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HomeMy WebLinkAboutEHPR-03-2016-23469.TIF SZ/ G THIS IS NOT A PERMIT Case # EI-IPR-03-2016-23469 Q 4 CATAWBA COUNTY HEALTH DEPARTMENT 0 �� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �•�trF'�: 1842 5. Environmental Health Plan Review - OSWP 3: IMPROVEMENT irPQC\iNcec � Applicant JOHNNY BUMGARNER, 4398 BiLL&BEULAH LN, NEWTON NC 28658 C:8282443008 Land Owner JOHN BUMGARNER,4360 BILL& BEULAH LN, NEWTON NC 28658-8915 NAME TO APPEAR ON PERMIT Johnny Bumgarner SITE ADDRESS: 6821BILL& BEULAH LN, NEWTON NC 28658 PIN # 360804632203 NAME of SUBDIVISION: Lot ft TR 2 Section/Block PROPERTY SIZE: Square Feet 426,888.00 Acres 9.8 DIRECTIONS: Hwy 10 West to Blackburn School Rd, 1/2 mile on Right Bill & Buelah Ln, Past small house on right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing 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: NUMBER OF EXISTING BEDROOMS: It OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Garage w/Apartment over 40x40 #OF NEW BEDROOMS:: 1 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-chapplic:vion 03/24/2016 16:15 Page 1 o14 CATAWBA COUNTY Case# EHPR-03-2016-23469 7'rag - ,y Public Health Department Subdivision Q r� En ironmental Health Division PIN# 360804632203 PO I3ox 389. 700-A Southwest Blvd,Newton. NC 28658 /g.2 ss NAME ON PERMIT: (JOHNNY BUMGARNER),4398 BILL Ks BEULAH LN, NEWTON NC 28658 ( Johnny Bumgarner) Site Address: 4382 BILL& BEULAH LN, NEWTON NC 28658 Property Size: Square Feet 426,888.00 Acres 9.8 Directions: Hwy 10 West to Blackburn School Rd, 1/2 mile on Right Bill & Buelah Ln, Past small 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. Ifyou need further information or assistance please call 828-466-7291 AREA2 'r 3- R t - '^^"^^RP"'li`3 y t i� I"` n ti is 3�If & I i� 2 ,�FEFNAME z °rl3mt 6rrt'F I 'DACE FEEAMOUNTo-1 i.„s :;a m ................._,...... 2 :F::. .,.,....0 I�� ....rd.: Improvement Permit Fee 03/24/2016 S150.00 IOCALHIIS s u ' '4^ .v s, � Et, 't�`# $15000ah. t + ",.x'1.0;So!JAE 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-ehappl■csuion 03/24/2016 16:15 Page 2 of 4 $A c G THIS IS NOT A PERMIT Case # EHPR-03-2016-23469 . `.>o CATAWBA COUNTY HEALTH DEPARTMENT err.,' ��� 0 U ` °"� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � { 1842 sm Environmental Health Plan Review - OSWP d a•• , • IMPROVEMENT ~'° • Applicant — JOHNNY I3UMGARNER, 4398 BILL& BEULAH LN, NEWTON NC 28658 C:8282443008 Land Owner JOHN BUMGARNER,4360 BILL& BEULAH LN, NEWTON NC 28658-8915 NAME TO APPEAR ON PERMIT Johnny Bumgarner SITE ADDRESS: 4360 BILL& BEULAH LN, NEWTON NC 28658 PIN # 360804632203 NAME of SUBDIVISION: Lot# TR 2 Section/Block PROPERTY SIZE: Square Feel 426,888.00 Acres 9.8 DIRECTIONS: Hwy 10 West to Blackburn School Rd, 1/2 mile on Right Bill & Buelah Ln, Past small house on right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Garage w/Apartment over 40x40 #OF NEW BEDROOMS:: 1 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplicatien 03/24/2016 15:25 Page 1 of4 ,$A CATAvVISA COUNTY Case i/ EI-IPR-03-2016-23469 Public Health Department Subdivision T ' Environmental Health Division r: �f-5.4- 360804632203 i P(1v6 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1842 s+ NAME ON PERMIT: (JOHNNY BUMGARNER), 4398 BILL& BEULAH I,N,NEWTON NC 28658 ( Johnny Bumgarner) Site Address: 4360 BILL& BEULAII LN,NEWTON NC 28658 Property Size: Square Feet 426,888.00 Acres 9.8 Directions: Hwy 10 West to Blackburn School Rd, 1/2 mile on Right Bill & Buelah Ln, Past small 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 identificatio, :nd -b-ling of II property lines and corners and making the site accessi•e o that - co ..-te site evaluation can be performed. Date: - _ Signature of Applicant or Agent ,r,'y z Aar,� /��/.fi - An Environmental Health Specialist will contact you witl4 n 5 eking dr)O application date. If you need lurther information or assi,c'ee please call 828-466-7291 AREA2 FPFNAME,, II E _.,_ - a t,..a. „ji;.�, .L".,a DATE, ' t®,.°FEE AMOUNT* Improvement Permit Fee 03/24/2016 $150.00 .. 3 I )H 1 rl O1 VL FEt Sk F•11 :' 10 10 ` d 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) 139-chapplication 03/24/2016 15:25 Page 2 of 4 CATA VBA THIS IS NOT A PERMIT COUNTY a . CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Pera Authorization to Construct n Septic Repair n Septic Malfunction ❑ Septic Expansion n New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address I • a Subdivision °� t�earAtarral Lot# Acres ,7„3 cot $ecti s n/Block/Phase Driving Directions to Property , / / / • _ !MS A / PS SO9/ 1915e 0e1) NAME TO APPEAR ON PERMIT? wner H Applicant n Contractor Applicaittentrinforrytation Lr,ncA /1, .rl Etc Name � I SA SO Address Phone Cell Phone Owner Contact Information Name Address s419 /i�gQ a f Lai /1/P(/iii9, 1;7e 1� /Y/y n Phone Cell Phone y, 3 Q r/ Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? n Owner n Applicant ❑ Contractor Description of Existing Structures on Site \jc(ymv Lois- # of Bedrooms *-j- Structure bimensions # of Occupants Basement H Yes n No Basement Fixtures H Yes 5 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 Ld No Does the site contain any jurisdictional wetlands? ❑ Yes GYNo Does the site contain any existing wastewater systems? ❑ Yes DiNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes II/No Is the site subject to approval by any other public agency? ❑ Yes hh/No Are there any easements or right of ways on this property? Describe Existing water supply in use T Individual Well ❑ Community Well H Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** H Yes tl'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 Any C ^TACT 7'p A 1711 CHIS IS NOT A PERMIT COUNTY ,,,,��^ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence V .,New Residence Addition to Residence # of New Bedrooms *-1' Project Description ./New H j�1'>0f"r- Structure Dimensions V O X r9 #of Occupants f Basement ❑ Yes ["No Basement Fixtures ❑ Yes ❑ No n Accessory Structure(s) Describe # of New Bedrooms 4t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes ❑ No Plumbing n Yes 7 No Describe Plumbing Needed (— Multi-Family Residence# Units #Bedrooms per Unit* Total# Bedrooms 11. 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 n Other Facility Type Specify If Church #of Seats Kitchen n Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well ❑ 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 confined 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. •Signature of Owner or Agent Date 3 . 9 V 716 Printed Name of Owner or Age 7A447 i&/2 G/ �'j�`4 /^ Catawba County Environmental Health Ili a , a u f say / (e, , MCI. x :.' ■ic:. 1 4—' 2` - x b x,51 a f r r , If F /ji /J : \ , )• \\1\i' . l to a74 Res I re., • , /7 . t f 1 / , ( .- . , diera: Parcel: 360804632203, 4360 BILL & BEULAH LN -I in=200ft 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 03/24/2016 Parcel Report Page I of I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 360804632203 Owner: BUMGARNER JOHN ASBURY Parcel Address: 4360 BILL & BEULAH LN Owner2: null City: NEWTON, 28658 Address: 4360 BILL AND BEULAH LN LRK(REID): 700381 Address2: null Deed Book/Page: 2063/1828 City: NEWTON Subdivision: null State/Zip: NC 28658-8915 Lots/Block: TR 2/ null School Information: Last Sale: School District: COUNTY Plat Book/Page: 44/1 Elementary School: BLACKBURN Legal: null Middle School: JACOBS FORK Calculated Acreage: 9.800 High School: FRED T FOARD Tax Map: null School Map Township: JACOBS FORK State Road #: 2031 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: $50,000 Zoning2: null Land Value: $42,800 Zoning3: null Assessed Total Value: $92,800 Zoning Overlay: DWMH-O,FPM-O Year Built/Remodeled: 2000/null Small Area: PLATEAU Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710360800J Building Details 2010 Census Block: 4003 WaterShed: null 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 mapheporl 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. http://gis.catawbacounty rnc.gov/nomap/parcef_report.php?key=360804632203&typ=P 3/24/2016 #s- Cp CATAWBA COUNTY 100A SOUTHWEST BLVD a NEWTON,NORTH CAROLINA 28658 RECEIPT iV PHONE: 828.465.8399 U 4r °a®P `C Thursday, March 24, 2016 1842 sM www.catawbacountync.gov PAYOR: Bumgarner, Johnny PAYMENTS TRANSACTION NUMBER: TRC-643 3 23-24-03-2 01 6 PAYMENT DATE : 03/24/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326460 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23469 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4360 BILL& BEULAH LN, NEWTON NC 28658 Applicant JOHNNY BUNIGARNER, 4398 BILL&BEULAH LN,NEWTON NC 28658 C:8282443008 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner JOHN BUNIGARNER,4360 BILL& BEULAH LN, NEWTON NC 28658-8915 receipt 03/24/2016 15:25 Page I or]