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HomeMy WebLinkAboutEHPR-02-2016-23254.TIF 0 THIS IS NOT A PERMIT Case # EHPR-02-2016-23254 1-7 CATAWBA COUNTY HEALTH DEPARTMENT " �� 4_14A3 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ° of 4;• 1842 sM Environmental Health Plan Review - OSWP ;o o 1 0.13 • tti { • a IMPROVEMENT • 4 c • n , Applicant LAVINE SCROGER, 383 N THOMAS LN, STONY POINT NC 28678 C:8285142485 Contractor CLAYTON HOMES (BOBBI LASAGE), PO BOX 132, TAYLORSVILLE NC 28681 C:8282173168 Land Owner BOBBY&JEAN SHOOK, 6256 MONFORD DR, CONOVER NC 28613 NAME TO APPEAR ON PERMIT Lavine Scroger SITE ADDRESS: 6245 ROCKY RD, CLAREMONT NC 28610 PIN # 375501351758 NAME of SUBDIVISION: ROXBURY FIELDS Lot if Section/Block PROPERTY SIZE: Square Feet 21,780.00 Acres 0.5 DIRECTIONS: 140 East, Exit 132, LEft at 2nd light, Right onto Hwy 16&go about 7 or 8 miles, Right onto River Bend Rd, Left onto Rocky Rd, 1st vacant lot on the Left. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Revised 3/31/16 - 2 BdRms 240 gal/day IP 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 EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: Vacant Lot NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW-SIRUQTURE DIM:: 16x76 Decks: front& back 6x6 #OF NEW BEDROOMS:: 2 EWT? -No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: F9-ehapplicaiioo 03/31/2016 15:45 Pagc 1 ors XEA • CATAWBA COUNTY Case a EHPR-02-2016-23254 R , tt Public Health Department Subdivision ROXBURY FIELDS Environmental h Health Division PINK 375501351758 PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 1g42 9 NAME ON PERMIT: ( LAVINE SCROGER), 383 N THOMAS LN, STONY POINT NC 28678 ( Lavine Scroger) Site Address: 6245 ROCKY RD, CLAREMONT NC 28610 Property Size: Square Feet 21,780.00 Acres 0.5 Directions: 140 East, Exit 132, LEft at 2nd light, Right onto Hwy 16&go about 7 or 8 miles, Right onto River Bend Rd, Left onto Rocky Rd, 1st vacant lot on the Left. 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 Noel g of all property lines and corners and making the site accessible thaty,�omplete site evaluation can be performed. Date: �( IJ/c4i Signature of Applicant or Agent An nvironmental 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 11 e3!ti f ,� i` s. ",1 '"--,-mqn,..� 3�i i u-.L, „. FEFNAME_ n. 2 r' u+ to v:eDATEt . t t)FEE°AMOUNT 1;I, Improvement Permit Fee 02/19/2016 $150.00 is ±i Irg/t `y�TOTALFEES fi,.,.�.'it!'' ,ua, I '. µv".....l.:.a..«,«s.s,6r,a,L,tiLl,.,.Sisd t3 J "Yd..Gaaid i.l will t.:+. ..+,.,."�1' Mi....:n.m.W4rn d..Ei.t' 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) 1::9-ehapplicwion 03/31/2016 15:45 Page 2 of 5 THIS IS NOT A PERMIT Case # EI-IPR-02-2016-23254 Q ti CATAWBA COUNTY HEALTH DEPARTMENT 0 %ca ti 0 � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES - Ig. 2 sM Environmental Health Plan Review - OSWP o .o S. Are IMPROVEMENT •O D Oia. Applicant LAVINE SCROGER, 383 N THOMAS LN, STONY POINT NC 28678 C:8285142485 Contractor CLAYTON l-IOMES (BOBBI LASAGE), PO BOX 132, TAYLORSVILLE NC 28681 C:8282173168 Land Owner BOBBY&JEAN SHOOK, 6256 MONFORD DR, CONOVER NC 28613 NAME TO APPEAR ON PERMIT Lavine Scroger SITE ADDRESS: 6245 ROCKY RD, CLAREMONT NC 28610 PIN # 375501351758 NAME of SUBDIVISION: ROXBURY FIELDS Lot# 2 Section/Block PROPERTY SIZE: Square Feet 21,780.00 Acres 0•5 DIRECTIONS: 140 East, Exit 132, LEft at 2nd light, Right onto Hwy 16 &go about 7 or 8 miles, Right onto River Bend Rd, Left onto Rocky Rd, 1st vacant lot on the Left. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP 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 EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: Vacant Lot NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16x76 Decks:front& back 6x6 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplical ion 02/19/2016 15:05 Page I of5 s CAT.AWBA COUNTY Case ie 1 HPR-02-2016-23254 Cam' +" �G Public Health Department Subdivision t� L ROXBURY FIELDS 6 bra' ^c Environmental Health Division PINt1 375501351758 / 'PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 184/1° NAME ON PERMIT: (LAVINE SCROGER),383 N THOMAS LN, STONY POINT NC 28678 ( Lavine Scroger) Site Address: 6245 ROCKY RD,CLAREMONT NC 28610 Property Size: Square Feet 21,780.00 Acres 0.5 Directions: 1 40 East, Exit 132, LEft at 2nd light, Right onto Hwy 16 &go about 7 or 8 miles, Right onto River Bend Rd, Left onto Rocky Rd, 1st vacant lot on the Left. 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 n labelin of all property lines and corners and making the site accessible •/ . ' at a complete site evaluation can be performed. Date: / 7/ 1(0 Signature of Applicant or Agent or is/ ailll � An Environmental Health Specialist will contact you within 5 working days of applicaA.n date. If you need further information or assistance please call 828-466-7291 AREA2 fi E Ntl*garitfi- RIMES „ € i F yr 2 @twt,,3 „ 1'ya°sIR TE^r>t'i'II FEE AMOUNT xtx. . 'nun, ,ml wt]k flit t- . gro a.,� Improvement Permit Fee 02/19/2016 $150.00 F „ T._OAL^FEES ua r "rR � �r�tr il l i %�,. a 5 150 0Ot Layy •• ''P, `!5!oy 4an`,C. 'ZSTRs`!1EL,P-0,4, -t3°aiiNh'Ai SayiY EI .:.i3=tk"t 'c.,ta,?.aCaag 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 02119/2016 15:05 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT COUNTY v CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permi' Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well H Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ Property Address (O„2 cc l' Zcl Subdivision r/tt.(� l' 1��rIS ua.fe rntm+ N G '� k le 6 '1 Lot# Acres _ Section/Bloch/Phase Driving Directions to Property fy e go :65f -46 f-X H" r3a- 1 Lava k • & ) +0 iinet t �hl l urn ��5h1 Gv +� i 1r ,44,,i-,,,A-. � � rn ) j a s � 3h vn frk /zt r Bun j 12d -i N 1,c_�� � : 1?� 2J 15+- ve.tc c4 ic- an k-S± . NAME TO APPEAR ON PERMIT? caner Applicant U Contractor Applicant Contact Information –7 �y Name La- ne L (n,�,n �C + OCc?,( t� �f� - � �(n l0 Address 3 3 N • . o ma, L-I'1 • S--1.-1»-\q YO t/t Phone 1 Cell Phone 5 <_- S) 1.1 —014 3 s Owner Contact Information��11 \ L J l ,54- Name 0 D kt,,^.U D I� h L e r1 !!1 �e-fc.n Address (� 5 ce /'! 0„,.. rlY 2 . (° ono\,-,e_eR' N G - 1 klP 13 Phone Cell Phone Contractor Contact Information I�p(,t c,.{n.rr— Name &5& (AS4L-7e ' E&y17NnL((-f-n4iej -/ License # J�91/->/3 Address ./C�5n COY1O tL, /3/,/c-C /0. (trio t-' t-/Uc- -2Y / 3 Phone 8, S_ Z) 7— 21e,is, Cell Phone ,(92 ,-2/7 _3/ea a WHO WILL BE THE PRIMARY CONTACT? ❑ Owner pplicant ❑ Contractor Description of Existing Structures on Site #of Bedrooms *j' Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ 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. ❑ Yes No Does the site contain any jurisdictional wetlands? ❑ Yes ' No Does the site contain any existing wastewater systems? ❑ Yes No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes allo Is the site subject to approval by any other public agency? ❑ Yes . No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well • ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes `14 No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): J (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Any CATA j 7Q A THIS IS NOT A PERMIT counr m,,,.,., a CATAWBA COUNTY HEALTH DEPARTMENT „an„5,,,,,n, Application for Environmental Services Page-2w A t t efrtProposed Facility Type / �,,A� �/ Primary Residence X New Residence n Addition to Residence # of New Bedrooms 4t .3 �fl!' /\ Project Description I X r� > JI�'t OL &1� Structure Dimensions / t.p > -7 Lo # of Occupants 1� Basement ❑ Yes yF- No Basement Fixtures n Yes kNo ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing n Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t 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 If Church# of Seats Kitchen ❑ Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well n Semi-Public Well ❑ Community Well Abandonment Type Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested in Yes ❑ 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(p.4.J/ ip 4.n.J e"O tX Date 02-/6-/Ce I Printed Name of Owner or Agent L izo ere/ Linn Se O t{X Catawba County Environmental Health 4 0 co co vi iV n7 N ito 09004'3 0 09004 ea ;1411i::::,- Cr go co' 1 V O r t` 57.7 Q ri v . N <--- 42.7 1025 n 1.411.ai1 100 co N co co 118.94 219.86 °' N 11.?ir 7 e 4t,'a4 �;1 N `' J rB 2„____. .."---N,,. i 0 0300399 co qa op op Parcel: 375501351758, 6245 ROCKY RD 1 in=50ft CLAREMONT, 28610 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 02/08/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375501351758 Owner: SHOOK BOBBY L Parcel Address: 6245 ROCKY RD Owner2: SHOOK JEAN F City: CLAREMONT, 28610 Address: 6256 MONFORD DR LRK(REID): 402803 Address2: Deed Book/Page: 2859/0762 City: CONOVER Subdivision: ROXBURY FIELDS State/Zip: NC 28613-8703 Lots/Block: 2/ Last Sale: School Information: Plat Book/Page: 51/31 School District: COUNTY Legal: LOT 2 PL 51-31 Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: .500 Tax Map: High School: BUNKER HILL Township: CLINES School Map State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $9,600 Zoning3: Assessed Total Value: $9,600 Zoning Overlay: WP-O Year Built/Remodeled: / 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: 1002 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. ©2015, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php'?key=375501351758&typ=P 2/8/2016 .�Y'A • CATAWBA COUNTY �" .� IOOA SOUTI-IWEST BLVD A P NEWTON,NORTH CAROLINA 28658 RECEIPT K/a= a Ja4 96 PHONE: 828.465.8399 j°a►°% Friday, February 19, 2016 842 sM www.catawbacountync.gov PAYOR: Clayton Homes Clayton Homes(Lasage, Bobbi) PAYMENTS TRANSACTION NUMBER: TRC-623831-19-02-2016 PAYMENT DATE : 02/19/2016 PAYMENT TYPE: Check 2572 INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325467 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-02-2016-23254 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6245 ROCKY RD, CLAREMONT NC 28610 Applicant LAVINE SCROGER, 383 N THOMAS LN, STONY POINT NC 28678 C:8285142485 Land Owner BOBBY&JEAN SHOOK, 6256 MONFORD DR, CONOVER NC 28613 Contractor CLAYTON HOMES, PO BOX 132, TAYLORSVILLE NC 28681 C:8282173168 ** NO PEOPLESOET ACCOUNT ASSIGNED ** receipt 02/19/2016 15:04 Page 1 of I