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HomeMy WebLinkAboutEHPR-04-2016-23545.TIF ,S1p'A ° THIS IS NOT A PERMIT Case # EHPR-04-2016-23545 cta CATAWBA COUNTY HEALTH DEPARTMENT P +, O Q y ::F 'C - •° ' ti 'grr `awl " PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 ..$124 sm Environmental Health Plan Review - OSWP ° + n 3 r IMPROVEMENT • •n Owner RANDY MOSER, 4061 CARLTON DR, CLAREMONT NC H:8284597720 C:8283031097 HOME:8284597720 NAME TO APPEAR ON PERMIT RANDY MOSER SITE ADDRESS: 4942 ROCK BARN RD, CLAREMONT NC 28610 PIN # 376301279838 NAME of SUBDIVISION: Lot# A-4 Section/Block PROPERTY SIZE: Square Feet 17,859.60 Acres 0.41 DIRECTIONS: 140 Rock Barn Ext from Hickory, Left onto Rock Barn Rd, Go past the golf course, go across the bridge, Community Rd will be on the Left& right across is 3 mobile homes, vacant lot past the 3rd. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP to ensure septic can go on lot. 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: SW 14x66, Decks: Front 8x8, Back 4x4 #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: F9-ehapplication 04/01/2016 10:55 Page 1 ors C e CATAWBA COUNTY cast EHPR-04-2016-23545 t% Public Health Department Subdivision 7( �r^e Environmental Health Division PIN# 376301279838 ® PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 g2 sw NAME ON PERMIT: ( RANDY MOSER),4061 CARLTON DR, CLAREMONT NC ( RANDY MOSER) Site Address: 4942 ROCK BARN RD, CLAREMONT NC 28610 Property Size: Square Peet 17,859.60 Acres 0.41 Directions: 140 Rock Barn Ext from Hickory, Left onto Rock Barn Rd, Go past the golf course, go across the bridge, Community Rd will be on the Left& right across is 3 mobile homes, vacant lot past the 3rd. 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 pr perty lines and corners and making the site act sable o that a complete site evaluation can be performed. Date: L(—) —9 O / Signature of Applicant or Agent h 72-) c9yz 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 F of rs a i t d ;_. M l` J ii' I " 11 f �i2F :l 4 FEENAME . iye r� szi tilliL-?ky t l,ns 1DATE EEAMOUNT Improvement Permit Fee 04/01/2016 5150.00 ' ;lird 4TOTALFEES t — ' 1a:. 04 + =S15000` Mf a . , _ . , l .pli ..� ss..L ..- o6;r� .-.r . . . .: ._« � ,p _c r �r i_ rk -,.E.... l'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-eliapplication 04/01/2016 10:55 Page 2 of 5 cATAWBA. THIS IS NOT A PERMIT „`coumrY v a CATAWBA COUNTY HEALTH DEPARTMENT „h�, Application for Environmental Services Page 1 Improvement Permit Authorization to Construct _ Septic Repair in Septic Malfunction ❑ Septic Expansion n New Well Permit n Replacement Well n Well Abandonment n Well Repair ❑ Existing System Inspection (Pre-Approval Required) n Application is for New Construction Existing Facility n Property Address if q L{ If oe,4 11(/7 KJ Subdivision Lot# Acres Section/Block/Phase Driving Directions to Property e 0, I) a _ e • ' • "/"f'Ke No,3E NAME TO APPEAR ON PERMIT? Owner H Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone `�1/ Owner Contact/Information 7R, Name u a/7 ci y� g /22„ be�. ile '\ Address L( D6 / 04 �{( T"ch i f C /,9-/tie 7,-7 6.1i YI/C 6"/6 Phone T „ ,,c? 7 ) -0,, 6 Cell Phone gfl- es3- j 6 9 7 Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site ‘3 11” # of Bedrooms *I" Structure Dimensi s - #of Occupants Basement H Yes ❑ No Basement Fixtures n Yes ❑ No T 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 �� Does the site contain any jurisdictional wetlands? ❑ Yes L�9"NNy- Does the site contain any existing wastewater systems? ❑ Yes I� N� Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes (3 No Is the site subject to approval by any other public agency? ❑ Yes El-NO— Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well H Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n Yes ENo 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 Cd"Any CATAWBA THIS IS NOT A PERMIT DA() CATAWBA COUNTY HEALTH DEPARTMENT B� Application for Environmental Services Page 2 o' Proposed Facility Type ❑ Primary Residence ®New Residence ry ❑ Addition to Residence #of New Bedrooms *t Project Description 077 9 ( Ml c,9, /e Structure Dimensions / it 6 # of Occupant Basement ❑ Yes 'No Basement Fixtures n Yes No n 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 n 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 ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested n 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. 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 7 P 402� Date q- / ,02O/6 Printed Name of Owner or Agent R a Catawba County Environmental Health • (350) ct a003 41%4.0 me Ur O 50 2p, SI h h • (102) o°j A I I[Hit. 0 //7713(65-41/2 \ Parcel: 376301279838, 4942 ROCK BARN 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 04/01/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 376301279838 Owner: MOSER RANDY PHILLIP Parcel Address: 4942 ROCK BARN RD Owner2: MOSER JANICE MARIE HOKE City: CLAREMONT, 28610 Address: 4061 CARLTON DR LRK(REID): 401055 Address2: null Deed Book/Page: 1782/0304 City: CLAREMONT Subdivision: null State/Zip: NC 28610-9649 Lots/Block: A-4/ null Last Sale: School Information: Plat Book/Page: 40/14 School District: COUNTY Legal: LOT A-4 A-4 PL 40-14 PL 40-14 Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: .410 Tax Map: null High School: BUNKER HILL Township: CLINES School Map State Road #: 1709 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-30 Building(s) Value: $0 Zoning2: null Land Value: $8,600 Zoning3: null Assessed Total Value: $8,600 Zoning Overlay: WP-O Year Built/Remodeled: null/null Small Area: ST STEPHENS/OXFORD 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 #: 3710376300J Building Details 2010 Census Block: 2012 WaterShed: WS-IV Protected 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=376301279838&typ=P 4/1/2016 r 100AA CATAWBA COUNTY p SOUTHWEST BLVD $ NEWTON,NORTH CAROLINA 28658 RECEIPT W� 4.! . PHONE: 828.465.8399 ye". Friday, April 1, 2016 1842 sm www.catawbacountync.gov PAYOR: MOSER, RANDY PAYMENTS TRANSACTION NUMBER: TRC-647585-01-04-2016 PAYMENT DATE : 04/01/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-326761 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EI-IPR-04-2016-23545 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4942 ROCK BARN RD, CLAREMONT NC 28610 Owner RANDY MOSER. 4061 CARLTON DR. CLAREMONT NC 14:8284597720C:8283031097 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/01/2016 10:54 Page 1 of 1