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HomeMy WebLinkAboutEHPR-09-2016-24662.TIF .sAS)A CO THIS IS NOT A PERMIT Case # EHPR-09-2016-24662 ,� � CATAWBA COUNTY HEALTH DEPARTMENT 0 + 0 Q R.- PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 3 a t ti 1842 SM Environmental Health Plan Review - OSWP • 'ULs • D r IMPROVEMENT o Owner JEREMIAH BUFF, 4971 S NC 16 HWY,MAIDEN NC 28650 C:8284554499 NAME TO APPEAR ON PERMIT Jeremiah Buff SITE ADDRESS: 1720 CORDIA CIR,NEWTON NC 28658 PIN # 366903120514 NAME of SUBDIVISION: BARRINGER WOODS PH 3 Lot# PT 89 Section/Block PROPERTY SIZE: Square Feet 103,672.80 Acres 2.38 DIRECTIONS: South on Hwy 16 toward Charlotte, Left at Balls Creek Bait&Tackle, 1st Left onto Barringer Woods, Left onto Cordio Court, Lot is on the Left after the curve. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only at this time* 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: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 58x44 #OF NEW BEDROOMS:: 3 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: E9-ehapplication 09/02/2016 14:40 Page 1 of4 SBA • CATAWBA COUNTY Case 8 EHPR-09-2016-24662 T4.72 t ! , Public Health Department Subdivision BARRINGER WOODS PH 3 Z - Environmental Health Division 1 &e PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 PIN# 366903120514 ig.2 :w NAME ON PERMIT: (JEREMIAH BUFF),4971 S NC 16 HWY, MAIDEN NC 28650 ( Jeremiah Buff) Site Address: 1720 CORDIA CIR,NEWTON NC 28658 Property Size: Square Feet 103,672.80 Acres 2.38 Directions: South on Hwy 16 toward Charlotte, Left at Balls Creek Bait&Tackle, 1st Left onto Barringer Woods, Left onto Cordio Court, Lot is on the Left after the curve. 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: O9 -O 2_0I tc Signature of Applicant or Agent 7Jvn,,J An Environmental Health Specialist will contact you within15 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 *********.*******k***********************************************t******************************************* r,,FEENAmE'' FDATEt ; FEE,AMOUNTV-1 Improvement Permit Fee 09/02/2016 $150.00 � , r ,=TOTAL FEES ' 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) 09-eliapplication 09/02/2016 14:40 Page 2 of 4 • CATAWBA THIS IS NOT A PERMIT COUNTY L� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit 2/ 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 IA Existing Facility ❑ Property Address \ LO Cor-A(0. Subdivision ljarr?r.se,r I.J0a /1Je,,4vn /JC 2_5G5' Lot# `61 Acres 2. Section/Block/Phase Driving Directions to Property V)),-.(, r -{-t-,...c I;,5 So ort Nt,J Y 16 -jot Ck -- o.H-e. + kQ leP4 a4 tR,,t 13 CrzJ.J /La /c @"4- \- cold m cle . rS4 \'< OY0 ��rrj.--S e ✓' 'vJ C o�5 . mace at-eolte✓ AGYT ei.T)c7 `D fr-r4 NAME TO APPEAR ON PERMIT? 12/Owner ❑ Applicant ❑ Contractor C"'C l( Applicant Contact Information Name ❑-ert,n oI g1 Address y111 $oL'� NC is Hf✓Y Y 1 \ G(e,-� 25-C,50' Phone Cell Phone 752_S -2-155-11` 9 Owner Contact Information Name Su ; ije,,,Cic Address 0e11I 50 Li y NC /C. F/WY .lo.i ev-\ 27(056 Phone Cell Phone y 55-4 9 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑.Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site VCT nLI Lof # of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures C) 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. ® Yes IgiKlo Does the site contain any jurisdictional wetlands? ® Yes ®'4o Does the site contain any existing wastewater systems? ❑ Yes SNo Is any wastewater going to be generated on the site other than domestic sewage? ® Yes O'Slo Is the site subject to approval by any other public agency? C Yes Eg/No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well I I Community Well LI Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ElYes F�/bq 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 ❑ Alternative 0 Conventional 0 Innovative ❑ Other A/Any • CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT — . Application for Environmental Services Page 2 Pro osed Facility Type [Primary Residence I"New Residence ❑ Addition to Residence #of New Bedrooms *t 3 _ Project Description \ ° f�Sg couse Wi bets en+ Structure Dimensions 57.11- U ;u1 19`'I Chep #of Occupants t-{ Basement Yes ❑ No Basement Fixtures ® Yes ® No H 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*j Total # Bedrooms *t Structure Dimensions H 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 Shill #of Shifts ❑ Other Facility Type Specify If Church #of Seats Kitchen ❑ Yes ❑ No It-Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Typev❑�Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ 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 performed. Signature of Owner or Agent t 441„,S4 Date 0 9 - 0 2- 201 (o (� 1 Printed Name of Owner or Agen Catawba County Environmental Health • C . I C3 __ ...- -- — '' — b,b, 91 a fri 1 u ce i SII,vc N� ' S6, -z" J `J- Aid it. 00 S N- � Al tb �' II �ta ' w ) g J O0 �� 14 �J • la Cr, t iPD,)(ait o� �� rilirre p����('fur11�� $ rl r,,i l� i 7 I �� llpn W f� 0 hula•{i�, NN,„,........., s26 Parcel: 366903120514, 1720 CORDIA CIR 1 in=60ft 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 09/02/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 366903120514 Owner: BUFF JEREMIAH EVERETT Parcel Address: 1720 CORDIA CIR Owner2: City: NEWTON, 28658 Address: 4971 HIGHWAY 16 S LRK(REID): 200204 Address2: Deed Book/Page: 2879/1886 City: MAIDEN Subdivision: BARRINGER WOODS PH 3 State/Zip: NC 28650-8103 Lots/Block: PT 89/ Last Sale: $45,000 on 2007-12-05 School Information: Plat Book/Page: 36/97 School District: COUNTY Elementary School: BALLS CREEK Legal: Middle School: MILL CREEK Calculated Acreage: 2.380 Tax Map: 001CK 01089 High School: BANDYS Township: CALDWELL School Map State Road #: 2123 TaxfValue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 • Building(s) Value: $0 Zoning2: Land Value: $36,600 Zoning3: Assessed Total Value: $36,600 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 #: 3710366900J Building Details 2010 Census Block: 3014 WaterShed: 2010 Census Tract: 011402 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=366903120514&typ=P 9/2/2016 Y'ACATAWBA COUNTY O� IOOASOUTHWEST BLVD RECEIPT (~ Y NEWTON, NORTH CAROLINA 28658 • "i !' H 7 PHONE: 828.465.8399 Friday, September 2, 2016 Ig 42 sM www.catawbacountync.gov PAYOR: Buff, Jeremiah PAYMENTS TRANSACTION NUMBER: TRC-813629-02-09-2016 PAYMENT DATE : 09/02/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332319 Improvement Permit Fee $150.00 TOTAL PAYMENTS : 5150.00 EHPR-09-2016-24662 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 1720 CORDIA CIR, NEWTON NC 28658 Owner JEREMIAH BUFF,4971 S NC 16 HWY, MAIDEN NC 28650 C:8284554499 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 09/02/2016 14:40 Page 1 of 1