • ci 0.i . o a i 0W �F 3 c J Y.. t t o!V N tr,i 4 Q u p 0 w y e = F N K rz A C7 e• � ; • ; III - I— 4 Li-1 o e O w ° ' '�/ I P 6 0 " R tzii "F 2 � , 1 InCaIn i t < d V V `J'P L-1 ,' N J al Lij > N Q �at W 1 � Li ¢ r CD i'i 1 i• e 7 Q J n r, 2 Q 0CC✓ r� 7 � a 7 = r 1 t A I N F ..M 3 • vJ�A �G • THIS IS NOTA PERMIT Case # CBPR-08-2016-24554 flaµ , ti CATAWBA COUNTY HEALTH DEPARTMENT 0`}I �. +''f fEl PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ••o- � '' 4 \ 1842 SM Commercial Building Plan Review - Building Alteration t o� '� _3 • .; IMPROVEMENT '-5 " Applicant OSBORNE HEFNER, 5500 LEE CLINE RD, CONOVER NC 28613 C:8283205650 Owner JEWELS LLC, 1839 12TH AVE NE, HICKORY NC 28601 NAME TO APPEAR ON PERMIT OSBORNE HEFNER SITE ADDRESS: 6610 N NC Lb HWY,CONOVER NC 28613 PIN # 375501086378 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 141,570.00 Acres 3.25 DIRECTIONS: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Public Water r DESCRIBE WORK: EH SEPTIC CHECK ONLY FOR SAFETY INSPECTION * Sapphire Hills Event Center- rental for special occasions 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? Does this site contain any existing wastewater systems? Is any of the wastewater going to be generated on the site other than domestic sewage? Is the site subject to approval by any other public agency? Are there any easements or right-of-ways on this property? Yes Property Easements Description: WELLAND SEPTIC APPLICATION FOR: Existing Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Other OTHER DESCRIPTION: EVENTS BUILDING DESCRIPTION OF EXISTING STRUCTURES - ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: # OF.00CUPANTS: PROPOSED CONSTRUCTION ' EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 3,600 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: • E9-chappl ication 08/22/2016 11:49 Page 1 of 4 �S3A n CATAWBA COUNTY Case CBPR-08-2016-24554 , Public Health Department mit® a Subdivision G 1 'Environmental Health Division 375501086378 _ �� "�' F1N# \812 / n0 Boit389, 100-A Southwest Blvd,Newton. NC 28658 NAME ON PERMIT: (OSBORNE HEFNER), 5500 LEE CLINE RD. CONOVER NC 28613 ( OSBORNE HEFNER) Site Address: 6610 N NC 16 HWY, CONOVER NC 28613 Property Size: Square Feet 141,570.00 Acres 3.25 Directions: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N 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 acces ile o that a co "I t site evaluation can be performed. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days o pplication date. If you need further information or assistance please call 828-466-7291 AREA2 *4*4444♦4....4#44t444fi4.44Y*444**.4444l444444s4e4444444444444444444444444444*4.4.444444444444444444444444444 . FEENAME DATE ' FEE AMOUNT Improvement Permit Fee 08/22/2016 $150.00 TOTAL FEES •• '' s 5150.00 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-chapplication 08122/2016 11:49 Page 2 of 4 >v,y,.,/"S.--r,p CATAWBA COUNTY , case tt CBPR-08-2016-24554 �1 Public Health Department ars w n sivirortmental Health Division Subdivision K____5,9 PINft 375501086378 .90 Bnr389, 100-A Southwest Blvd,Newton,NC 28658 Igo . se, NAME ON PERMIT: (OSBORNE HEFNER), 5500 LEE CLINE RD, CONOVER NC 28613 ( OSBORNE HEFNER) Site Address: 6610 N NC 16 HWY, CONOVER NC 28613 Property Size: Square Feet 141,570.00 Acres 3.25 Directions: PROPERTY NEXT TO RIVERBEND PARK ON HWY 16 N Catawba County Environmental Health Application, Evaluation,and Permitting Procedures For Septic Systems and Well Construction A. Applications 2. Prior to the lot evaluation,you must notify the 1. Complete applications must be submitted for Environmental Health Specialist assigned to your case, Improvement Permit(IP),Authorization to Construct(AC), that all required preparations are complete. The or Well Permit as applicable for proposed use.The owner Environmental Health Specialist will visit the lot to flag or his authorized agent must sign all applications. areas where"soil test"holes or pits are to be dug for the 2. The current fee for each permit must be paid at the time soil evaluation. Test holes or pits shall be dug in the the application is submitted. Applications will not be following manner: accepted until all fees are paid. a. Holes or pits must be located as near as possible to 3. Complete applications must be accompanied by a plat the previously placed flags. prepared by a surveyor on a scale of no less than 1"=60', b. Holes or pits must be a minimum of 40 inches deep ora site plan prepared by the applicant. A separate plat 4 feet long,and 2 feet wide with sloped or stepped or site plan must be submitted for each lot application. access in and out. For safety reasons,at no time Plats or site plans must show all proposed property lines, should the pit be deeper than 44 inches. lot corners,home locations,all roads, bodies of water c. After holes or pits are dug,the applicant will notify (creeks,streams,lakes,ponds),existing wells within 200', the Environmental Health Specialist and an evaluation all lot dimensions,easements,and right of ways. date(s)will be scheduled. "Post holes"are not 4. Applications will be considered on a first-come,first-serve acceptable for a soil evaluation. basis and will be activated only when complete d. Exceptions to item 2.c.,will be granted if a backhoe applications are received. Incomplete applications will pit evaluation has been previously scheduled with the not be activated. Environmental.Health Specialist evaluating your lot. B. Evaluations 3. The soil site evaluation will be conducted by evaluating I. All lots must be properly prepared for evaluation in the each previously dug hole or pit in the manner prescribed following manner: by current state rules. A soil profile from each will be a. All lots must be fully accessible. Access roads must be described on a soil evaluation form for each lot at least"roughed in." Overgrown or very thickly application submitted. The soil evaluation form will wooded lots must be adequately cleared prior to include, but not be limited to,the following: evaluation to allow for proper access. a. Soil profile description to include soil depth and b. All lot corners must be true corners(iron pins,axles characteristics etc.)and must be marked and readily indentified in b. Topographical features the field. All lot sidelines are to be flagged or strung c. Usable soil areas and locations the entire length and width of the lot. Exceptions to d. Possible system type(s) flagging lot sidelines may be made if all corners can he e. Problems and/or unsuitable characteristics seen from any part of the lot. f. Determination of suitability for system and repair c. Proposed "cut out"lots must be marked as indicated areas on site plan or plat for IP only and will be required to 4. Well construction applications will be evaluated based be surveyed and recorded at the Register of Deeds on required location criteria as established by state well before an AC will be issued. regulations. d. All home sites and accessory structures(garages,out- D. Notification buildings,pools,etc)as indicated on the plat must be The Environmental Health Specialist, upon completion of staked or flagged on the lot at the time of permits for approved lots,etc.,shall notify the owner or evaluation. applicant(as indicated on the application)when permit(s)are completed. Denial letter(s)explaining reasons for the denial Improperly prepared lots will not be evaluated and and addressing the appeal process will be issued in a timely will be placed in an inactive status. Applications will manner when lots are not approved for system installations. be reactivated when all required preparations are complete. These procedures will be required for all applications subject to approval under the current North Carolina Laws and Rules Note:Additional fees and delays may be incurred by for Sewage Treatment and Disposal Systems(15A NCAC 18A the applicant if the lot has not been properly .1900)and North Carolina Well Construction Standards(1SA prepared for evaluation or if Items are not flagged NCAC 2C.0100) on site,indicated on the site plan,or subsequently changed. E9-ehapplication 08/22/2016 11:49 Page 4 of 4 CATvR T 7 BA •T•HIS IS NOT A PERMIT COU �r"- CATAWBA COUNTY HEALTH DEPARTMENT „c.',„ Application for Environmental Services Page 1 Improvement Permit Authorization to Construct n Septic Repair I 1 Septic Malfunction❑ Septic Expansion New Well Permit n Replacement Well ❑ Well Abandonment _ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction n Existing Facility K. Property Address 4,(0 ((n Ni (3C A k.-4911,347147 Subdivision Lot# Acres Section/Block/Phase Driving Directions to Property Iropey* tie* * �tVev' heta c( pry& NAME TO APPEAR ON PERMIT? 'K Owner n Applicant Contractor Applicant Contact Information Name 0Sborn)e & Qv Address � . � Phone ' Cell Phone pig , 320 -5450 Owner Contact Information Name St( Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 4 Owner n Applicant ❑ Contractor Description of Existing Structures on Site eVet3k Cevsj,r / Foo J st'Viiice_ #of Bedrooms *j' Structure Dimensions g 0 'X L,x #of Occupants , Basement ❑ Yes W No Basement Fixtures CI Yes FaNo 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 O,No Does the site contain any jurisdictional wetlands? l -Yes 0 No Does the site contain any existing wastewater systems? rnes 0 No Is any wastewater going to be generated on the site other than domestic sewage? .Yes 0 No Is the site subject to approval by any other public agency? 0-Yes 0 No Are there any easements or right of ways on this property? Describe Alt Se c.- Existing water supply in use [ Individual Well n Community Well n Semi-Public Well VS County/City/Township Water Line Is a public water supply available? ** 1:2. 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) 0 Accepted 0 Alternative 0 Conventional ❑ Innovative 0 Other Any /�r� \ 7i A THIS IS NOT A PERMIT ' ' - ' . . CODUN.i CYA���_1f. CATAWBA COUNTY HEALTH DEPARTMENT , �-. Application for Environmental Services Page'2' Proposed Facility Type n Primary Residence ❑ New Residence _ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement n Yes IT No Basement Fixtures ® Yes ® No n Accessory Structure(s) Describe # of New Bedrooms *j if applicable Structure Dimensions # of Occupants Accessory Dwelling IT Yes n No Plumbing IT Yes F No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms 41 Structure Dimensions f 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 u(y1 LL? Reit*- Imo'✓ Retail Floor Space # of Employees per Shift # of Shifts Occits I 75 peaks-- _ Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes n No If Daycare Specify Occupancy • Application for Well Construction/Abandonment/Repair Proposed Well Type E. Individual Well ❑ Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n Unknown Well Repair Requested [ Yes IT 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 RG4taW 4 Date 2' ' ZOI Printed Name of Owner or Agent