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HomeMy WebLinkAboutEHPR-04-2016-23569.TIF gA THIS IS NOT A PERMIT Case# EHPR-04-2016-23569 CATAWBA COUNTY HEALTH DEPARTMENT CI 0. ti " PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 SM Environmental Health Plan Review - OSWP ao 0 0 . IMPROVEMENT •� - o .o Applicant *BLUE MOON BUILDING COMPANY (FREDRICK CAUSBY), 100 NORTH MAIN AV,NEWTON 28658 C:8286383774 BLUEMOONBUILDING@GMAIL.COM GMAIL.COM Land Owner STEWART COOK, 1015 ROLLING GREEN DRIVE,NEWTON NC 28658 NAME TO APPEAR ON PERMIT *Blue Moon Building Company (Fredrick Causby) SITE ADDRESS: 1931 MILTON ST, NEWTON NC 28658 PIN # 372012858538 NAME of SUBDIVISION: AVIAN WOODS PH 3 Lot# 37 Section/Block PROPERTY SIZE: Square Feet 44,866.80 Acres 1.03 DIRECTIONS: Radio Station Rd, Old Conover Startown Rd, Left to Startown Rd, Right at Light about 2 miles Right on Milton St, Corner of Thurber& Mullion St 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:: 74'6"X 75, Future Pool 28x18 w/concrete #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: 69-ehappllcation 04/05/2016 10:48 Page 1 of 5 CATARBA COUNTY Case# PHPR-04-2016-23569 �r `G Public Health Department Subdivision AVIAN WOODS PH 3 < Environmental Health Division PIN# 372012858538 i ® PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 isn't. ,V NAME ON PERMIT: *BLUE MOON BUILDING COMPANY ( FREDRICK CAUSBY), 100 NORTH MAIN AV, NEWTON NC 2865: *Blue Moon Building Company ( Fredrick Causby) Site Address: 1931 MILTON ST, NEWTON NC 28658 Property Size: Square Feet 44,866.80 Acres 1.03 Directions: Radio Station Rd, Old Conover Startown Rd, Left to Startown Rd, Right at Lilght about 2 miles Right on Milton St, Corner of Thurber& Muilton St 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 and labeling of all property lines and corners and making the site accessib f. so that a compl- - ,' - -valuation can b p.rformed. Date: — Signature of Applicant or Agent '@ _. ���� _ . _ 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 ************************************************************************************************************ .yam titFEENAME l�'s' �9x k� fi( ,+ DATE v 'F „mFEE AMOUN+T.'/ .:;.r _. w:: Improvement Permit Fee 04/05/2016 $150.00 OTAL FEES° 11 t E;st tert tz t ':.. .�•y 3' vt(jl t .S15000e t sa.„ I iNa 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-ehapplicalion 04/05/2016 10:48 Page 2 of 5 cTAwB e THIS IS NOT A PERMIT CQUNN r ..r iJt b CATAWBA COUNTY HEALTH DEPARTMENT „,1 Application for Environmental Services Page 1 Improvement PermitX Authorization to Construct❑ Septic Repair ❑ Septic Malfunction n Septic Expansion n New Well Permit n Replacement Well n Well Abandonment ❑ Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction K Existing Facility n Property Address AI ' - a foes Subdivision t/ i C —+it �„ �q Nc i-.)4O1/1 1 C_ Lot# 3-7 Acres / . n:1_ Section/Block/Phase * Driving Directions to Property e. r,k;0 S { 04n,.. '-c" "1-p lent 5 41-r, 1 I tat-. CokirlLGr-0 64 0V1 fei 4- , Go e,✓,i e,,, 01 / r a-- b 14111-6-),..-. 0 kn. 18 6` 4 NAME TO APPEAR ON PERMIT? 1'6 'ner E Applicant I Contractor Applicant Contact Information Name {� Address `/it cz of t !cckC Cr a k4f. 77 G/ iJO7 3 ' St, Ind F - ,frfVP/ (Ai :2Jb 13 Phone z Y ( ,3 3 » y Cell Phone 8-2,2.R- 43s-3 17,x-/ Owner Contact Information / Name S C - e r' S A 6 d L/P Address Phone Cell Phone Contractor Contact Information Name S nv� S e C^ 4 V Q License# Address v Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? WrStwner ❑ Applicant ] Contractor Description of Existing Structures on Site \Are f- Corp(/ #of Bedrooms *t Structure Dimensions o Occupants Basement ❑ Yes H No Basement Fixtures H Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to `t— the property)? question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes Yr o Does the site contain any jurisdictional wetlands? ❑ Yes Does the site contain any existing wastewater systems? El Yes LNo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes Is the site subject to approval by any other public agency? ❑ Yes IIVo Are there any easements or right of ways on this property? Describe Existing water supply in use H Individual Well H Community Well H Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** H 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 0 Alternative Konventional El Innovative ❑ Other El Any cATA BA THIS IS NOT A PERMIT co } •- VV 13 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type hnrimary Residence [lNew Residence H Addition to Residence # of New Bedrooms *t 3 Project Description r, e 1.3 �'; „` c J cv l gay; oba_".c;_ . Structure Dimensions ? )-j /�'` X7s' of Occupants 1 3 Basement ❑ Yes Basement Fixtures H Yes -Hit Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling H Yes n No Plumbing ❑ 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.) n Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen H Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ,Individual Well IH Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug P Unknown Well Repair Requested ❑ Yes H 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. j If structure is plumbed but no bedrooms, calculated design (low 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 ._ ! _S - e �_ Date /7(-1-/—/‘ Printed Name of Owner or Agent - , 1 . �- • Catawba County Environmental Health 4°. jrntli 1 t',. 9 l' 14.72 i, kv 82.99 .68 / /AER tK 143.09 77.71 20 ,ter 5 / .60 1,5>M O 7".7 tir .9.32 .---, �;% O .th� - z- l$\ y err. *A«- 223. 2 \ As Li, / IP 96.21 "I 90.46 350.37 118.77 Parcel: 372012858538, 1931 MILTON ST 1 in=50ft 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 04/05/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 372012858538 Owner: COOK STEWART H Parcel Address: 1931 MILTON ST Owner2: COOK TAMBRA B City: NEWTON, 28658 Address: 1015 ROLLING GREEN DRIVE LRK(REID): 903066 Address2: null Deed Book/Page: 3176/0884 City: NEWTON Subdivision: AVIAN WOODS PH 3 State/Zip: NC 28658-9229 Lots/Block: 37/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: 54/133 Legal: LOT 37 37 PL54-133 AVIAN WOODS PL Elementary School: STARTOWN Middle School: MAIDEN 54-133 Calculated Acreage: 1.030 High School: MAIDEN Tax'Map: null School Map Township: NEWTON State Road #: null TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $0 Zoning2: null Land Value: $38,600 Zoning3: null Assessed Total Value: $38,600 Zoning Overlay: null Year Built/Remodeled: null/null Small Area: STARTOWN 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 #: 3710372000J Building Details 2010 Census Block: 2002 WaterShed: null 2010 Census Tract: 011701 Voter Precinct: P34 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 Geaspatial 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=372012858538&typ=P 4/5/2016 ØA 2'p CATAWBA COUNTY Ti 4 CI IOOASOUTHWESTBLVD V NEWTON, NORTH CAROLINA 28658 RECEIPT d ' S VPI PHONE: 828.465.8399 U les°' Tuesday, April 5, 2016 1842 5M www.catawbacountync.gov PAYOR: `Blue Moon Building Company *Blue Moon Building Company(Causby, Fredrick) PAYMENTS TRANSACTION NUMBER: "IRC-649884-05-04-2016 PAYMENT DATE : 04/05/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-326861 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-04-2016-23569 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1931 MILTON ST. NEWTON NC 28658 Applicant *BLUE MOON BUILDING COMPANY, 100 NORTH MAIN AV, NEWTON NC 28658 C:8286383774 BLUEMOONBUILDINGaGMAIL.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner STEWART COOK, 1015 ROLLING GREEN DRIVE, NEWTON NC 28658 receipt 04/05/2016 10:46 Page 1 of 1