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HomeMy WebLinkAboutEHPR-08-2016-24602 (2).TIF 17 rent 6.��a� '#''.�.4:57,'. r-i,7.A".. �wwAVATI,: rCSk k-RE^o TOPIT'C'-f� �" +37 ' Catawbal county„Worth" arolina iDlsbursement VoTu ,e - �^ `it;:tri :Tf n ,[.t 1iea�.u,'�5��!�1::�P Vendor No. ate 08/29/16 Make Payment To: gi\ CO Voucher No(s). Clement T. Milbourne &15,4C $ 'Z �llp H 4653 Perkins Rd o 'n• 4 Charlotte NC 28269 \g!-� ATTACHMENT Prepared by: Katherine Harris Description Amount Improvement Permit 150.00 Sub-Total $ 150,00 Food Tax Sales Tax Total $ 150.00 ,,, a "`._' ,, ,i 4 ,Ali, 1`,1 ^tea •k i '�, F'* �ei.°�'„ y %FF, ,�, ,37,3i 7 i �� �, � �� � p a� +''�{ For Accounting Fund `1 Gost Centers Obteet �: Pro ect, ' ; ; Amount3 S o ,. Us O tY;�y -iik1,10., L j580200i : 663000 Total - The undersigned hereby certifies that the goods or services specified above have been received or performed. Payment has not been previously authorized and this expenditure is a proper charge to the appropriation indicated. The above charge is certified to you for payment. (SIGNATURE-APPROPRIATE OFFICIAL) cir[ij& \ iltA Environmental Health - Division of Public Health COUNTY r PO Box 389—100-A South West Blvd.-Newton, North Carolina 28658 ' l� !R'., ,a (828)465-8270—Fax (828)465-8276 a iiVr North earonnovvvvvv.catawhacountvnc.gov/cmtironmentalhealth/ AUTHORIZATION OF REFUND Date: August 29, 2016 Case #: EHPR-08-2016-24602 Applicant: Clement T. Milbourne Refund Amount: 5150.00 Refund Reason: Applicant Requested to Withdraw Application. Stated he Planned to get a 3' party evaluation in order to save Time prior to closing. Authorizing Signature: (% p k 3 Received By Staff: \ e 14,0/$ , I ADate: SA 7Qi lLD Leading the 11/at to a Ilealthrer- Community "f4;• �.y ¢70n �i QLI1� L V ‘4541,:, 1.1; i Public Health A CATAWBA COUNTY ��' CO t�� 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT , LIP' PHONE: 828.465.8399 U '�`-wfit410)1 ''C Monday, August 29, 2016 1$[�2 sm www.catawbaconntyncgov PAYOR: Milboume, Clement(Tim) PAYMENTS TRANSACTION NUMBER: TRC-807088-29-08-2016 • PAYMENT DATE : 08/29/2016 PAYMENT TYPE: DV INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332071 Improvement Permit Fee (SI 50.00) TOTAL PAYMENTS : (S150.00) EHPR-08-2016-24602 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7303 WOOD DUCK CT, DENVER NC 28037 Applicant CLEMENT(TIM) MILBOURNE,4653 PERKINS RD, CHARLOTTE NC 28269 C:7049997815 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner BRUCE&SUZANNE CONWAY,7284 BAY RIDGE DR,DENVER NC 28037 Contractor KEMP CUSTOM HOMES INC, 378 WILLIAMSON RD 203, H:7046601022C:7046349350 KEMPHOMES@GMAIL.COM receipt 08/29/2016 15:04 Page I of I 4.1.. A �G it wits.. S PO , A }.RMIT Case # EHPR-08-2016-24602 ,:'f e1;9 5 .. ", "'ter ■ ' - :'t ■ • L DEPARTMENT ❑; j9 ❑ `3 O41 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES a,�* /g. 2 sM Environmental Health Plan Review - OSWP J 1 �.id, ti of k. IMPROVEMENT0 o- V AVAKOWn - STI)K0 Applicant CLEMENT(TIM) MILBOURNE,4653 PERKINS RD, CHARLOTTE NC 28269 C:7049997815 Contractor KEMP CUSTOM HOMES INC (CLINTON KEMP), 378 WILLIAMSON RD 203, 1-1:7046601022 C:7046349350 HOME:7046601022 KEMPHOMES@GMAIL.COM Land Owner BRUCE& SUZANNE CONWAY, 7284 BAY RIDGE DR, DENVER NC 28037 NAME TO APPEAR ON PERMIT Clement (Tim) Milbourne SITE ADDRESS: 7303 WOOD DUCK CT, DENVER NC 28037 PIN # 460601269849 NAME of SUBDIVISION: PEBBLE BAY PH 3 REVISION Lot 4 PT 109 Section/Block PROPERTY SIZE: Square Feet 49,658.40 Acres 1.14 DIRECTIONS: Hwy 16 North, Left onto Campground Rd, Left onto Catawba Burris Rd/Burris Rd, Right onto Bankhead Rd, 1st Right to stay on Bankhead Rd, 1st Left onto Gold Finch Dr, *Gate Code* is#3110 (the#MUST be first), 1st Right onto Bay Ridge Dr, 1st Left onto Wood Duck Court, Lot will be on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: Revised 8/29/16 - Applicant Requested Application to be withdrawn. Applicant stated he was getting a 3rd party soils evaluation in order to save time before his loan closing. Application was not sent to area. No Site Visit Made. Refund Issued. IP for Purchase* New 4 BdRm House 90'10" x 412" Detached Garage 24x24 w/ 1/2 Bathroom (sink &toilet Only) NO Living Quarters, NO Kitchen, NO Bedrooms, No Additional GPD for 1/2 Bath Only. 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: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 90'10"x 412" , Detached Garage 24x24 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: P9-chapplicatinn 08/29/2016 14:56 Page 1 of 5 st, !! a10 COUCase it EHPR-08-2016-24602 ,C'�. irp Suivision PEBBLE BAY PHREVION n• PIN# 460601269849 °"&F PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 iib ,w NAME ON PERMIT: (CLEMENT(TIM) MILBOURNE),4653 PERKINS RD, CHARLOTTE NC 28269 ( Clement(Tim) Milbourne) Site Address: 7303 WOOD DUCK CT, DENVER NC 28037 Property Size: Square Feet 49,658.40 Acres 1.14 Directions: Hwy 16 North, Left onto Campground Rd, Left onto Catawba Burris Rd/Burris Rd, Right onto Bankhead Rd, 1st Right to stay on Bankhead Rd, 1st Left onto Gold Finch Dr, *Gate Code*is#3110 (the#MUST be first), 1st Right onto Bay Ridge Dr, 1st Left onto Wood Duck Court, Lot will be on 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 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 AREA1 I11p'"��C'rIr(,ti `,I° j9" i '{II , Eli4FFENAME ".,! 42Ami lith �I(,lipir° I i iIIIII I{. i1IIIIIdDATE I`I){JINi311EEEAMOUNT.1iu Improvement Permit Fee 08/26/2016 $150.00 I ''TOTALFEES �� 4' "" I`�� ° i PIM, �� slso 00 (tl' �II��I. Off ��i(��' », a ,'ii�l.t���l�, 14 ��t.�i Ua'Nr � a'{1W101IIN011i16iNtNm, a m,�.IIIIfL�IIIIIGWIW>GW'sl' ' ni Ism WttWBNna;t "aWlIIIIIAII� +-9w4uNliwi'nwuuNlOilli.a:.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-ehapplication 08/29/2016 14:56 Page 2 of 5 yaY A THIS IS NOT A PERMIT Case# EHPR-08-2016-24602 a � ' - -a., ;��„r CATAWBA COUNTY HEALTH DEPARTMENT .req t0 v tS `C •. gig'! PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES v 842 sm Environmental Health Plan Review - OSWP o •`o t o?. c. IMPROVEMENT O Els V:0 ' rad A�7Q)Ko . Applicant CLEMENT(TIM) MILBOURNE,4653 PERKINS RD, CHARLOTTE NC 28269 C:7049997815 Contractor KEMP CUSTOM HOMES INC (CLINTON KEMP), 378 WILLIAMSON RD 203, H:7046601022 C:7046349350 HOME:7046601022 KEMPHOMES@GMAIL.COM Land Owner BRUCE& SUZANNE CONWAY, 7284 BAY RIDGE DR, DENVER NC 28037 NAME TO APPEAR ON PERMIT Clement (Tim) Milbourne SITE ADDRESS: 7303 WOOD DUCK CT, DENVER NC 28037 PIN # 460601269849 NAME of SUBDIVISION: PEBBLE BAY PH 3 REVISION Lot# PT 109 Section/Block PROPERTY SIZE: Square Feet 49,658.40 Acres 1.14 DIRECTIONS: Hwy 16 North, Left onto Campground Rd, Left onto Catawba Burns Rd/Burris Rd, Right onto Bankhead Rd, 1st Right to stay on Bankhead Rd, 1st Left onto Gold Finch Dr, *Gate Code*is#3110 (the#MUST be first), 1st Right onto Bay Ridge Dr, 1st Left onto Wood Duck Court, Lot will be on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* New 4 BdRm House 90'10" x 41'2" Detached Garage 24x24 w/ 1/2 Bathroom (sink & toilet Only) NO Living Quarters, NO Kitchen, NO Bedrooms, No Additional GPD for 1/2 Bath Only. 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: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 90'10"x 412" , Detached Garage 24x24 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chapplicailnn 08/29/2016 10:37 Page I of 5 �e • CATAWBA COUNTY Case U EHPR-08-2016-24602 Ft.°� .C' ,, Public Health Department Subdivision PEBBLE BAY PH 3 REVISION 4 '&33, 1 4 Environmental Health Division PIN'S 460601269849 kWy' PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 )8.2 sa NAME ON PERMIT: (CLEMENT(TIM) MILBOURNE),4653 PERKINS RD, CHARLOTTE NC 28269 ( Clement (Tim) Milbourne) Site Address: 7303 WOOD DUCK CT, DENVER NC 28037 Property Size: Square Feet 49,658.40 Acres 1.14 Directions: Hwy 16 North, Left onto Campground Rd, Left onto Catawba Burris Rd/Burris Rd, Right onto Bankhead Rd, 1st Right to stay on Bankhead Rd, 1st Left onto Gold Finch Dr, *Gate Code'is#3110 (the#MUST be first), 1st Right onto Bay Ridge Dr, 1st Left onto Wood Duck Court, Lot will be on 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 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 AREA1 r IITIF"'':i,^,sf!i�i }j R""71IhlP Ir"n;a lil i` I It1'p 7:' 1AM i! r^I'i nl pp �mT1iRIB T LEEENAME.tr•I,Itlltltalnt`. " u..1.4411 111111�I1��ui .DATEi (L II�IFEE'AMOUNTf 1 Improvement Permit Fee 08/26/2016 $150.00 ° '11�� 1 '� 11111lil{�TOTA�IIFEESIEW ItI °III'UI''ll�lta ;,l ',111111G111i 11.111billlki f °I lIi!s15Q100 I rl,ui 1. it li, J11�g . e Wnit a` ll.111.0 111 ,ou'itullUfl`.1 a. ,"ltHi� i r+ i 'row 14r.lt�k;m• i t 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-ehapplicatinn 08/29/2016 10:37 Page 2 of 5 F n n o s x N1CR � X . F x o6 _I n _ o Q •• 3a .A. . 3 A •• o m = .< r r o A co p Wim. c = 3 m O w ro CD n in to _. 3 n I o Co co v d 07 3 un c ( 0 W = � n y. N c S v 0 * v W m T fl m C J) mna) Tn m m _ m o � J D n'� o r� v ul � = mES-- V oX � � C. v �70w _. s N N N p Cr r N c o C. O N 3 { • ° rn o • S N rn� m a � 3 0 N K m N Cr �. m N A O 5 a- --AK = g .3_._ C 0 wo o c 0 W m C 3 < ea c a CO / -% �. v5' 0a m a 0 a C S S Cl o CO m o S M. _ m a_ m mc cn CDn ri Z n n v m sro co �- 0.3 -. � 0 0 o� 0 m inc a la0 A-'0.r W 0 .y tA_ C G THIS IS NOTA PERMIT Case # EHPR-08-2016-24602 ` t G CATAWBA COUNTY HEALTH DEPARTMENT l; . • r 4: ice (..)74,4“ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES •'. �'' v t 1842 sM Environmental Health Plan Review - OSWP eiri o • IMPROVEMENT 0' JD Applicant CLEMENT(TIM) MILBOURNE, 4653 PERKINS RD, CHARLOTTE NC 28269 C:7049997815 Contractor KEMP CUSTOM HOMES INC (CLINTON KEMP), 378 WILLIAMSON RD 203, H:7046601022 C:7046349350 HOME:7046601022 KEMPHOMES n GMAIL.COM Land Owner BRUCE & SUZANNE CONWAY, 7284 BAY RIDGE DR. DENVER NC 28037 NAME TO APPEAR ON PERMIT Clement (Tim) Milbourne SITE ADDRESS: 7303 WOOD DUCK CT, DENVER NC 28037 PIN # 460601269849 NAME of SUBDIVISION: PEBBLE BAY PH 3 REVISION Lot# PT 109 Section/Block PROPERTY SIZE: Square Feet 49,658.40 Acres 1.14 DIRECTIONS: Hwy 16 North, Left onto Campground Rd, Left onto Catawba Burris Rd/Burris Rd, Right onto Bankhead Rd, 1st Right to stay on Bankhead Rd, 1st Left onto Gold Finch Dr, `Gate Code*is#3110 (the#MUST be first), 1st Right onto Bay Ridge Dr, 1st Left onto Wood Duck Court, Lot will be on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 580 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* New 4 BdRm House 90'10" x 41'2" Detached Garage 24x24 w/full bathroom (sink, toilet, shower) 100 GPD Total = 580 GPD 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: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 90'10"x 412" , Detached Garage 24x24 #OF NEW BEDROOMS:: 4 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES , Other described: E9-ehapplication 08/26/2016 13:00 Page 1 of5 s, ,� CATAWBA COUNTY Case a EHPR-08-2016-24602 f'i; 4 Public Health Department Subdivision PEBBLE BAY PH 3 REVISION 6lif ®.1 „''t, Environmental Health Division PIN# 460601269849 '"'► PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 /942 :M NAME ON PERMIT: (CLEMENT(TIM) MILBOURNE),4653 PERKINS RD, CHARLOTTE NC 28269 ( Clement (Tim) Milbourne) Site Address: 7303 WOOD DUCK CT, DENVER NC 28037 Property Size: Square Feet 49,658.40 Acres 1.14 Directions: Hwy 16 North, Left onto Campground Rd, Left onto Catawba Burris Rd/Burris Rd, Right onto Bankhead Rd, 1st Right to stay on Bankhead Rd, 1st Left onto Gold Finch Dr, *Gate Code*is#3110 (the#MUST be first), 1st Right onto Bay Ridge Dr, 1st Left onto Wood Duck Court, Lot will be on 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 identification and labeling of all property lines and corners and making the site accessible so that a complete site a al ation can be performed. Date: 8126/2o/6, Signature of Applicant or Agent (' - i#to i e 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 AREA1 .***********..*.......********....**...******....**************..**********.******.***..*.....*...*********. rE` AR;I42111fl1 --tp r) ( ,r t ',i, r.^ v r } iII „o� J hlf . ?"diad' vT - FEFNAME • 1:1iIllS ^ ;1 1DATElilt LFEEAMOUNT ',t _ • mow , t ,J _ Improvement Permit Fee 08/26/2016 5150.00 a , llt p pr ni iltr P ;l11110179 �I�TOTALFEES N�ayhiN� ��llnl['�r�r t)ll��lll�� �,I���I�u' ��u1��61;'x S150 OOP �1 . L, ' a1li;�._._r.1i,tihlUF 'i. M.;a.,.„x,,,.�hnaltnu01.4!LUd1611Y@P't,o-, 1LJWIWIi8hu(NL...2Lh,hNfik Y ,•_..,,i�rlllt 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) 09-ehapplicaiinn 08/26/2016 13:00 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT 32_ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct❑ Septic Repair n Septic Malfunction ❑ Septic Expansion ❑ New Well Permit n Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑! Existing Facility ❑ Property Address 7303 Wood Duck Court Subdivision Pebble Bay Denver, NC 28037 Lot# 109 Acres 1.137 Section/Block/Phase Phase 3 Driving Directions to Property The property is locatable via GPS. You should enter the community through Gold Finch Drive. The gate code is#3110. You MUST press the#first. NAME TO APPEAR ON PERMIT? t❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Clement T. Milbourne Address 4653 Perkins Road, Charlotte NC 28269 Phone 704-999-7815 Cell Phone 704-999-7815 Owner Contact Information Name Clement T. Milbourne Address 4653 Perkins Road, Charlotte NC 28269 Phone 704-999-7815 Cell Phone 704-999-7815 Contractor Contact Information Name Clinton Kemp Address 631-300 Brawley Sch Rd#114 Mooresville,NC 28117 Phone 704-634-9350 Cell Phone 704-634-9350 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Contractor Description of Existing Structures on Site None # of Bedrooms *t Structure Dimensions # of Occupants Basement Yes ❑ No Basement Fixtures a 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. CI Yes it,No Does the site contain any jurisdictional wetlands? ® Yes No Does the site contain any existing wastewater systems? ❑ Yes Ci 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? in Yes El No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well U Community Well F I Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** • 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 0 Alternative iia Conventional ❑ Innovative ❑ Other ❑ Any Gravity sewer from basement to septic tank. No pumps. CATAWBA THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑� Primary Residence n New Residence ❑ Addition to Residence # of New Bedrooms *i 4 Project Description New home construction on recently purchased lot. Structure Dimensions 9010"x 412" # of Occupants 4 - Basement ❑Y Yes ❑ No Basement Fixtures ri Yes ® No ❑� Accessory Structure(s) Describe Detached Garage #of New Bedrooms *j if applicable 0 Structure Dimensions # of Occupants 0 Accessory Dwelling ❑ Yes • No Plumbing n Yes ❑ No Describe Plumbing Needed Full Bathroom E Multi-Family Residence# Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions LI 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 ❑ Ycs D No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair 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 1. 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. 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 (hr./4T ,> Pie CfrtU c� Date August 24, 2016 Printed Name of Owner or Agent Clement T. Milbourne • WOOF PUCK LOOP \ a \ \ 1 / 4 ;,! � €°I `i �' i ; r / / t It :� OP .44) O KV / \ / \ / PROPOSED PLOT PLAN \ / ,....n \ / WOOD PUCK LOOP V/ __ ..a,.e...o.q. 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Q .s, Sb.. • �9- O' y �q5. tt • o„ o • • • • • N \ \ •\ v 2, / \ / / / • / \ / -0 C1 Catawba County Environmental Health WOOD DUCK GTS. 40 , 70.0 \ \ CO \ N \ \ lit/ \ ASO\ \ \ \ 21.00 I;: pp Nat ,(ii: \ coNlilt , , \ ,till� i;Iy,II 'S.Y� ryryit L�-+ 114' ii•'f \ ',p�lilli�' ,0 � 135.39 AO 0 filr. /6:0 Parcel: 460601269849, 7303 WOOD DUCK CT 1 in=50ft DENVER, 28037 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 08/26/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460601269849 Owner: CONWAY BRUCE A Parcel Address: 7303 WOOD DUCK CT Owner2: CONWAY SUZANNE L City: DENVER, 28037 Address: 7284 BAY RIDGE DR LRK(REID): 802802 Address2: Deed Book/Page: 3339/0707 City: DENVER Subdivision: PEBBLE BAY PH 3 REVISION State/Zip: NC 28037-8477 Lots/Block: PT 109/ Last Sale: School Information: School District: COUNTY Plat Book/Page: 62/105 Elementary School: SHERRILLS FORD Legal: PT LOT 109 PL 62-105 Middle School: MILL CREEK Calculated Acreage: 1.140 Tax Map: High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: Land Value: $39,500 Zoning3: Assessed Total Value: $39,500 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / 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 #: 3710460600J Building Details 2010 Census Block: 4013 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 Agricultural District: 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=460601269849&typ=P 8/26/2016 CATAWBA COUNTY 100A SOUTHWEST BLVD Q � a NEWTON,NORTH CAROLINA 28658 RECEIPT q :' s1P PHONE: 828.465.8399 U a` t. bva`w= 'C Friday, August 26, 2016 is 4 L, sM www.catawbacountync.gov PAYOR: Milbourne, Clement (Tim) PAYMENTS TRANSACTION NUMBER: TRC-801710-26-08-2016 PAYMENT DATE : 08/26/2016 PAYMENT TYPE: Check 1676 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332071 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24602 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7303 WOOD DUCK CT, DENVER NC 28037 Applicant CLEMENT(TIM) MILBOURNE,4653 PERKINS RD, CHARLOTTE NC 28269 C:7049997815 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner BRUCE& SUZANNE CONWAY, 7284 BAY RIDGE DR, DENVER NC 28037 Contractor KEMP CUSTOM HOMES INC, 378 WILLIAMSON RD 203, H:704660I022C:7046349350 KEMPI-TOMESnGMAIL.COM receipt 08/26/2016 12:57 Page 1 of 1