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HomeMy WebLinkAboutEHPR-03-2016-23315.TIF 4,0A •G THIS IS NOT A PERMIT Case # EHPR-03-20 1 6-23 3 1 5 .ginCATAWBA COUNTY HEALTH DEPARTMENT � ,'.` y 0 s�►e 18 °' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • ti• 'r` it 42 su Environmental Health Plan Review - OSWP o oo •IMPROVEMENT 3�it El?0Old -CINTV) rr Applicant JEFFREY&ASHLEY HARTSOE, 222 BRENTWOOD DR, MAIDEN NC 28650 C:7045023377 Owner JERRY LAWING, 6837 E MAIDEN RD, MAIDEN NC 28650 C:704483258 I NAME TO APPEAR ON PERMIT Jeffrey & Ashley Hartsoe SITE ADDRESS: 4955 LEBANON RD, MAIDEN NC 28650 PIN # 367604926377 NAME of SUBDIVISION: Lot d Section/Block_ PROPERTY SIZE: Square Feet 645,559.20 Acres 14.82 DIRECTIONS: East Maiden Rd towards Hwy 150, Left onto Lenanon Church Rd, Property on Right about 1/2 mile down the road. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Revised 4/5/16 - House dimensions will be 71x60. Revised 4/4/16 - Received Revised hous -plan house dimensions have also changed. IP for Purchase* 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 O F EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 71x60 #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-rhapplicat;of 04/05/20 16 09:52 Page 1 of4 , CATAWBA COUNTY Case a EHPR-03-2016-23315 f' Public Health Department Subdivision < p,�, Environmental IlealthDivision PIN# 367604926377 ® PO Box 389. I00-A Southwest Blvd,Newton.NC 28658 Ig42 s, NAME ON PERMIT: (JEFFREY& ASHLEY HARTSOE), 222 BRENTWOOD DR, MAIDEN NC 28650 ( Jeffrey & Ashley Hartsoe) Site Address: 4955 LEBANON RD, MAIDEN NC 28650 Property Size: Square Feet 645,559.20 Acres 14.82 Directions: East Maiden Rd towards Hwy 150, Left onto Lenanon Church Rd, Property on Right about 1/2 mile down the road. 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 c•:y>ete evaluation can be performed. Date: //AV/6, Signature of Applicant or Agent _ i/_����5� An Environmental Health Specialist will contact you wit in or ing days of application date. If you need further information or assistance please call 828-466-7291 AREA1 *FII I,. I n r. v I SFt 9'4" n : 1 �r.= i ,�I€ +wr :`6 ,II� now itn iti I +FFFNAMEs k ,,�at,ti,, :: 1 r k r� i " DATE,ta I FEFIAMOUNT1 Improvement Permit Fee 03/03/2016 $150.00 l iTOTAL FEFSTZ III t" ,,r '�,� „I - ��, � � I ,$ X5150 00, ,,; I.h , �p��i •-_ ,.. S'�., 1.- .LJ. .v..�.4,Ca�At.L ............... ... ,_�T:i�,L..L ....+'`4.__:.,.,-_... ..._ �+,., 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) 19-chappli ca ion 04/05/2016 09:52 Page 2 of4 �V'' 0 THIS IS NOT A PERMIT Case # EHPR-03-2016-23315 CATAWBA COUNTY HEALTH DEPARTMENT CI D . .o ..g CI 18 '�' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � { 42, sn Environmental Health Plan Review - OSWP ,„ ,4 o•• f�. T IMPROVEMENT 4:w Applicant JEFFREY& ASHLEY HARTSOE, 222 BRENTWOOD DR, MAIDEN NC 28650 C:7045023377 Owner JERRY LAW'ING, 6837 E MAIDEN RD, MAIDEN NC 28650 C:704483258I NAME TO APPEAR ON PERMIT Jeffrey & Ashley Hartsoe SITE ADDRESS: 4955 LEBANON RD, MAIDEN NC 28650 PIN # 367604926377 NAME of SUBDIVISION: Lot 14 Section/Block PROPERTY SIZE: Square Feet 645,559.20 Acres 14.82 DIRECTIONS: East Maiden Rd towards Hwy 150, Left onto Lenanon Church Rd, Property on Right about 1/2 mile down the road. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Revised 4/4/16 - Received Revised house plan & house dimensions have also changed. IP for Purchase* 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: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 70'6"x 48'8" #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: IN-ehapplicaion 04/04/2016 11:08 Page 1 of4 aA CATAWBA COUNTY Case it EHPR-03-2016-23315 ,T I".r.9 ri. Public Health Department Subdivision 4 d�- r®4 ,�^, Environmental Health Division PIN# 367604926377 '- - PO Box 389, 100-A Southwest Blvd.Newton. NC 28658 /842 ,• NAME ON PERMIT: (JEFFREY &ASHLEY HARTSOE), 222 BRENTWOOD DR, MAIDEN NC 28650 ( Jeffrey & Ashley Hartsoe) Site Address: 4955 LEBANON RD, MAIDEN NC 28650 Property Size: Square Feet 645,559.20 Acres 14.82 Directions: East Maiden Rd towards Hwy 150, Left onto Lenanon Church Rd, Property on Right about 1/2 mile down the road. 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 la eling of all property lines and corners and making the site acces .le so that a co j: - e site evaluation can be performed. Date: �7//4o Signature of Applicant orAeent--, An Environmental Health Specialist will contact you wU •'wo ki g days of application date. If you need further information or assistance please call 828-466-7291 AREA1 7 r�' ,r7 ,FEENAMES,!,t i9r..a f4lFLprhtt ,- 1 v/r. '," n.iE, i„7 DATE .E. f§ "FEE?AMOUNTapi Improvement Permit Fee 03/03/2016 $150.00 „4 s 1, x TOTAL FEES ar h, '° z 191.4`116 11.1 x u d 01 lal 11`5150 OO� ti _ar_`..Lgi.z 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 04/04/2016 1 1:08 Page 2 of 4 3A •-• • THIS IS NOT A PERMIT Case # EHPR-03-2016-23315 ;$1 CATAWBA COUNTY HEALTH DEPARTMENT 0 '0 e' .10 ` '� 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL, SERVICES ,t 1842 sM Environmental Health Plan Review - OSWP } n { a c Fr • • 1 • IMPROVEMENT S T S'. _ Applicant JEFFREY& ASHLEY HARTSOE, 222 BRENTWOOD DR, MAIDEN NC 28650 C:7045023377 Owner JERRY LAWING, 6837 E MAIDEN RD, MAIDEN NC 28650 C:7044832581 NAME TO APPEAR ON PERMIT Jeffrey & Ashley Hartsoe SITE ADDRESS: 4955 LEBANON RD, MAIDEN NC 28650 PIN # 367604926377 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 645,559.20 Acres 14.82 DIRECTIONS: East Maiden Rd towards Hwy 150, Left onto Lenanon Church Rd, Property on Right about 1/2 mile down the road. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 65x60 #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplicalion 03/03/2016 10:54 Page 1 of4 r$ CATAWBA COUNTY Case# EHPR-03-2016-23315 ,.T 1 •L Public Health Department Subdivision 6 , ,yc, Environmental Health Division PIN# 367604926377 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 42;42 SM NAME ON PERMIT: (JEFFREY&ASHLEY HARTSOE),222 BRENTWOOD DR, MAIDEN NC 28650 ( Jeffrey &Ashley Hartsoe) Site Address: 4955 LEBANON RD, MAIDEN NC 28650 Property Size: Square Feet 645,559.20 Acres 14.82 Directions: East Maiden Rd towards Hwy 150, Left onto Lenanon Church Rd, Property on Right about 1/2 mile down the road. 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.label'ng of all property lines and corners and making the site acce ale so that - or • - : tion can be performed. Date: 3/,27//0 Signature of Applicant or Agent �...., /�i �0 An Environmental Health Specialist will contact you wit'in work ng says of application date. If you need further information or assistance please call 828-466-7291 AREA1 j'lafi5`»f'' Y• Y n + iilLtitt-j 1y. i Hi �t,G t k t ? I '` H,A D rsl q OFF ge tbk mot` . .n .. xiwaM#°,`�P^ DATEta nt ,iFEE AMOUNT$`=_#, Improvement Permit Fee 03/03/2016 _ $150.00 V 4 TOTALES rivit '% .1111Jl tl2t _ r4EPIP Y $I561'6 �k E ; i . 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-ehapplic lion 03/03/2016 10:54 Page 2 of 4 CAi'AIrV BA THIS IS NOT A PERMIT COUNTY .. .,,, CATAWBA COUNTY HEALTH DEPARTMENT F „ h. Application for Environmental Services Page 1 Lnprovement Permit Authorization to Construct n Septic Repair n Septic Malfunction IT Septic Expansion n New Well Permit❑ Replacement Well n Well Abandonment n Well Repair IT Existing System Inspection (Pre-Approval Required) n Application is for New Construction Existing Facility ❑ .. Property Address(45 ) I Subdivision , r( V Lot# Acres I�}o �(O �" Section/Block/Phase 8- Driving Directions to Property ark �idevr Rd /,,..)a G_'o/ At), /So ci /erY L'. dG A J "ice ‘0/ - P#7 _ r - AA i .aci- / fhl ko C/or ciN /' oar. • NAME TO APPEAR ON PERMIT? n Owner Applicant n Contractor Applicant Contact Information ' Name ''P.crrey ot- /&kte y Ha r+soe Address ,72a,_ gpent-wocd 1.,2,tte , Flo'G+ c NC a2S(056 Phone Cell Phone 70 e(-soa -3377 Owner Contact Information Name Then. tn.rurwy Address 6y83 /y E" we 1/Sd myy , Mo'-de ,7 A/C & C o2� SO Phone 7o y—q. ' 3-ase 1 Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner Applicant n Contractor Description of Existing Structures on Site A1 *t Occupants p Basement ❑ Yes n No Basement Fixtures ❑ Yes n 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 Io Does the site contain any jurisdictional wetlands? ❑ Yes EFINIo Does the site contain any existing wastewater systems? ❑ Yes liff\To Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes EL-No Is the site subject to approval by any other public agency? ❑ Yes LT No Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well ❑ Community Well n Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n Yes R'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) V" ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ID-4y CATAWBA THIS IS NOT A PERMIT cot Iry CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 ' Proposed Facility Type ❑ Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description (-cause "-f a 1-ietetkeci 9G kale Structure Dimensions 625' X !00 #of Occupants 3 Basement n Yes [v]'No Basement Fixtures n Yes nTo ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable _ Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes n 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 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 n Community Well Abandonment Type n Drilled n Bored ❑ Dug n Unknown Well Repair Requested ❑ Yes n 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. t_ — Signature of Owner or Agent , 7 /laii//�r_J"- Date 3424/o Printed Name of Owner or Agent ,/-egi-ey 2 . ! ./ oP Catawba County Environmental Health • I J IM1 .. . ) y..„,,,,,),,,,,\:):: I 18) l i 11,1 � ' O €004 40)1 I i , \iiiiri°7: 1 r ishi I e' I 1• a 5033 U1 .ts 4//141/1/2/0. it \ . • i 3 D "'f I rA r Z F Parcel: 367604926377, LEBANON RD MAIDEN, 1 in=200ft 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 03/03/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367604926377 Owner: LAWING JERRY R Parcel Address: LEBANON RD Owner2: LAWING WINIFRED H City: MAIDEN, 28650 Address: 6837 E NC 150 HWY LRK(REID): 201147 Address2: Deed Book/Page: 2575/0919 City: MAIDEN Subdivision: State/Zip: NC 28650-9288 Lots/Block:/ Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: LEBANON RD Elementary School: TUTTLE Middle School: MAIDEN Calculated Acreage: 14.820 High School: MAIDEN Tax Map: Township: CALDWELL State Road #: 1856 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS Zoningl: R-40 FORD/BANDYS Zoning2: Building(s) Value: $0 Zoning3: Land Value: $95,000 Zoning Overlay: Assessed Total Value: $95,000 Small Area: BALLS CREEK Year Built/Remodeled: / Split Zoning Districts: / Current Tax Bill Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: Building Details 2010 Census Block: 3016 WaterShed: 2010 Census Tract: 011600 Voter Precinct: P9 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. ©2015, Catawba County Government, North Carolina. All rights reserved. Zia 55 LkIPCJI) http://gis.catawbacountync.gov/nomap/parcel_report.php?key=367604926377&typ=P 3/3/2016 yCATAWBA COUNTY tinoj 100A SOUTFIWEST BLVD r; .m l at ra NEWTON, NORTH CAROLINA 28658 RECEIPT \�\ 4 a► ;.i PHONE: 828.465.8399 e +' �C Thursday, March 3, 2016 \1\842 sM ww'w.calawbacountync.gov PAYO R: Hartsoe,Jeffrey& Ashley PAYMENTS TRANSACTION NUMBER: TRC-630891-03-03-2016 PAYMENT DATE : 03/03/2016 PAYMENT TYPE: Check 1363 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325801 Improvement Permit Fee $150.00 TOTAL PAYMENTS : 5150.00 EHPR-03-20 1 6-23 3 1 5 CASE TYPE: Environmental Health Plan Review WORK CLASS: OS WP SITE ADDRESS: 4955 LEBANON RD, MAIDEN NC 28650 Applicant JEFFREY& ASHLEY HARTSOE, 222 BRENTWOOD DR, MAIDEN NC 28650 C:7045023377 ** NO PEOPLESOFTACCOUNTASSIGNED ** Owner JERRY LAWING, 6837 E MAIDEN RD, MAIDEN NC 28650 C:7044832581 receipt 03/03/2016 10:53 Page I of I