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Home My WebLink AboutEHPR-12-09-3102 (2).TIF THIS IS NOT A PERMIT Case # EHPR-12-09-3102 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 5M Environmental Health Plan Review - OSWP EXS_SYSTEM ANRLICANT QWNI k ( ONTRACTQR MICHAEL.SAINE MICHAEL SAINE 2407 ARCADIA HEIGHTS RD 2407 ARCADIA HEIGHTS RD LINCOLNTON NC 28092-1110 LINCOLNTON NC 28092-' 1 I"10 . NAME TO APPEAR ON PERMIT MICHAEL SAINE Pin#: 362716822617 SITE ADDRESS: 6376 STARTOWN RD, Maiden, NC DIRECTIONS: STARTOWN RD S/ PASS OVER 321/ GO PAST BLACKBURN BRIDGE RD/ ON LET NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.64 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home Dimension of Structure Bedrooms 0 Basement: No Water I Jsing Fixtures in Basement:uo No. in Family Whirlpool Tub : Ga1.Capacity: MULTIPLE FAMILY RESIDENCE: Units Total Number .of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining°Afea Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? _ If so, describe: _ Has any grading, removal, or addition of soil been done to this property? . If so, describe Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well X Community Well Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a norrexpiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation'by you of house or structure location should conform to applicable setbacks. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA 1 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 80 FEE NAME DATE AMOUNT °-a 7-717- Side 10 Exrstm; `I ank Check-knee .J211 2009$80.00 Rear 5 TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/15/09 11:27 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check [V( New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ I . Name to Appear on Permit M i ArA e ( t r e_ 2. Permit Requested By Business Phone Address Home Phone 25`IS- 3. Property Owner C e S e_ Business Phone Address 3 r- I o .v ` e i~ Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address 5 a 01 E- Directions to Property-f v~r~o ty I- s, !tea 5 -t- a(a.C.[~~f 13r~` cJa e i2cQ Pik /P - I ` V \J 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY House Mohile Hone Dimension of Structure Bedrooms* !'And room that will be.intended lot- siccping at the tllll,' k1I C')Hl truclk'll of col hitIIIC ~t~ll~l~l~'f~ltl~?Il he Il,,1,2d'a~ ~l h~CIrOOm'alld CnUnt:(1 Oil all app! lc illiol-~ The nulllhcr ~~l hC~~Ii~i nl~ vv III h,' Coll Illll~'d h\ I'L'Il(IlI.d Oil`110Use plan ;ltiza b.~droonl at*thc Illly , l building ~~Cllllll IOno ,,Uallcc 1~h' Ill,ty ~1j~vwlll I11C IlC'~~I ~~ll ~~~,t Jll ~I/ nCl:~l~~ Ill the ltttrlic Basement: yes Water Using Fixtures in Basement: ye no No. in Family Whirlpool Tub yes nod Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1 st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes No \ If so, describe: ' 2 S Sc) s- ( b e -t IF 8. Has any grading, removal, or add' ' n of soil been done to this roperty? Yes / No If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / o 10. Is a public water supply available on or adjacent to the above property? Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well I understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.** J G~Gc~ Date Signature of Owner or Agent ~)/,z Catawba County, North Carolina This map product was prepared from the Catawba Comity, NC, Geographic Information S~ stem. N Catawba Comity has made sub.ctamial cyforls to ensue the accuracy oflocation and labeling ityorm(Moo contained 017 this map. Catawba Comm, promotes and recommends the independent verification ofatny Bala couamed on this map product by the user. The Comm, oJCatawba, its emplovees, agents and personnel disclaim, and shall not be held liable for aav and all damages, loss or liability, whether dlrecl, indirect or consequential which arises or may arise from this map product or the use thereof by mty person or emits. Legend Selected Parcel Number: ~f c 1 inch = 60 feet Prepared for: 0 4.60 / - '314-60 ~ji G f r p N 1 CI { s ` } I 2. 64Ak l J - VC 1 { try ii 9 ~ ~ t ~ r JJJ rr ~ ~ ~l 9 - i ? t r 6) u 3 CTI 7 3 ~r ifv t 1 _-1 ' f - ! r i I i t 1° l 'r f i i k f - -fit LAtl~ TI-IIS IS NOT A LEGAL DOCUI\9ENT Thursday, December 10, 2009 03:40 PINT I Al- I ! ~ 1~ i 1 i 1 l V ' CATA'vVBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3627-16-82-2617 Name: SAINE MICHAEL ANDREW Name2: Address: 2407 ARCADIA HEIGHTS RD Address2: City: LINCOLNTON State: NC Zip: 28092-1110 Account: 172296 Calc Acreage: 2.64 Tax Map: 012 J 03021 LRK: 12517 Deed Book: 0952 Deed Page: 0282 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 6376 Street Name: STARTOWN RD Site Zip: 28650 Township: JACOBS FORK Fire Code: MAIDEN RURAL City Code: COUNTY State Road: 1005 Total Bldgs Value: $60,000 Land Value: $22,100 Total Value: $82,100 Year Built: 1969 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 113 Watershed: Watershed Split: Voter Precinct: P34 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MAIDEN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011702 Census Block 2010: 1035 Small Area Plan: STARTOWN Agricultural District: Printed: Thursday, December 10, 2009 03:41 PM CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE Newton, NC 28658- (828)465-8399 Tuesday, December 15, 2009 1, 84 Z sM www.catawbacouiityiic.gov Plan Case: EHPR-12-09-3102 Invoice Number: INV-12-09-258028 Environmental Health Plan Review Invoice Date: 12/15/2009 Fee Name Fee Amount Existing Tank Check Fee Fixed $$0.06 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 12/15/2009 Cash -1 $80.00 $0.001; Total Paid: $80.00 Total Due: $0.00 plan invoice ;3aab2c95-(1628-4Oh6-ad6e 9fxh37d8961'a;.rpt 12/15/2009 11:36