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HomeMy WebLinkAboutEHPR-09-2016-24653.TIF StiLA • THIS IS NOT A PERMIT Case # EHPR-09-2016-24653 Q a CATAWBA COUNTY HEALTH DEPARTMENT 0 Dov €0 v mitPLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES i /842 SM Environmental Health Plan Review - OSWP o.tr'0 o +ri IMPROVEMENT t • a ox Applicant JOSE VALLADARES, 2998 S NC 16 HWY, NEWTON NC 28658-9676 C:8284617464 Land Owner WENDELL MCCASLIN, 3262 SIGMON DAIRY RD, NEWTON NC 28658 NAME TO APPEAR ON PERMIT Jose Valladares SITE ADDRESS: 4456 MOCKINGBIRD LN, MAIDEN NC 28650 PIN # 365602682592 NAME of SUBDIVISION: CARDINAL ESTATES Lot# Section/Block PROPERTY SIZE: Square Feet 17,859.60 Acres 0.41 DIRECTIONS: E Maiden Rd to Jim Beard Rd, Robinette Rd to Mockingbird Ln, Last lot on the Right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32x45 #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: F9-ehappllcatlon 09/02/2016 10:40 Page 1 of 4 g • CATAWBA COUNTY Case 14 EHPR-09-2016-24653 7i, Public Health Department Subdivision CARDINAL ESTATES < HEnvironmental Health Division �'. PINK 365602682592 PO Box 389. 100-A Southwest Blvd,Newton,NC 28658 2g.2 ,. NAME ON PERMIT: (JOSE VALLADARES),2998 S NC 16 H WY,NEWTON NC 28658-9676 ( Jose Valladares) Site Address: 4456 MOCKINGBIRD LN, MAIDEN NC 28650 Property Size: Square Feet 17,859.60 Acres 0.41 Directions: E Maiden Rd to Jim Beard Rd, Robinette Rd to Mockingbird Ln, Last lot 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 identificatioyA and lab ling of all property lines and corners and making the site accessiy a c9mplete site evaluati n n be performed. Date: l� 2� to Signature of Applicant or Agent te-CG—Lrccz2--i An Environmental Health Specialist will contact you within 5 working days of applicatiot ate. If you need further information or assistance please call 828-466-7291 AREA1 r FuNlllffl"I`Plfd h�4 i ,° ,fi n,{ (� - 411'1118lf :I��'j�lIfl 1m1 w �a,�i�lq!Iirn EENAMEi,ry'..�� ({ I � r, • ';'*' tit h{yW{i�!'.gkii'" DATE ELjidihIIFEE:AMOUNTia�l Improvement Permit Fee 09/02/2016 5150.00 .Ikl 71111,11 i � il�'+-,TOTAE EEES I +! a /119 � ���G ��{��1�����I�1d141111111,1111111t ;t $ 0'00 . ti,4 VziEaWtlu'pnrnnbru,,gpi'I"o'aaoL.uilotu nr11pIIWmUgL.y: ,rmglnllltl.. linJwl110 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) r:9-ehappl ication 09/02/2016 10:40 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT cour . CATAWBA COUNTY HEALTH DEPARTMENT „o„„G,,,, Application for Environmental Services Page 1 Improvement PermitX Authorization to Construct❑ Septic Repair❑ Septic Malfunction% Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ / Application is for New Construction Existing Facility H Property Address /"I0cl ` I 05 e- to ICIne Subdivision Aig(*leel Lot# 9 Acres tiny/ Section/BIock/Phase Driving Directions to Property E , m�---c(.Ow�.?c� —t 3 u,„,,, 8_ ret e t nottr R4Q +0 mD(.K-Ivlf'hI.rd L-/J - NAME TO APPEAR ON PERMIT? ❑ OwnerApplicant ❑ Contractor Applicant Contact Information f Name ,J OS2 K , 4/fa 'Otte" S • r / T Address —9 K A/6 /4 /7`4`J/ it .A.9 74k? ol/C 9 mrd c8 Phone Cell Phone g 24 1.714/ 7 (1.4 Owner Contact Information Name 3 Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site U iCA/-i C U— # of Bedrooms *j' Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes ® 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. in Yes ')No Does the site contain any jurisdictional wetlands? fl YesNo Does the site contain any existing wastewater systems? in Yes No Is any wastewater going to be generated on the site other than domestic sewage? ® Yeso Is the site subject to approval by any other public agency? El Yes o Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well H Semi-Public Well ❑ 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 Sys em Type(s): (systems can be ranked in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other ICAny CATA 7THIS IS NOT A PERMIT COUNTY „V.V 1J�A CATAWBA COUNTY HEALTH DEPARTMENT „,jzApplication for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence I[1 Addition to Residence #of New Bedrooms *j Project Description f. I e c/5_, Structure Dimensions $- Z X US # of Occupants 'r,r Basement ❑ Yes rg No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe #of New Bedrooms 41. if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing [ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*f Total#Bedrooms *f Structure Dimensions ❑ Food Service Specify Type # Seats _ Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) Li 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 ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug 7 Unknown Well Repair Requested ❑ Yes n 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 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 snaking the site accessible so that a complete site evaluation can be p formed. 7 ,,, -2 / Signature of Owner or Agent Date Printed Name of Owner or Agent —D � 5 , t GlAtit<4 tr5 Catawba County Environmental Health • • �9 9> 6O •pp •S2 i 1o 6 co 20 or r 8 20 �C. ° . Uli 6 .Nsiiiiiii %, ti N� `i P...@$ c i O P ^O' •• :' Parcel: 365602682592, MAIDEN, 28650 1 in=50ft 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 09/02/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365602682592 Owner: MCCASLIN WENDELL RAY Parcel Address: Owner2: City: MAIDEN, 28650 Address: 3262 SIGMON DAIRY RD LRK(REID): 9975 Address2: Deed Book/Page: 1170/0999 City: NEWTON Subdivision: CARDINAL ESTATES State/Zip: NC 28658-9766 Lots/Block: / School Information: Last Sale: Plat Book/Page: 7/98 School District: COUNTY Legal: 9C PL16-244 CARDINAL PL 7-98 Elementary School: TUTTLE Middle School: MAIDEN Calculated Acreage: .410 Tax Map: 010 K 04037 High School: MAIDEN Township: CALDWELL State Road #: TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MAIDEN RURAL Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $9,000 Zoning3: Assessed Total Value: $9,000 Zoning Overlay: Year Built/Remodeled: / Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710365600J Building Details 2010 Census Block: 5032 WaterShed: 2010 Census Tract: 011602 Voter Precinct: P9 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 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. qq 1)i r'rkfq g rot tf t http://gis.catawbacountync.gov/nomap/parcel_report.php?key=365602682592&typ=P 9/2/2016 i?'ACATAWBA COUNTY OG ]OOA SOUTHWEST BLVD L .<`' V NEWTON,NORTH CAROLINA 28658 RECEIPT dmovirnnia� i PHONE: 828.465.8399 \ D •sc, 1842 sm www.catawbacountync.gov Friday, September 2, 2016 PAYOR Valladares,Jose PAYMENTS TRANSACTION NUMBER: TRC-812889-02-09-2016 PAYMENT DATE : 09/02/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332290 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-09-2016-24653 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4456 MOCKINGBIRD LN, MAIDEN NC 28650 Applicant JOSE VALLADARES, 2998 S NC 16 HWY,NEWTON NC 28658-9676 C:8284617464 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner WENDELL MCCASLIN, 3262 SIGMON DAIRY RD, NEWTON NC 28658 receipt 09(02(2016 10:39 Page I of I