The URL can be used to link to this page

Home My WebLink AboutEHPR-06-2016-24023.TIF StY'A THIS IS NOT A PERMIT Case # EHPR-06-2016-24023 ~� '. ' CATAWBA COUNTY HEALTH DEPARTMENT �`'� ''- i0 4 w°9.( • v� � i°" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ' t 1842 s�� Environmental Health Plan Review - OSWP {o4 `o o . IMPROVEMENT- AUTH_CONST - EXPANSION - iiPT.o r ABANDONMENT Applicant DAVID TUCKER, 3458 N OXFORD ST, CLAREMONT NC 28610 C:8282440277 NAME TO APPEAR ON PERMIT David Tucker SITE ADDRESS: 3458 N OXFORD ST, CLAREMONT NC 28610 PIN # 375208976640 NAME of SUBDIVISION: Lot 4 Section/Block PROPERTY SIZE: Square Feet 35,719.20 Acres_ .820 DIRECTIONS: 1-40 exit 135 North Oxford St, 1/2 mile on right second driveway past Keller St PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER D• •_ 360 WATER SUPPLY: Public Water DESCRIBE WOR : Revised 7/21/16 -Abandonment Re.uired to issue the Repair Permif. urren y aving issued with septic system. Existing 2 BdRm Home. Also proposing future addition 16x20 to include 1 BdRm. 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? Yes 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 42x43 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Addition 1 6x20 #OF NEW BEDROOMS:: 1 BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Drilled E9-eliapplication 07/21/2016 16:38 Page 1 of 8 s V,A CATAWBACOUNTY Case It EI-IPR-06-2016-24023 Q 4 Public Health Department Subdivision , Li ` - --.c®1 „'s,I Environmental Health Division PIN# 375208976640 PO Box 389. 100-.A Southwest Blvd.Newton.NC 28658 18 2 s. NAME ON PERMIT: (DAVID TUCKER), 3458 N OXFORD ST, CLAREMONT NC 28610 ( David Tucker) Site Address: 3458 N OXFORD ST, CLAREMONT NC 28610 Property Size: Square Feet 35,719.20 Acres .820 Directions: 1-40 exit 135 North Oxford St, 1/2 mile on right second driveway past Keller 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. understan hat I am solely responsible for the proper identification and labeling of all property lines and corners and making the site ac ss' le so that complet ite evaluation can be performed. Date: 7'02/- /6 Signature of Applicant or Agent A, qth' / / _...- 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 iFEENAMEr NAIL „ , �ii��11I�.wl;II��iglf� .AD>TE,Trinip, I�Ji111;FEEA�MOUNTi� Authorization to Construct Fee (New/Expansion) 06/03/2016 $150.00 Fee Improvement Permit Fee 06/03/2016 $150.00 Well Abandonment Fee 07/21/2016 $100.00 I'7I 1171'fl TOTAL,FEES ` 1,0,.,,I„!,1„.,I l rili I U ,In III /�� ,115400100 I� Pfl tiIii!1.! I,,, .�:i111t a ` I' 'I1 e a/IIIIIIWIW i'i#' e ,- tiTh t nl t I , 11N'I,O,LW`0. 11N1W� �111�11 Yu"' rinIxi 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) 1i9-ehapplicatlon 07/21/2016 16:38 Page 2 of 8 CATAWBA THIS IS NOT A PERMIT � j 22L oux�� CATAWBA COUNTY HEALTH DEPARTMENT .. Application for Environmental Services Page I Improvement Permit ❑ Authorization to Construct ❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment m❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Q Property Address 3458 NORTH OXFORD STREET Subdivision CLAREMONT NC 28610 Lot# Acres Section/Block/Phase Driving Directions to Property NAME TO APPEAR ON PERMIT? ❑ Owner [ Applicant ❑ Contractor Applicant Contact Information Name DAVID TUCKER Address 3458 NORTH OXFORD STREET CLAREMONT NC 28610 Phone Cell Phone 828 244-0277 Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑u Applicant ❑ Contractor Description of Existing Structures on Site SINGLE STORY FRAME VINYL # of Bedrooms *t 2 Structure Dimensions 451X 42' #of Occupants 2 Basement ❑® Yes ❑ No Basement Fixtures Q Yes CI 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. O Yes p No Does the site contain any jurisdictional wetlands? O Yes la No Does the site contain any existing wastewater systems? ❑ Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes O No Is the site subject to approval by any other public agency? O Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well ❑® County(City/Township Water Line Is a public water supply available? ** LJ Yes ❑ 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) O Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT coart- - _ _ CATAWBA COUNTY HEALTH DEPARTMENT - ,w. '" a� Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *i Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® 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 *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 U No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type Q 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. 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 per med. Signature of Owner or Agent �, Date 7 /' / Printed Name of Owner or Agent H Ili e! "13,,,AiniC) CATAWBA COUNTY IOOA SOUTHWEST BLVD E, L _ NEWTON, NORTH CAROLINA 28658 RECEIPT d eaPHONE: 828.465.8399 U MS vdThursday, July 21, 2016 \84www.catawbacountync.gov PAYOR: "fucker, David PAYMENTS TRANSACTION NUMBER: TRC-744880-21-07-2016 PAYMENT DATE : 07/21/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330773 Well Abandonment Fee S100.00 TOTAL PAYMENTS : $100.00 EHPR-06-2016-24023 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3458 N OXFORD ST, CLAREMONT NC 28610 Applicant DAVID TUCKER, 3458 N OXFORD ST, CLAREMONT NC 28610 C:8282440277 ** NO PEOPLESOFTACCOUNTASSIGNED ** receipt 07/21/2016 16:38 Page 1 of 1 y�Y A THIS IS NOT A PERMIT Case # EHPR-06-2016-24023 CATAWBA COUNTY HEALTH DEPARTMENT 0 �o. f U 0\ ro l c � -'Kt- PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ,1 /84175. Environmental Health Plan Review - OSWP U U - o lit•IMPROVEMENT - AUTH CONST - EXPANSION o mo . Applicant J DAVID TUCKER, 3458 N OXFORD ST, CLAREMONT NC 28610 C:8282440277 NAME TO APPEAR ON PERMIT David Tucker SITE ADDRESS: 3458 N OXFORD ST, CLAREMONT NC 28610 PIN # 375208976640 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 35,719.20 Acres .820 DIRECTIONS: 1-40 exit 135 North Oxford St, 1/2 mile on right second driveway past Keller St PRTACT: Applicant SEWER TYPE: Septic Tank GALLONS P DAY: 360 j WATER SUPPLY: Public Water DESCRIBE WORK: Gurre`ntly having issued with septic system. Existing 2 BdRm Home. Also proposing future addition 16x20 to include 1 BdRm. 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? Yes 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING XISTING R �uMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM'• dition 16x20 #OF NEW BEDROOMS:: 1 BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 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. If you need further information or assistance please call 828-466-7291 AREA2 ************************************************************************************************************ 139-ehappllcauon 06/08/2016 08:26 Page I of 4 S�7A CATAWBA COUNTY Case a EHPR-06-2016-24023 gift(s Public Health Department Subdivision < "ac Environmental Health Division PINT/ 375208976640 '731K.9. PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 Jg.2 ,s NAME ON PERMIT: ( DAVID TUCKER), 3458 N OXFORD ST, CLAREMONT NC 28610 ( David Tucker) Site Address: 3458 N OXFORD ST, CLAREMONT NC 28610 Property Size: Square Feet 35,719.20 Acres .820 Directions: 1-40 exit 13 5 North Oxford St, 1/2 mile on right second driveway past Keller St prali I 1il - }e 4n r ,.411th i) " IHf . a A j Ai4. lj IIrti 4Puori ii0;H fg DATE IFEEAM OUNTa Authorization to Construct Fee (New/Expansion) 06/03/2016 $150.00 Fee Improvement Permit Fee 06/03/2016 $150.00 411 "�ti�. . i noO�Ttu A�Lr Imnnuithmli atli ajumm ilW1'6ifi11nfi IDisAtiWI�IIti r o7stmo $300nr0suJ',9'' 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-ehapplicnion 06/08/2016 08:26 Page 2 of 4