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HomeMy WebLinkAboutCBPR-09-2016-24733.TIF THIS IS NOTA PERMIT Case # CBPR-09-2016-24733 CATAWBA COUNTY HEALTH DEPARTMENT ❑' . ,�6' .6v ' !' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 4_)7,1741 � 1842 SM Commercial Building Plan Review - Building Alteration 'o_ o � IMPROVEMENT oo ;� e,V\-\'I .OHI 0. .�.�r „ Applicant CHANGING LIVES, LLC (RICHARD MACON), PO BOX 86, HIDDENITE NC 28636 C:7042242364 Contact Person CHANGING LIVES, LLC (RICHARD MACON), PO BOX 86, HIDDENITE NC 28636 C:7042242364 Owner TIMOTHY SCAER, 4675 HICKORY-LINCOLNTON HWY, NEWTON NC 28658 NAME TO APPEAR ON PERMIT Changing Lives, LLC (Richard Macon) SITE ADDRESS: 4675 HICKORY LINCOLNTON HWY,NEWTON NC 28658 PIN # 361701194614 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 83,199.60 Acres 1.91 DIRECTIONS: Rocky Ford Rd to Hickory Lincolnton Hwy, Go past Grace Church Rd, 4th house on Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: IP for change of use &to designate repair area. Residential Group Home for Children. 4 BdRM - Max 8 occupants. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: MULTI-FAMILY RESIDENCE FACILITY TYPE: Other OTHER DESCRIPTION: Residential Group Home/Children DESCRIPTION OF ranch style home EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 79x67 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 3,400 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: r9-chappl ication 09/15/2016 15:20 Page 1 of‘1 Ci.' CATAWBA COUNTY Case/I CBPR-09-2016-24733 .0 G Public Health Department Subdivision4 ,"s, Environmental Health Division PIN// 361701194614 PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 /g 42 :ii NAME ON PERMIT: CHANGING LIVES, LLC ( RICHARD MACON), PO BOX 86, HIDDENITE NC 28636 Changing Lives, LLC ( Richard Macon) Site Address: 4675 HICKORY LINCOLNTON HWY,NEWTON NC 28658 Property Size: Square Feet 83,199.60 Acres 1.91 Directions: Rocky Ford Rd to Hickory Lincolnton Hwy, Go past Grace Church Rd, 4th house on 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 AREA2 3rimu 1 wBr. til t �Irf�'11I14�I 1 . '' i1� ' nil i , I r'.iIitt! 41071 �, FEENAME.:'r 4i I III l I ll jIi.VII il'1I! I 21 n ,u. ,DATE) 1FEE'AMOUNT Improvement Permit Fee y p 09/15/2016 $150.00 P i I brill:IR '11 i SititA LIIF E ES III11�i1�IIIilj l`I 111 "ib�lllilIg11111111f11�t1i1llili;Ia a '[11 111 yU��1r ` I �l 4th, IIII,IIr� VIVI,III „,.$lso 0o I' f' .'Sloi, ' , n ,- et n in41IIVIwvnI' ,J nflttb:Jaw , ,.IU,6,L 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) P9-ehapplication 09/15I20t6 15:20 Page 2 of4 BA � THIS IS NOT A PERMIT Case # CBPR-09-2016-24733 Q H CATAWBA COUNTY HEALTH DEPARTMENT !' , Yoe•. " '" E PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 842 Commercial Building Plan Review - Building Alteration •n_ o 'D 4. IMPROVEMENT a a Applicant CHANGING LIVES, LLC (RICHARD MACON), PO BOX 86, HIDDENITE NC 28636 C:7042242364 Contact Person CHANGING LIVES, LLC (RICHARD MACON), PO BOX 86, HIDDENITE NC 28636 C:7042242364 Owner TIMOTHY SCAER,4675 HICKORY-LINCOLNTON HWY, NEWTON NC 28658 NAME TO APPEAR ON PERMIT Chan • in . Lives, LLC Richard Macon SITE ADDRESS: 4675 HICKORY LINCOLNTON HWY,NEWTON NC 28658 PIN # 361701194614 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 83,199.60 Acres 1.91 DIRECTIONS: P PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water DESCRIBE WORK: **SEPTIC CHECK ONLY** Res Care for 4 to 6 children 8-21 year of age. (group home care) SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: MULTI-FAMILY RESIDENCE FACILITY TYPE: Other OTHER DESCRIPTION: Residential Group Home/Children DESCRIPTION OF ranch style home 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: SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 3,400 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 09/15/2016 14:18 Page 1 of4 V-IVA CATAWBA COUNTY Case# CBPR-09-2016-24733 (iinPublic Health Department Subdivision d Environmental Health Division PIN# 361701194614 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Igo :M NAME ON PERMIT: CHANGING LIVES, LLC (RICHARD MACON), PO BOX 86, HIDDENITE NC 28636 Changing Lives, LLC ( Richard Macon) Site Address: 4675 HICKORY LINCOLNTON HWY, NEWTON NC 28658 Property Size: Square Feet 83,199.60 Acres 1.91 Directions: P 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 i `1tf5 *********************************AREA2*****************�':**�.,****v '****t* __ LFEENAME• .DATE FEE AMOUNT Improvement Permit Fee 09/15/2016 $150.00 I ,, TOTAL-FEES $150:00-1 •_.. 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 09/15/2016 14:18 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „„U o Application for Environmental Services Page 1 Improvement Permit Authorization to Construe, �, Septic Repair n Septic Malfunction ❑ Septic Expansion y New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Constructionl ❑ Existing Facility Property Address q4 I S I Jt -.-� L+Kc�l�e t het Subdivision 1 Lot# Acres Section/Block/Phase Driving Directions to Property 7A55 �r�ff� L-cF+ uN W- cic , iLjNt 1aoti h'S 0tit +11 NAME TO APPEAR ON PERMIT? ❑ Owner U Applicant [ Contractor Applicant Contact Information Name iZtttlazi e. Jockw t Address ' ,} e0, g,,x5G / Ifhe1ctr ;F2 rJC Zne3G Phone C1oH) ,;.W.(4 - G j Cell Phone (70 ) Li9 -13G q Owner ContacInformation Name cc,ciw d t titcovi 4, Address L((, )S Hit lcdr L; toll-c� jCc� Phone CM rf ._ 36t��( �/�� �(��( Cell Phone ( ?oy/.�)n _211—�23Cy41 q" � Name-,i'1 J `�llA /L?/ V A s Vu` V C_ ,L&D\S Address Phone Cell Phoi e WHO WILL BE THE PRIMARY CONTACT? ❑ Owner [ pplicant ❑ Contractor Description of Existing Structures on Site f2-•v�oi4 # of Bedrooms 1. 9 Structure Dimensions #of Occupants H - Basement ❑ Yes No Basement Fixtures Q Yes No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property i question. If the answer to any question is "yes", applicant must attach supporting documentation. ® Yes i Does the site contain any jurisdictional wetlands? Yes Ner. Does the site contain any existing wastewater systems? C Yes — `'No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes 0 Is the site subject to approval by any other public agency? C YesNo Are there any easements or right of ways on this property? Describe Existin ater supply in use ❑ Individual Well H Community Well LJ Semi-Public Well County/City/Township Water Line Is a public water supply available? **NS,Yes ❑ No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) \ ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Ng Any W • leiklym bap Nov - n1uxB AR chee 6w CArI'AWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT N'tivess � ,, Application for Environmental Services Page 2 Proposed Facility Type • ❑ Primary Residence ❑ New Residence n Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ®No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing E. Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*j' Total#Bedrooms *t Structure Dimensions ❑ 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 Qri,dt ✓- el ore- (d < /clel k r1 . �'a. 6&i 8 'k_ If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy eAPI Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well . Abandonment Type H. Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes H 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 fiture 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. j 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. e a� Signature of Owner or Agent mow_ is1 Date 1 /i 5 - Printed Name of Owner or Agent Fr cl�c_rrl �% tiVLltn. Catawba County Environmental Health (-13 ....- / / I 4 (130) N \\111\1 1 1-..... N 1 \I\1\ 1 255.84 A A. 11 1 r 1 n 1 0551 y (201) 0 2 925--ter y -� `3951 0 q� LO' r2, ?.J 920 fr['9 J 6' O Parcel: 361701194614, 4675 HICKORY 1in=80ft LINCOLNTON HWY NEWTON, 28658 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 09/15/2016 Parcel Report _ Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 361701194614 Owner: SCAER TIMOTHY P Parcel Address: 4675 HICKORY LINCOLNTON Owner2: SCAER TIMOTHY P HWY Address: PO BOX 445 City: NEWTON, 28658 Address2: LRK(REID): 5896 City: CONOVER Deed Book/Page: 2958/0821 State/Zip: NC 28613-0445 Subdivision: Lots/Block: 1/ School Information: School District: COUNTY Last Sale: Elementary School: BLACKBURN Plat Book/Page: 18/154 Middle School: JACOBS FORK Legal: LOT 1 1 PL 18-154 P HEAVNER PL 18- High School: FRED T FOARD 154 School Map Calculated Acreage: 1.910 Tax Map: 006 J 07012C Township: JACOBS FORK State Road #: 1008 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $143,900 Zoning2: Land Value: $14,500 Zoning3: Assessed Total Value: $158,400 Zoning Overlay: Year Built/Remodeled: 1958/1997 Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / • Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710360600J Building Details 2010 Census Block: 4009 Watershed: 2010 Census Tract: 011802 Voter Precinct: P3 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. 7 Ov. y 4S° vm itruo-bn,_. wdern ya CSI 1 th °http://gis.catawbacounty.gov/nomap/parcel_report,php?key=361701194614&typ=P 9/15/2016 op CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465-8270 TDD: (7 4 465-8200 Improve. Permit Authorization to Construct3 Repair Permit •( Oper. Permit/ ',System Type TTL€ I' �j/ 7 Owner/Agent L€ (-L/a.v 11/4.1•-y--- . Phone /A2 —/6 57 Address 7.5 ,z/'C- C/N /m^-7' Subdivision /(/et.A./'r"--t Section/Block/Phase Lot# Lot Size Directions: /0 /,\/ CCX /oJ Y / -at. .4 f-,- !{r, r 2,5:-h t- a >- 6,,,r /zt fes,-,,,. CA . Facility: House Y' Mobile Home Business . Other: Tax Map # • Multi-family Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures . 100% Repair Area yes/no Basement yes/no Basement Plumbing yes/no Water Supply: Private Well Public Type of System: Trench Bed ,Y Pump Pump/Panel Panel LPP Other • Tank Size: Septic Tank Size 6)iic 7•'v G/��s Pump Tank Size 606 Nitrification Field: Total Square Feet Depth of Stone / Z Bed Size /O K6 l) Trench Width Total Length of All Trenches Number of Trenches Individual Trench Length / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL WHEN WET* Topo % Slope Texture • 3A4541-ii Aft...! / /o -r 4/vsr/ M/ c�x G Structure ,J / /N 0-Yr/C-C 61--/ kC. Ale _ Clay Min. // / Soil Wetness Qr/F-rw/-/r/G✓ X71 6e \-- Soil Depth " Restric. Hoz. at " d /-i,ZS f- (0 et Cr o Available space yes/no Co U Overall Class S PS /'7 X Comments: L 1. 1--I j L-T6Xo'Srtro(] I60 **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Own�Permit Date /- Zoe-5' /�z///J ,/ //11 nt ii_ 77?" I 1+i Sanitarian/C tt6-tj. v� .$.._ Instal-led-By /Q/jy n"4yw Date /Z-o- /.5 Sanitari x,526.6","/I ,/� ,�/`T 76_5 White-Office " Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct