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HomeMy WebLinkAboutEHPR-06-2016-24187.TIF �$• �� THIS IS NOTA PERMIT Case# EHPR-06-2016-24187 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /8 2 5M Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION yeti 1 Sid c1 e,,f y - Contractor LEATHERMAN SEPTIC TANK SVC INC (I IARVEY LEATHERMAN),8420 REEPSVILLE RD RD, LINCOLTON NC 28092 11:828244440913:7044622194 C:8284612985 HOM E:8282444409F:7044622636 Owner CORINNE DOOLEY,3772 MAT TINGLY DR,HICKORY NC 28602 NAME TO APPEAR ON PERMIT Corinne Dooley SITE ADDRESS: 3772 MAITINGLY DR,HICKORY NC 28602 PIN# 371009059289 NAME of SUBDIVISION: HIDDEN CREEK ESTATES PHASE III Lot/I 46 Section/Block PROPERTY SIZE: Square Feet 16,552.80 Acres 0.38 DIRECTIONS: Sandy Ford Rd,Right onto River Rd,Left at Hidden Creek Dr,Take the 1st Left,House on the Right. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 ATEk SUNPL1i'1 Community Well 7...2)- DESCRIBE WORK: Tank Only Replacement* Tank has collapsed. It is covered by plywood currently. 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: 50x30 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: eL:ggiliratmn 02/02/2023 10:52 Page I of6 4.,, A �G THIS IS NOT A PERMIT Case # EHPR-06-2016-24187 x CATAWBA COUNTY HEALTH DEPARTMENT D v n r'E t U \ ' ,.! PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES { 1842 sm Environmental Health Plan Review - Septic Malfunction '- I : eglitiL }T Tel y ' AUTH CONST - SEPTIC_MALFUNCTION •0 ,S'o� 1 1, a, 4 i 4.337(Contractor LEATHERMAN SEPTIC TANK SVC INC (HARVEY LEATHERMAN), 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:8282444409B:7044622194 C:8284612985 HOME:8282444409F:7044622636 Owner CORINNE DOOLEY, 3772 MATTINGLY DR, HICKORY NC 28602 NAME TO APPEAR ON PERMIT Corinne Dooley SITE ADDRESS: 3772 MATTINGLY DR, HICKORY NC 28602 PIN # 371009059289 NAME of SUBDIVISION: HIDDEN CREEK ESTATES PHASE III Lot# 46 Section/Block PROPERTY SIZE: Square Feet 16,552.80 Acres 0.38 DIRECTIONS: Sandy Ford Rd, Right onto River Rd, Left at Hidden Creek Dr, Take the 1st Left, House on the Right. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank Only Replacement* Tank has collapsed. It is covered by plywood currently. 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: 50x30 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION 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-ehappl i cation 06/30/2016 16:54 Page 1 of 7 OA Co CATAWBA COUNTY 7: 1 . tai 100A SOUTHWEST BLVD QI�__ y NEWTON, NORTH CAROLINA 28658 INVOICE/RECEIPT g1g aiii PHONE: 828.465.8399 C t) V4sV Thursday, June 30, 2016 1842 sm www.catawbacountync.gov Invoice Number: 06-16-329909 Invoice Date: 06/28/2016 EHPR-06-20 1 6-24 1 87 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3772 MATTINGLY DR, HICKORY NC 28602 Oywru \\ CORINNE DOOLEY, 3772 MATTINGLY DR, HICKORY NC 28602 Contractor) LEATHERMAN SEPTIC TANK SVC INC, 8420 REEPSVILLE RD RD, LINCOLTON NC 28092 H:8282444409B:7044622194C:8284612985F:7044622636 ACCOUNT: 50131 PAYOR: `LEATHERMAN ELECTRIC, INC FEES EHPR-06-2016-24187 FEE AMT DUE AMT Authorization to Construct(Repair) Fee 06/28/2016 $150.00 $150.00 FEES: $150.00 $150.00 TOTAL FEES : $150.00 $150.00 invoicereceipt 06/30/2016 16:56 Page 1 of 1 t3A THIS IS NOT A PERMIT Case # EHPR-06-20 1 6-24 1 87 GG CATAWBA COUNTY HEALTH DEPARTMENT E "~I o a• "finr:y PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES I. . y842 s^M Environmental Health Plan Review - Septic Malfunction AUTH CONST- SEPTIC_MALFUNCTION 0}04: Contractor *LEATHERMAN ELECTRIC, INC (BOYCE LEATHERMAN), 1549 SKYWAY LN, LINCOLNTON 28092 B:7047328332 C:7047328322F:7047328232 LEATHERMANBOYCE n YAHOO.COM Owner CORINNE DOOLEY, 3772 MATTINGLY DR, HICKORY NC 28602 NAME TO APPEAR ON PERMIT Corinne Dooley SITE ADDRESS: 3772 MATTINGLY DR, HICKORY NC 28602 PIN # 371009059289 NAME of SUBDIVISION: HIDDEN CREEK ESTATES PHASE III Lot# 46 Section/Block PROPERTY SIZE: Square Feet 16,552.80 Acres 0.38 _ DIRECTIONS: Sandy Ford Rd, Right onto River Rd, Left at Hidden Creek Dr, Take the 1st Left, House on the Right. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Tank Only Replacement" Tank has collapsed. It is covered by plywood currently. 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: 50x30 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION 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-ehnpplicauun 06/28/2016 13:57 Page 1 of7 ATiA T CAPAWBACOUNTY Case# EHPR-06-2016-24187 Public Health Department Subdivision HIDDEN CREEK ESTATES PH) 4 Q,�: Environmental Health Division ,,, ", .,,, PIN# 371009059289 F/% PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 IH 2 s+i NAME ON PERMIT: (CORINNE DOOLEY), 3772 MATTINGLY DR, HICKORY NC 28602 ( Corinne Dooley) Site Address: 3772 MATTINGLY DR, HICKORY NC 28602 Property Size: Square re Feet 16,552.80 Acres Directions: Sandy Ford Rd, Right onto River Rd, Left at Hidden Creek Dr, Take the 1st Left, House on the 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 identificption la la ling of all property lines and corners and making the site accessible so that a ompl to site `ation,can b- .- ormed. �, Date:'�/ ���� Signature of Applicant or Agent _ , S t �,• l _ 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 t— i t r — u i 1 t" -7 t �� ,�1s.: �.,Iny , i e1 "U II�!tgi i s,i � i7i , �im C, fiAt i.1�^ fuI ! ELLFEENAME - I,I�p{ S,: " I {/bill,: hDATE� I, FEE!AIVIOUNT fl L� ,e.,.,� -e.��..n.....,.. r 7..1 Ii,1,vJY) .�.._-_.II a- it 1 Authorization to Construct (Repair) Fee 06/28/2016 5150.00 f u : r IV lll,,�ly�.... TOTAL-FEES ' a,, '�,V� a illy 1({ni >rlslso 00,�1�. .�?I�s Yillll N ILL_-,.L u.uh . J,!:L ..�:ri uai;..i_::, ..unX221111l 4.211:_4111ilL • 4'!3 I.,.2u.0Rt 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) F9-diappl ieation 06/28/2016 13:57 Page 2 of 7 CATM1�T1RA THIS IS NOT A PERMIT cLo,,, ,,,.c vy�/V .ILA,.➢ CATAWBA COUNTY HEALTH DEPARTMENT °° r."— Application for Environmental Services Page 1 - norm c�.oi Improvement Permit n Authorization to Construct ❑ Septic Repair Septic Malfunction 4 Septic Expansion CI Well Permit ❑ Replacement Well CI Well Abandonment 111\ Well Repair n Existing System Inspection (Pre-Approval Required) \0 - Application is for New Construction ❑ Existing Facility _ Property Address _ 2 & G m... a Subdivision ��- / -4r7 ivG / Lot# Acres SSection/Block/Phase Driving Directions to Property .,(�aq- /0-L / e ko-e- - "tai ' /` / -r•-n - iiI- i 0 On eit NAME TO APPEAR ON PERMIT? Owner _ Applicant VContractor Applicant Contact Information Name Address Phone Cell Phone . Owner Contact Information Name (, ,L n__ Address 3 792 ,V -& -14 A,„ /fitted ' /Erz-y 4/ Phone 11 Phone Contractor Contact Information Name a o.v '_1 n,..ar __ q 4 Address 8 /ea i2e AI 9 -e-:2-,c....-1-8C--t ,il 2 5'27y 2, Phone '1p [/ !'/) .2/� ”, Cell Phone �257 4/I, / .2 ff,f WHO WILL BE THE PRIMARY CONTACT? Li Owner ❑ Applicant 0 ontractor \Description of Existing Structures on Site 46'.2...2.c./( /> -2.7._ # of Bedrooms , 3 i Structure Dimensions SOX-70 #of Occupants j Basement 111 Yes FD4o Basement Fixtures CI Yes IC-1(o 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. p Y5 f Does the site contain any jurisdictional wetlands? es �0 Noo Does the site contain any existing wastewater systems? 0 Yes EH Is any wastewater going to be generated on the site other than domestic sewage? El Yes Is the site subject to approval by any other public agency? Qs 0 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 n County/City/Township Water Line Is a public water supply available? ** ❑ 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) u" Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any CATA wJL�B A THIS IS NOT A PERMIT Ct1UNI1 CATAWBA COUNTY HEALTH DEPARTMENT „ c Application for Environmental Services Page 2 Proposed Facility Type Primary Residence ❑ New Residence I I Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement Li Yes n No Basement Fixtures ® Yes 0 No Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling IT Yes ❑ No Plumbing n Yes No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions IT 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 n Semi-Public Well IT Community Well Abandonment Type n Drilled n Bored IT Dug IT 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. f 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 < a yew roc Date t6 - 2.51 �ry Printed Name of Owner or Agent G9 � L eq ILA et mi Catawba County Environmental Health F oco .7rl ' / F •! ''_ �` r ,_ , is? / 10223 / •89.38 °co ctb' ' r • 112.78 /cniV IS 9 , ( s "-1 r/ r 0R 98.0C\\ 92.28 \/''.. ,r\. ,vo / 705 6:. x499 $s� 108.63 1, if \,,,............./ Parcel: 371009059289, 3772 MATTINGLY DR 1in=50ft HICKORY, 28602 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 at 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 06/28/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 371009059289 Owner: DOOLEY CORINNE A Parcel Address: 3772 MATTINGLY DR Owner2: null City: HICKORY, 28602 Address: 3772 MATTINGLY DR LRK(REID): 600334 Address2: null Deed Book/Page: 3296/0325 City: HICKORY Subdivision: HIDDEN CREEK ESTATES PHASE State/Zip: NC 28602-9771 III School Information: Lots/Block: 46/ null Last Sale: $150,000 on 2015-06-25 School District: COUNTY Elementary School: BLACKBURN Plat Book/Page: 33/121 Middle School: JACOBS FORK Legal: LOT 46 PL 33-121 High School: FRED T FOARD Calculated Acreage: .380 School Map Tax Map: 187H 10012 Township: HICKORY State Road #: null TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $127,600 Zoning2: null Land Value: $16,900 Zoning3: null Assessed Total Value: $144,500 Zoning Overlay: ED-O Year Built/Remodeled: 1994/null Small Area: MOUNTAIN VIEW 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 #: 3710371000J Building Details 2010 Census Block: 2069 WaterShed: null 2010 Census Tract: 011102 Voter Precinct: P23 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(or 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=371009059289&typ=P 6/28/2016 **",Op. Permit and/or Cert. Op. Required_ (Must be completed prior to final) 06201 C A T A W S A COUNTY HEALTH D E P A R T M E N T (704) 465-8270 Lot Eval._(Immpproove.�Permit �!Repair Permit Cert. of Comp. Permit/� oper. Permit_ Owner/Agent 7I �'-2-rC. - / Phone ay �/— 3ocR Address !4 .- AlAr. .' Ls + : c-C Subdivision .. ' i Section/Block/Phase NS Lot# Lot Sze �3 /� Directions: / r:c D/e /-4.->-- ;'? ,IC ..Y , Facility: House Mobile Home Business_ . Other: Tax Map # / O e_-- - 0 Multi-fami _ Other . Zoning Approval # .. L700 7 a- Bedrooms . 4 Seats Employees . Application Rate c GPD Flow j60 Hot Tub or Spa es/no Special Fixtures . 100% Repair Area s/no REPAIR NOTICE: Basement yes o Basement Plumbing yes/no . REPAIRS MUST BE 30 DAYS OR Water Supply: Private . Public Z.------- . DAYS FROM DATE OF PERMIT. Type of System: Trench!/ Bed_ Pump /n1/��Pump/Panel_Panel LPP_Other Tank Size: Septic Tank /OOt) i1..�.e er i Pump Tank Nitrification Field: Total SquarcFeet 900 Depth of Stone '/i:R// Bed Size Trench Width ,C3 Total Length of All Trenches S0 U Number of Trenches S Individual Trench Length_/_/, /x / Feet on Center 9 l Maximum Trench Depth-21i( Distance of Nearest Well f{/Lot Evaluation: Approved yes/no (Void After 24 months) Topo C % Slope Sketch of lot Evaluation Site - System Design - Final _- Texture _. -- -- --. .-,-- / 6 - -- . r, 2� - - -�Y Structure �; Clay Min. /�/ Soil Wetness " '- — — — — — — Soi1 Depth - Restric. Hoz. at " -o 0 1 Available space yes/no .' Overall Class S PS U 1\3°1/4 f I i I ' Comments: -9 ) j l i 0 ..,cc-eN)--- '1\ w m( Septic Tank Contractors t an Ma " d; MUST contact the ( 0' `�. Sanitarian BEFORE changing permit. ) **NO GUARANTEE OR WARRANTY IS IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date 9 -rat -93 (Improvement Permit void after 60 months) rani rian G //'i /-2 (i42, Owner/Agent _ -/FJ Installed By '//.1, Date Sanitarian A.A . . .. .— ( tote any changes/information in red or by sketc on back) *Af****IF A PERMIT HAS TO BE REDESIGNED AND/CR RETRIPS MADE TO THE PROPERTY. THERE******** IS AN ADDITIONAL $25 CHARGE. White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp. I .P. ep CATAWBA COUNTY \� 100A SOUTHWEST BLVD INVOICE/RECEIPT A NEWTON, NORTH CAROLINA 28658 d rna►w PHONE: 828.465.8399 `oaso Tuesday, June 28, 2016 YY l�'r /842 SM www.catawbacountync.gov Invoice Number: 06-16-329909 Invoice Date: 06/28/2016 EHPR-06-20 1 6-24 1 87 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 3772 MATTINGLY DR, HICKORY NC 28602 Owner CORINNE DOOLEY, 3772 MATTINGLY DR, HICKORY NC 28602 Contractor *LEATHERMAN ELECTRIC, INC, 1549 SKYWAY LN, LINCOLNTON NC 28092 B:7047328332C:7047328322F:7047328232 LEATHERMANBOYCE a,YAHOO.COM ACCOUNT: 6612 PAYOR: *LEATHERMAN ELECTRIC, INC FEES EHPR-06-2016-24187 FEE AMT DUE AMT Authorization to Construct(Repair) Fee 06/28/2016 $150.00 $150.00 FEES: $150.00 $150.00 TOTAL FEES : $150.00 $150.00 invoicereceipt 0628/2016 13:55 Page 1 of 1