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HomeMy WebLinkAboutEHPR-03-2016-23422.TIF / $A THIS IS NOT A PERMIT Case # EHPR-03-2016-23422 FT ;04 H CATAWBA COUNTY HEALTH DEPARTMENT 0 •w �o, a. 0 °!'�' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :I • i /842 SM Environmental Health Plan Review - OSWP .o n o. r ti t IMPROVEMENT 0 S'9' . Applicant JAMIE&APRIL PHARES, 5692 ADOLPHUS ST, CATAWBA NC 28609 Contractor CMH HOMES (DEENAABEE),2026 NORTHSIDE DR, STATESVILLE NC 28625- C:7042393693 Land Owner DONLAD SPENCER,2850 SPENCER RD NE,CONOVER NC 28613 Paid By *ABEE'S CLEARING&GRADING (DEENA ABEE), 2381 US HWY 64 W,MOCKSVILLE NC 2702 C:7042393693 ABEESCG a AOL.COM NAME TO APPEAR ON PERMIT Jamie & April Phares SITE ADDRESS: 5186 CORBAN ST, CLAREMONT NC 28610 PIN # 376402950465 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 497,455.20 Acres 11.42 DIRECTIONS: 321 North, Right onto Conover Blvd, Left onto Oxford School Rd, Left onto Riverbend, Right onto Bolick, Left onto Corban St& property is at the end on upper Right corner. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only for Purchase* Modular Home 32x76, Attached Garage 24x24, Front Porch 6x36, Back Porch 10x12 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Vacant Land EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 46x100 #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-chapplication 03/17/2016 13:40 Page 1 of /p9A \ CATAWBA COUNTY Case 4 EHPR-03-201 6-23 422 /3/'rat y\ Public Health Department Subdivision ����47 "',Gt=t k Environmental Health Division PIN# 376402950465 \' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 !gam s, NAME ON PERMIT: (JAMIE&APRIL PHARES), 5692 ADOLPHUS ST,CATAWBA NC 28609 ( Jamie & April Phares) Site Address: 5186 CORBAN ST, CLAREMONT NC 28610 Property Size: Square Feet 497,455.20 Acres 11.42 Directions: 321 North, Right onto Conover Blvd, Left onto Oxford School Rd, Left onto Riverbend, Right onto Bolick, Left onto Corban St& property is at the end on upper Right corner. 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 responsi e for the proper identification d la eling of all property lines and corners and making the site - ces-'•le so that a complete si - -�:1 d ion can be pe ormed. Date: a3 i�I I C Signature of Applicant or Agent ,� / 0, iv _�a�r_ 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 ******..**...*.**.....*.**.***.*..******....*****....******..****.*..*****......**...**...*.*..*...******... pommittysin FEENAME pI dam" E 1:iih g a� 3 { ,v��aµ '. i'2ri r�'v(Ij°f 'l �'.a: rare+;.,4 EFi1% 1"p di_._ _. iga. s it';!,5 9„a st:!;+aS,I..3.,:y n lib aNd :DATET . an 1S FEE:'AMOUNTri Improvement Permit Fee 03/17/2016 $150.00 a'1[�ey TOTACFEES ' x i y f ,I" , r 4E ,.:`�5. as ' 51511110 _ ,a�Pd1� >.a4I.C � n,. *�3G.qura2`, Y .c_a;a='E'a ,a,a,,;iita"�o�nG t�,pF.,`..�1>+�'��a..., AZog:a.�.. �4ra s _*_?#� 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 03/17/2016 13:40 Page 2 of 5 CeT wB THIS IS NOT A PERMIT `cODUNTY f v r aJ` > CATAWBA COUNTY HEALTH DEPARTMENT ,,;;d,�„ ,. Application for Environmental Services Page I Improvement Permit W Authorization to Construct❑ Septic Repair CI Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction A Existing Facility ❑ Property Address 51 Sty ! Qrll n n Si-, Subdivision Car n—nni-, A/6 4E65,ID Lot# Acres /i, `i-a- /1 Section/BlocWPhase Driving Directions to Property ,3, I KT — C ( pnov,,r '�h rd - (D w-C'-,^mot 3r hnn 1 — g) K_N EAoim - (Rya-Aid,: --(D oN Co r hn,.r, - pro p1 ' ft3 a.: r f F- NAME TO APPEAR ON PERMIT? ❑Owner xi Applicant ❑ Contractor Applicant Contact Information Name .` Th rv-Ni(2) $ Apr;1 Elmore S Address 5106gQ Atin iphi 4c St- On 47n1 n bit,, NJe Phone I Cell Phone. Owner Contact Information Name �nr-v-7 Id 11 SpaneaT Address 48 63 S rzrein r tJ H F Cncm m e , NC.) Phone i Cell Phone _ _Contractor-Contact.Information - . Name ( cT 4 J rnt c.,' T /In a ' Ah0e> I License# Address c90- 1.0 Nir rI-fiC uru#) `fir, &a:L.2 w iu I e, if 0 Phone. Cell Phone 17Q4--499- ,. i.,,,95.,..3 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ALContractor • Description of Existing Structures on Site #.of Bedrooms st Struc mensiohs" r #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. Oyes al No Does the site contain any jurisdictional wetlands? ❑Yes ,fg No Does the site contain any existing wastewater systems? ❑Yes ,1RNo Is any wastewater going to be generated on the site other than domestic sewage? Ayes ❑No Is the site subject to approval by any other public agency? ❑ Yes SINo Are there any easements or right of ways on this property? Describe Existing water supply in use E! Individual Well ❑Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available?** ❑ Yes o 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 ❑ Any -Ctiu Tifia 1f CATAWBA COUNTY 1iJ AUni R :I AK11VILL IN ,,,,,,,...„-, Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence , 5 New Residence ❑ Addition to Residence if of New Bedrooms 'f Project Description_1l(rli) S. x 7a Mori) wf -{rootrcb 1 io klaCa back ppa4L el- Structure Dimensions L v~ 100 .#of Occupants 5 OLteac&el rrnia-■ Basement ❑ Yes No Basement Fixtures ❑Yes ,4 No ❑ Accessory Structure(s) Describe #of New Bedrooms*t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑Yes ❑No Plumbing ❑Yes ❑No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total#Bedrooms 51. 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 ❑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 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. OQ,/Za..)Q(ir-e Date )a J/(€ Printed Name of Owner or Agent T oenCC. e Q=t Catawba County Environmental Health • /__ `' 56.85 ' 7 / 585---- 13.8 ° a m rn rn 2•..p f 38 25 299.48 45.78 jj 45. 8 7 353..1 U- (630) . II Ai c "1 co p it l �' i G D 0 _, ' \ sso E act N. \ \ Parcel: 376\\402950465, 5186 CORBAN ST 1 in=80ft 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 03/17/2016 ,� Catawba County Environmental Health 2t. : r. i 59.95 l 13.:• a . al Ommog q 45.+: 353 51 u�a) ma O N . an MN immy ro OP m ra la o m w U G n _ a 209. to 0 A t rid t. r ... . It...200 ' 0, i co , 4,, )10, \i Aci 1111 t i Ike, G.,,,,.„„ 4 ce 175 CO N. CONKER ST U .. io9 t ti r —°—_ �' too 6 Parcel: 376402950465, 5186 CORBAN ST 1 in=150ft 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 03/17/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 376402950465 Owner: SPENCER DONALD RAYFORD Parcel Address: 5186 CORBAN ST Owner2: City: CLAREMONT, 28610 Address: 2850 SPENCER RD NE LRK(REID): 60125 Address2: Deed Book/Page: 2056/0759 City: CONOVER Subdivision: State/Zip: NC 28613-8237 Lots/Block: / Last Sale: $12,000 on 1980-08-01 School Information: Plat Book/Page: School District: COUNTY Legal: CORBAN ST Elementary School: OXFORD Calculated Acreage: 11.420 Middle School: RIVER BEND Tax Map: 1809 01007A High School: BUNKER HILL Township: CLINES School Map State Road #: 2408 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: $37,300 Zoning3: Assessed Total Value: $37,300 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: 2007-12-18 Building Permits for this parcel. Firm Panel #: 3710376400K Building Details 2010 Census Block: 1010 WaterShed: WS-IV Critical Area 2010 Census Tract: 010101 Voter Precinct: P27 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=376402950465&typ=P 3/17/2016 CATAWBA COUNTY �" OG 100A SOUTHWEST BLVD H NEWTON,NORTH CAROLINA 28658 RECEIPT 4 ®i► PHONE: 828.465.8399 C) �, °vdw,< Thursday, March 17, 2016 184 . SM www.catawbacountync.gov PAYOR: `Abee's Clearing & Grading *Abee's Clearing& Grading(Abee, Deena) PAYMENTS TRANSACTION NUMBER. TRC-639 1 63-1 7-03-20 1 6 PAYMENT DATE : 03/17/2016 PAYMENT TYPE: Check 6484 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326226 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23422 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5186 CORBAN ST, CLAREMONT NC 28610 Applicant JAMIE&APRIL PHARES, 5692 ADOLPHUS ST, CATAWBA NC 28609 Land Owner DONLAD SPENCER,2850 SPENCER RD NE,CONOVER NC 28613 Paid By *ABEE'S CLEARING &GRADING, 2381 US HWY 64 W, MOCKSVILLE NC 27028 C:7042393693 ABEESCG@AOL.COM AOL.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor CMH HOMES. 2026 NORTHSIDE DR, STATESVILLE NC 28625- C:7042393693 receipt 03/17/2016 13:39 Page 1 of 1