HomeMy WebLinkAboutEHPR-07-2014-19522.TIF .r A • THIS IS NOT A PERMIT Case It EHPR-07-2014-19522
4 �.'Vr 'G CATAWBA COUNTY HEALTH DEPARTMENT 0 .r1
4I PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES .
/842 5M11 Environmental Health Plan Review - Septic Malfunction D.are ch.crai
Sr
AUTH_CONST - SEPTIC_MALFUNCTION 0 sf
Applicant HILLCREST MOBILE HOME PARK (AL ALFONSO), 2010 11 TH ST CT, HICKORY NC 28601
B:8284642662 C:8282175480
Owner COMMUNITYONE BANK NA, PO BOX 1328, ASHEBORO NC 27204
NAME TO APPEAR ON PERMIT
Communityone Bank NA
SITE ADDRESS: 2184 GREENE DR, NEWTON NC 28658 PIN # 372016831333
NAME of SUBDIVISION: Lot# Section/Block
PROPERTY SIZE: Square Feet 193,406.40 Acres 4.440
DIRECTIONS: Radio Station Rd, left on Old Conover Rd, right on Millwood Dr into Hillcrest Mobile Home Park
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
(GAL QNS PER DAY: 480 j E-WAT —SUPPLY: Cammu ' e11
DESCRIBE WOR Revised 5/17/16 - Septic supplies 2 Mobile Homes. 2192 &2184 Greene Dr.
`2 BdRms Each -Total of 480 GPD (Both homes will be staying on property.)
sewage on ground NOV sent
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? Yes
Property Easements Description: roads into park
APPLICATION FOR: Existing Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Mobile p OTHER DESCRIPTION:
DESCRIPTION OF C 2 - SW 14x70
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDRO MS: 4 #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:
19-eliapplicalion 05/17/2016 13:47 Page 1 of7
,aw CATAWBACOUNTY Casey EHPR 07-2 0 1 4-1 95 22
.�a� Public Health Department Subdivision
f��` k Environmental Health Division PIN# 372016831333
7�F PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
1842 s,
NAME ON PERMIT: COMMUNITYONE BANK NA ( ), PO BOX 1328, ASHEBORO NC 27204
Communityone Bank NA ( )
Site Address: 2184 GREENE DR,NEWTON NC 28658
Property Size: Square Feet 193,406.40 Acres 4.440
Directions: Radio Station Rd, left on Old Conover Rd, right on Millwood Dr into Hillcrest Mobile Home Park
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 rulesr—li 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: (- 7 7 . /£ Signature of Applicant or Agent 7 r.- `
An Environmental Health Specialist will contact you within wo mg days of application date.
If you need further information or assistance please call 828-466-7291
AREA2
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[_FEE NM _ 11'G a-:. -, a” lhHr4,u iLwJ iiili DE 1 FEEAMOUNT,
Authorization to Construct (Repair) Fee 07/16/2014 $300.00
Authorization to Construct(Repair) Fee 05/17/2016 $150.00
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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-ehappl ication 05/17/2016 13:47 Page 2 of 7
Catawba County Environmental Health
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Parcel: 372016831333, 1055 OLD CONOVER 1 in=100ft
STARTOWN RD 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
05/17/2016
.gA co CATAWBA COUNTY
Ckri 100ASOUTk-IWESTBLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
s1►e PHONE: 828.465.8399
Alt Tuesday, May 17, 2016
1842 sM www.catawbacountync.gov
PAYOR: Hillcrest Mobile Home Park
Hillcrest Mobile Home Park(Alfonso, Al)
PAYMENTS
TRANSACTION NUMBER: TRC-674420-17-05-2016
PAYMENT DATE : 05/17/2016
PAYMENT TYPE: Check 1068
INVOICE NUMBER FEE NAME FEE AMOUNT
05-16-328453 Authorization to Construct (Repair) 8150.00
Fee
TOTAL PAYMENTS : $150.00
EHPR-07-2014-19522
CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction
SITE ADDRESS: 2184 GREENE DR, NEWTON NC 28658
Applicant HILLCREST MOBILE HOME PARK, 2010 11TH ST CT, HICKORY NC 28601
B:8284642662C:8282 175480
** NO PEOPLESOFT ACCOUNT ASSIGNED **
Owner COMMUNITYONE BANK NA, PO BOX 1328,ASHEBORO NC 27204
receipt 05/17/2016 13:46 Page 1 of 1