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HomeMy WebLinkAboutEHPR-08-2016-24600.TIF C. THIS IS NOT A PERMIT Case # EHPR-08-2016-24600 Pfl 4 , CATAWBA COUNTY HEALTH DEPARTMENT D • 1 6 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '1 : f �^ 1847, SM Environmental Health Plan Review - OSWP ABANDONMENT o • Applicant BRIAN BEEBE, 7285 RED BANK RD, GERMANTON NC 28019 B:3367445486 C:3363995894 BEEBEE.BACKHOE @YAHOO.COM Owner JOYCE LOFTIN,4025 S NC 16 HWY, MAIDEN NC 28650 NAME TO APPEAR ON PERMIT Brian Beebe SITE ADDRESS: 4025 S NC 16 HWY, MAIDEN NC 28650 PIN # 367803021637 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 42,253.20 Acres 0.97 DIRECTIONS: Hwy 16 S, PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: NC 16 Widening Project 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: ROW APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF home to be torn down EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Bored 1:9-ehapplication 08/25/2016 16:15 Page 1 of 8 gA CATAWBA COUNTY Case# EHPR-08-2016-24600 tjtiik Public Health Department Subdivision , Environmental Health Division PIN# 367803021637 \ - PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /842 sM NAME ON PERMIT: (BRIAN BEEBE), 7285 RED BANK RD, GERMANTON NC 28019 ( Brian Beebe) Site Address: 4025 S NC 16 HWY, MAIDEN NC 28650 Property Y Size: Square Feet Acres Directions: Hwy 16 S, 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,labefng of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Si Date: n DS I ILP Signature of Applicant or Agent e An Environmental Health Specialist will contact you with 5n 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 ************************************************************************************************************ FEENAME I , 33 Well Abandonment Fee 08/25/2016 $100.00 • 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-ehapplicadon 08/25/2016 16:15 Page 2 of 8 l■ 1 ' f CATkViTBA 'ITILS IS NOT A?Engl. k,\IILOD 4 Ot ,'6 V4: 0,04,e141PIN L A.. CAT A,WFS A (.0 LI IN'r`It' H EALTH DEP ARMY'F,'NT I) Application for EnVirOntillental Setvieefi P4ge 1 Improvement permit 0 Autliorizatiou to Construct D Septic,Rp,pal r 0 Septic Malfunction 0 Septic Expansion 0 New'Wen Permit 0 Replacement Well 0 Well Abandonment Z,,r- Well Repair 0 Existing System In ion (Pre-Approval Required) 0 Application is for New Construction Di 'Existing F atifity 0 .„---- 1, , , tz i i c- Property Address i\ 7 JILLj (7, 13 T IO.:) Subdivision 1,1C,,,,,, ::,3ke,;_,)-D _ LW l4 Acres......„_,..... ___ Seetionflitockt.PlutSe Driving i)ireetions to Property_ NAME TO APPEA_R ON PERMIT? 0 own.- La Apprien,,t 0 Contractor Applicant Contact Info rmatiOn ...........--- --- --Name -17,31.1.'4,,n . . ___, Address - "'te- ..,), ) y T.-12 _.,,,,,e71,,E2,4„ ,,,4,,,, If -lc 2 1 Uf fil Phone ?J — 7 ± • cell ?how y $7y 1 Owner Contact InforMation. '.. ..*04.4 Name A.),(... r ,,,,,,.-1 ' .._ 1 Address ■,410.10 tim......,m,ryon*** ...4Irn .VIRM I PhOt It Cell 'Phalle Contrnetor Contnei in kr rrri-a-iiO'n _ ,a.", 6■404,* o,....., Phone "--177;c11 Pbtooe TO WILL IT TI-It PRIMARY CONTACT? 0 Owner I:: Applicant 0 Contra-10r ..ascosiosark. `46,,awkoho.;======pgatetok Ao - . Description of Ex,hail%St nitwits on Si to 6fri,-,_ -,FtcTrfe3r-,16,a,„,,„,, 4-;of Bedrooms l't Structure Dimeosinos 4'of Occupants —„ „„-- — 0trietneot 0 Yes 0 No Basemen; Fix tareii 0\ 0 No The Applicant stali no(tifY the local health department tipoo,sobmittal of this applt=tion if ebY or the thlthwing aPPlY)I.) the prOperty in question. if the answtt,7 to any question is"yes',applicant must attach supporting dorm mem:glom 0'Yt 0 No Does thc she contalo any juristliettortal wetlands? 0 Yes 0 No Dolt;the sitc•col t Can nny Misting wslAtn,vater*stems? 0 Yes 0 No is any wogesteate: goinz to he generated elt the site othcr 1,14:10 0'Yes 0 No Is the she sobject to approval by arty oth aa. nubile ogeney? 0 Yes, 0 No Are tlacie rny easements cr ri4a of ways on this prOpettyl Describe. „,, ggwiffrettuzam====ln ., ., 77"." • leutoweitaiNNINOMINIS 3 i. Fstisaing water supply in use ins3ividnal Weil Community Weil Setzti-1 abbe.),I.di 0 ettnuay/Ciry/Towriship Water Line Is n public vcateT suPP1:9 avltallbta? 'i 4 0 Yes 0 NI) if applying for fin improvement Perinit or Authori2atto ft to Co skstrut I,Pltease indicate Desired System Typet* (systems cm he ranked in order of your prdercnce) 0 Amerned 0 Abta-native 0 Conventional 0 Innovelive 0 Oiber M■111”, 0 ATV,' 2110===a11111iimiaffill211.1101■A. .„,__, ...-.. ,.-..........-.......—.,, . - ..-,, .....**No■..,............Mmillp*Or/Pre■rnil,./.1.■■•■.....011■01wo CATANVBA TI HS IS NOT A PP RrMIT CATAWBA COUNTY HEALTH DEPARTMENT ApplicAtion 167 bnvironannuil Scrvicc5 Page 2 Proposed Facility Type 0 Primp ry Residence 0 New Re;idence 0 Addition to Reisiclencc 4 of Nem,Reatirourns PrOjOZI Descrip;i0f1 Piewtt!, lt() CN,A.„ 1-6,rn. ot„...1 Structure Dirnensions #or Occupants Basmnent 0:Yes 0 No Basement Fixtures 0 Yts 0 No ,Aeet;SQry St reirlLl re(t;) niNcw Iladrooarut *-t if npplicable Structure 1)imens;ort g Occupants AccvSSOry owciiing 0 yk^,' 0 Nu Pmbing, 0 Yes 0 No Describe Plumbing Needed anuly 14,testilence Dolts RRMIr1601115,per Untll'i Total#Bedrooms **I' Structure lAnittisions it Food Service Specify Type Scots Floor Space.-Entire Food Servics:Facility (Sy Ft) Ennfloyees per Shill #of Shifts I)irting Aro (Sq. f-1.) El Business Specific Type of gusitiess_._ Retai '''foor spatt 4 of Employees per Shill alS'hifts Other Facility Type Spetity tr(::fmrch#„,IScats Kitchen LI Yo No I r l'fayeacc Specify Occupancy Application for Well Co nstructiort/AbundonmentiRepair Proposed Well Type D thdividtuii wen El !'.icirrti-Publie Well Conurainiry Well Ahapdanment Type El Drilled Boxed 0 Du 13 Well Repair Requested 0 Yes 0 No Deselibe. "-:),2!2” d;„ zit de,i) /7 Calculated Deli Flow,Cononcycial t, Athrlitional itici,,Itrstration natty be required to determine design flow front tortilla facilities. ThiS vu e%vitt bo:determined doling consultation with on-site staff. , - - 'Arty rt.fart that will he intauled for,ICtpirt,?,,ot th rima of tom:truce:cc Or fur future ixoriliderritiom Ateetid c nouni ns,n,ixteiroogrk;mkt counted on all find itedicrik The number of bedrotaras will be catitirmed by rooms identified an house plans as z tacitly=n the time of boildin rTht issuamcc. This may provut the rtteri frer septic system size ink:mai,:in din fixture. I' II tiirtugtot.:i:..tpitunitietti but no bedroom/S.(210014%1d design flow is required. *ft If Na.a well perniit rung be issued with the AulhOrinlinon to Comdrum. SYS'EENI REDESIGN .A.NI)/014 R1'UW W HA. INCUR AN APDFI*1°NAL CIIAR4;E(SEE FEE SCITEDUIE) boproyemeot Pcnniz$Ls.,:rucci Lt.% reNuit of this information=re leatid for 5 as or maybe coo.engiringt under certain specified ereeditiens.Air Authorization to Comzstio isstunt hy thiA department h v:,:tinid I't' froc ycarns from Ilse daze 460,E,4 and itc rt.a romsfenthk;improvement 0...rinits:la Welt Penni its,are trarectrtible, NI-mitt;nary b revoked if the irtfnrmatim on TIM:applicutiert. site plans or inictuJed to:ensii:,Algtnns,far the propo9oJ 161;fiity. hmoe rend this applietttionfatui=ley that the Intortiott irovicted herein is truz,complete ntui oarrcet- Authecixcil courtryttatt-aatz Alt:tub;are..4rdtutexi fish:of entry to conduct neeessory impect cra i.to dom.:hi:le ocritplidrIce with d.pplie-able lw ho Rik*. encleria=fd that I am so.lely,responoThle for the propti ideriiification arid labeling of all gropealy lines and cm-masa:lid maidng the site acre:stalk. 1)Ault 41 comp/etc gat,evaluation on ha performed,. 11) StralUrd OValter or Agcnt. (2"*,(A.,4 " Datc a- 2 i - Printed Nutt e of Owner or Agent 1) 1\ . ..,...„,„. \,,, . .„.„ , \ . . \--' - „.. 1,,,. .... , 0, ,., „....,, ,...._,,,„ , ...,,..,_ . ..,...„ .,,.... „ , .„,.... ,... , , \\,'' ...„......„_,.. 4 1..,.... ._.) . I . .,..) _ . . ,...... 13 1 11 i , ........ ........____... ,......._ ..m........____ _...-........... Catawba County Environmental Health (29) ON \N\ ' ; „Iiiiiworeb...„ , rV Q #ili i i i i i 0, ' .-105 /le , "' °%,,,.. Parcel: 367803021637, 4025 S NC 16 HWY 1 in=60ft MAIDEN, 28650 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 08/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 367803021637 Owner: LOFTIN JOYCE I Parcel Address: 4025 S NC 16 HWY Owner2: null City: MAIDEN, 28650 Address: 4025 S NC 16 HWY LRK(REID): 4860 Address2: null Deed Book/Page: 2095/1980 City: MAIDEN Subdivision: null State/Zip: NC 28650-8925 Lots/Block: null/ null Last Sale: School Information: Plat Book/Page: 40/153 School District: COUNTY Legal: HWY 16 PL 40-153 PL 40-153 Elementary School: BALLS CREEK W Calculated Acreage: .970 Middle School: MILL CREEK Tax Map: 005 K 03009 High School: BANDYS Township: CALDWELL School Map State Road #: 16 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoning1: R-40 Building(s)Value: $114,500 Zoning2: null Land Value: $13,300 Zoning3: null Assessed Total Value: $127,800 Zoning Overlay: RP-O Year Built/Remodeled: 1955/null Small Area: BALLS CREEK 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 #: 3710367800J Building Details 2010 Census Block: 2000 WaterShed: 2010 Census Tract: 011601 Voter Precinct: P1 Agricultural District: Proximity 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=367803021637&typ=P 8/25/2016 . 8A Cp CATAWBA COUNTY '7"' �'" 100A SOUTHWEST BLVD F"� NEWTON,NORTH CAROLINA 28658 RECEIPT : � � PHONE: 828.465.8399 �el® Thursday,August 25, 2016 /8 4'2' sM www.catawbacountync.gov PAYOR: Beebe, Brian PAYMENTS TRANSACTION NUMBER: TRC-800662-25-08-2016 PAYMENT DATE : 08/25/2016 PAYMENT TYPE: Credit Card 171034992 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332049 Well Abandonment Fee $100.00 TOTAL PAYMENTS : $100.00 EHPR-08-2016-24600 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4025 S NC 16 HWY, MAIDEN NC 28650 Applicant BRIAN BEEBE, 7285 RED BANK RD, GERMANTON NC 28019 B:3367445486C:3363995894 BEEBEE.BACKHOE @YAHOO.COM **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner JOYCE LOFTIN,4025 S NC 16 HWY, MAIDEN NC 28650 receipt 08/25/2016 16:15 Page 1 of 1