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HomeMy WebLinkAboutEHPR-08-2016-24599 (2).TIF �A CO? THIS IS NOT A PERMIT Case# EHPR-08-2016-24599 d, a CATAWBA COUNTY HEALTH DEPARTMENT 0 •". !pi.*"f'•...i rr PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES k • f 1842 SM Environmental Health Plan Review - OSWP 1,5-•:...-='o' o:. ABANDONMENT 0 '.° . o � • Applicant BRIAN BEEBE,7285 RED BANK RD, GERMANTON NC 28019 B:3367445486 C:3363995894 BEEBEE.BACKHOE @YAHOO.COM Owner BRIAN POOLE, 3391 OAK RIDGE CIR, LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT Brian Beebe SITE ADDRESS: 3705 S NC 16 HWY, MAIDEN NC 28650 PIN # 366802760044 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 102,366.00 Acres 2.35 DIRECTIONS: Corner of NC 16 and Mt Ruhama Church Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: NC 16 Widening Project 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? No Are there any easements or right-of-ways on this property? Yes Property Easements Description: ROW APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF home to be torn down EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Bored E9-ehapplication 08/25/2016 16:13 Page 1 of 8 gA \ CATAWBA COUNTY Case# EHPR-08-2016-24599 �L\ Public Health Department P Subdivision ,E Environmental Health Division PIN# � �'c 366802760044 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 7842 5m NAME ON PERMIT: (BRIAN BEEBE), 7285 RED BANK RD,GERMANTON NC 28019 ( Brian Beebe) Site Address: 3705 S NC 16 HWY, MAIDEN NC 28650 Property Size: Square Feet 102,366.00 Acres 2.35 Directions: Corner of NC 16 and Mt Ruhama Church Rd 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 lab ling of all property lines and corners and making the site accessible o.that a complete site evaluation can be performed. Date: S1)51/10 Signature of Applicant or Agent {1cAL. An Environmental Health Specialist will contact you within 5 orking days of application date. If you need further information or assistance please call 828-466-7291 AREAI ************************************************************************************************************ EoFEE NAM E 3 E 3.^ DATES �, '�� FEE AMOUNT Well Abandonment Fee 08/25/2016 $100.00 TOTAL FEES. ;i�� .• '•• } ` vS100 0`0 al FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 08/25/2016 16:13 Page 2 of 8 ,....._ .._ . ._ , __ .. m..._ _., , ......_ ..._ . , C ATAWBA 1ms Ls'N(Yr A PERMIT ) LICV. '.,, ' CAT AWBA COUNT)" HEALTH DE P A RT N1ENT ' ' Application tor Litviranaututal Scrviec$ Pa v 1 Improvement Permit El Authorization to Construct 0 Septic Repair 0 Septic Mal funetion 0 Septic' Expansion 0 NO W Well Permit'0 Replacement Well 0 Well Alban&nmcnt 0" Wal Repair 0 Exivting System Inspeetion(Pre-Approval Required) 0 Applicatinti is for New Construction 0 Existing Facility 0 / c i , Properly Address Z ' (.5 .:-,L,li(di,,L,r)(-; ../.leaid:r„,„ tiff&.4i Y, i,t`17 615-4? Lot# Acres — . --, Section/Klock/Phase -- - Driving Diareetiona to Property NAME TO APPEAR ON PC 141.011T? 0 Owner a-d,,,,r,,L.,,,, 0 Contromor Applicant Contaet Information ------_, -Adeir' s Phone , ,ft..,,„ 7 (IN_ ,,,,-- ti,ey Celi Phone V- Piii4:-/ OwnerContzet Information art[ 256)( 1~,,esi-r: ""----R .—„,.. ..-- — __ — Address _ ag.IMM. Minm, - .1X11,Mr, cell 4.^ Mr,. mm .■ ..., . Contractor Contain IriforrnMion _.....- Name, Address Phoin, M *..„....■*..e Cell Phone .—...... MP 1..0. . 1 ..1 WAIP,.. nno■W.., „„.„ , x„x WHO WILL BL THE PA'MARY'CONTACT? 0 Owner 0 Affplitatia 0 Conitnetor li, seiription at'Ex isting Structums on Site ii a ilk,thouvn, ,i-_,, _ . tructu Dim rt ensions __ if of Occupants Basement 0 Yes 0 N B, th ent vildurci Yes El No me Applicara stzati tiotify the iniat heiftlah department upon submittal of this zipplication if any of the following:apply to the progeny in quesliOn, if the answer to any iitne5lion is"yev-,applizata must attach.stipporting iimainacutation. lj Yes 0 No Dots the site contain any jurisdictional wetlands? 0 Yes 0 No Does the site contain any existing wastewater systems? 0 Yes CI No Is any wastewater riot to he generated on the site other dem donne:tie sewage? (:3 Yes 0 No Is the site subject tO iipprovat by Any OthcS'public tigCTIVY? 0 Yes 0 No Axe there any easements or right of woys on this property? Dnserithe Catetl======.101110.40446, xi sti;le,svana•supply in Ilse la Individual WIttit I Community Well I Serni-Publie Well 0 CtatatylatyrroviTtc-hip Water Line is a public water supply available?•* 0 Yes ID Na ....... ................iiii.r.i. -vam.........time======== Tr vApplyiniz for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Types): (systems 6n he ranked in order of your pet 0 AOCCPIPC1 0 Ain:motive 0 Couvenaional 0 'lino vative 0 Oftra 0 Any it Ern ‘_ _ rIES iiiQT A PLRIVIII ' CATNVVI3A ' („"A'll'A NYBA COUNTY ii P:A1-1'11-1 DIE P ART NM NT ;._.., Application for linvirt:mmiental Services Patt,c.1 proosad Futility Type 0 Primary Residence 0 New'Residence 0 Addition 1,0 Residence #of NeW Bedrooms "''' Profs'ct ilteriPlio# ,....41.0=04As- tao be. in r el ail es.itiA. inInuM 1 u ■n Strisettwe Dimensions S° of 0 cc II no t its Rusement 0 Yes 0 No Rose:merit Fixtures 0 Yes 0 NO , vredalthikkeN11020111061111111116.P4 0 Accessory Structure(s) D.ta.;erirbe ....,, #of New Bedroninit'''''t if applienhle Strueture D imams ions -- #of OecAlpfams Acmsory i)wiitti ing 0 Yea 0 NO Plumbing 0 Yes 0 No Deserrhe Numbing Neesled . . .___. . . ... .,....._.__.... Multi-Family Residence #Units __ tHicdroctims per Unit+7 ...... Foal#f.icdooms *"t . Striteture Dimensions — ,,,,,,,j Food Service Specify Type — — Floor Space-Entire Food Service.Facility (S4 Ft) to:ittEtmps slopyee-ctt:r:ari:il):if::,r,BkLz,oess #Ll'ir SilifIS Pillil)gt As'.e-fl (Sq.FL) Retail Hoar Space .,-- t1 of Empinyees per Shift Of Ifflaldl= ,,,,,„1' Other Facility Type SpeeilY l r(ihureh#of Sir Killehem 0 Yes 0 Na If ii)u)eare Specify Occupancy ._. . ... . ........ . ... . , ., ... A polio tin n for Well Co fist ruction/Abaodoo tot ntilltipair Propteoxl Well Type 0 Inelividual Well 0 semi-N.1,1i,,well 0 Community Well -,,,,,, Abandonment Typc 0 Deilled Lid Bored 0 Dug 0 Unknown Well Repair Requweid 0 Y'es 0 Na escribe 2: y 'id icl ) 7 ' 1 ,) / 7 i' \ci “, ci, . . Calculated Detsii.n Flow,.Commercial t _ Additional informstion may be required to determine design flow trout eertnin facilities. This value will be determined durin g consultation with on-site start ell.agematlikliiii; . .. . 'Any rafxit that will he int crAtod for sleeping,rit the lime of eonsuetetiOn or fare faktre consideration Atould tv noted ns a istarnarti rind counted on oil applications.The number of bcdrixims will be,lern firrnsai by moats identified on boos*plitios:ts a be:tracers at the time arbaikling permit issoarwe, This may prevent the oared AV 1411T tic ;:yrAcui .:■421„0 increase in the foam% t If stoacture is plumbed but no Is-Amens,ettlenlated design fla.te is rewind. •* It No,a sett permit mina be iiwoed iaith the A1301;444,6 ration,to Ceesso-net, SYSTEM ratIEs 2( N ANfl1O1 RETIRIP WILL INCUR AN ittef)It ITIONAL CHARGE(SEE FEE SCI(I3p1)1.E) Imrrovement Pits issued as a result of this infarroni hal tee /Air) for 5 yeairS or may he nottexpeaing under certain specified eetseitiesis,An Audioritarion to Coro:Pct I:slated by thia department is valid for(5)live years from the date isseett laid is nen temferibia:Improvement Pennits and Wafi Permit%WC transierroble. Permits may be revoked B the int'orenolion on this application, site pisato or intended tise awnwns foc the propoved 1lit y, I bow 1=411*,application trod,eertif,y that the infontuon provided herein is toott,&ttlftflicle and poireet. Authorized county and slate officials ore grunted ridst of entry to conduits necessary inspections to determine coanpliance with appLicatita Iu o‘. and rolas. 3 understand-11.ot t arn!solely responsible ate the Koper itientifientiein and labeling of all property lines and writers and making the site itenessibfe inn that a citnirletC Site evaluation ean.he performed. Signature of Owner cir Agent i4,...itt.,/,',,,„,,...4,;;i.t...'} ..._.„.„.„, DAC .-• Printed Nartle of(,)waer or Agent ..., .. ., .,_ • 1\11 '\\\\.. ....,mm, ..., c\-...zr.----7 ,....-1 U %.,,,, -.4„. , r--- --- , ..........„..... 'N.' . —,„ , CT_ \it N.,.. ---7 ss. 111 )111 \ E. (\ Catawba County Environmental Health - dam r00 , itio. ,:- s Ark,r 0 Ilig i, T (277 / Z' ''{ / 4 / / ? ., I jg {2f8) , a Ar'). )1111011Pr rL ''.\\4\f \ 4' \ d) r"- 4 h . ,), k Parcel: 366802760044, 3705 S NC 16 HWY 1 in=80ft MAIDEN, 28650 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: 366802760044 Owner: POOLE BRIAN N Parcel Address: 3705 S NC 16 HWY Owner2: POOLE TONY MARVIN City: MAIDEN, 28650 Address: 3391 OAK RIDGE CIR LRK(REID): 4847 Address2: null Deed Book/Page: 2695/0482 City: LINCOLNTON Subdivision: null State/Zip: NC 28092-7655 Lots/Block: null/ null Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: 3705 S NC 16 HWY Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 2.350 High School: BANDYS Tax Map: 005 K 03001 Township: CALDWELL School Map State Road #: 16 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: $98,500 Zoning2: null Land Value: $28,700 Zoning3: null Assessed Total Value: $127,200 Zoning Overlay: RP-O Year Built/Remodeled: 1966/null Small Area: BALLS CREEK 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#: 3710366800J Building Details 2010 Census Block: 2000 WaterShed: 2010 Census Tract: 011601 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=366802760044&typ=P 8/25/2016 Kpl CATAWBA COUNTY �7 '\.C- � I 00A SOUTHWEST BLVD C y, NEWTON,NORTH CAROLINA 2865E RECEIPT d �� ' �r PHONE: 828.465.8399 V 4 Thursday,August 25, 2016 1842 SM www.catawbacountync.gov PAYOR: Beebe,Brian PAYMENTS TRANSACTION NUMBER: TRC-800661-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Credit Card 171034992 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332048 Well Abandonment Fee $100.00 TOTAL PAYMENTS : $100.00 EHPR-08-2016-24599 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3705 S NC 16 HWY, MAIDEN NC 28650 Applicant BRIAN BEEBE,7285 RED BANK RD, GERMANTON NC 28019 B:3367445486C:3363995894 BEEBEE.BACKHOE @YAHOO.COM **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner BRIAN POOLE, 3391 OAK RIDGE CIR, LINCOLNTON NC 28092 receipt 08/25/2016 16:12 Page 1 of 1