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HomeMy WebLinkAboutEHPR-09-2016-24707.TIF 4z1v,A • THIS IS NOT A PERMIT Case # EHPR-09-2016-24707 �Ga CATAWBA COUNTY HEALTH DEPARTMENT ❑' 713 `fEl V' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1g42 s�� Environmental Health Plan Review - OSWP •ro, IMPROVEMENT o U Applicant FLAVIUS RUSU, 1242 HUCKLEBERRY DR, LINCOLNTON NC 28092 C:8286391006 Owner RONALD BENFIELD,4895 HICKORY LINCONLTON H, LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT Flavius Rusu SITE ADDRESS: 3421 SWEETGUM LN, LINCOLNTON NC 28092 PIN # 361702567565 NAME of SUBDIVISION: BLACKBURN RIDGE PH 2 Lot# 21 Section/Block PROPERTY SIZE: Square Feet 35,719.20 Acres 0.82 DIRECTIONS: Hickory Lincolnton Hwy, Blackburn Ridge Rd, Left into Woodgreen Dr, 1st Right onto Sweetgum Ln, 5th house on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well 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: 35x50 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION #OF NEW BEDROOMS:: 4 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-ehapplication 09/12/2016 14:48 Page I of 4 y• - CATAWBA COUNTY Case t) EHPR-09-2016-24707 ; i.yalpm .., Public Health Department Subdivision BLACKBURN RIDGE PH 2 6 -u Environmental Health Division ,�)y YIN# 361702567565 \ wbPO Box 389, 100-A Southwest Blvd,Newton.NC 28658 \2842 sM NAME ON PERMIT: (FLAVIUS RUSU), 1242 HUCKLEBERRY DR, LINCOLNTON NC 28092 ( Flavius Rusu) Site Address: 3421 SWEETGUM LN, LINCOLNTON NC 28092 Property Size: Square Feet 35,719.20 Acres 0.82 Directions: Hickory Lincolnton Hwy, Blackburn Ridge Rd, Left into Woodgreen Dr, 1st Right onto Sweetgum Ln, 5th 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 identification and labelingeof all property lines and corners and making the site accessible•so that a complete site evaluation can be performed. Date: Cvl -L2-I6 Signature of Applicant or Agent — ,,,r An Environmental Health Specialist will contact you within .'worki g days of application date. If you need further information or assistance please call 828-466-7291 AREA2 ............................................................................................................ Um1118iIfiBn'�Ih o! �� r �' I tUt••ti�fgr I f r''inrf u� ('�I TIIIoto:;- s.nt NIT FEENAM' E�'(�Sii giusi l;„1ir�G, tjlII pulIIIIAI [Li ) 'ill- DATEw�JII FEE'AMOUNTj),,. Improvement Permit Fee 09/12/2016 $150.00 j iISN°°u''"' • lip l ufwasa uiWw�l°Ill Uiliii-alililbwI ilimlIl�uriP 1��i�9�I�EIINIII iVllwlil'i�`Nu i11riiir inui1ai,&'. '' litu II 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) E9-application 09/12/2016 14:48 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT \ c`o�unTY CATAWBA COUNTY HEALTH DEPARTMENT -s%, Application for Environmental Services Page I Improvement Permit Authorization to Construct❑ Septic Repair ElSeptic Malfunction 111 Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ • tt Application is for New Construction ❑ Existing Facility ❑ Property Address 3"7,L I S C4 ewx [ , Subdivision Lot# „? I Acres 7±W&M Section/Block/Phase Driving Directions to Property 1` NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information NameX-Lr re.4 S >'2US o 4 Address 12 i1 4--(4,,c ee,, evr of A/ijCoLwaw A/C /JOy6 Phone O?/0 ('S 9 I d0C 3 Cell Phone Owner Contact Information Name ,12o�1'4 G:\ 5 4.,--,,,i 1-7t%b Address Lj /7 J O kovy .L,C0tn/70/1/ tiel4/it/CoL�V`7CY✓ Phone I 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_ fP ( Sc # of Bedrooms *t 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. ri YesNo Does the site contain any jurisdictional wetlands? El Yes o Does the site contain any existing wastewater systems? 0 Yes No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes LdNo Is the site subject to approval by any other public agency? ❑ Yes pC.No Are there any easements or right of ways on this property? Describe Existing water supply in use C� Individual Well ❑ Community Well [i 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 System Type(s): ti .(systems can be ranked in order of your preference) �/❑ Accepted ❑ Alternative ❑ Conventional ❑ hinovative 0 Other .( Any CArg'A 7j� A THIS IS NOT A PERMIT COUNTY VV L7L-1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence R.New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions 35 X D U # of Occupants Basement ❑ Yes No Basement Fixtures ® Yes No ❑ Accessory Structure(s) Describe # of New Bedrooms *j if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *j Structure Dimensions ❑ 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 ❑ 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. 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 making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Date Printed Name of Owner or Agent 10-tiU c /2u g u 1 Catawba County Environmental Health r J" \5 Ari fr '' 1 ,:.1i, r 89.2 1 ;{ w' t' 76 * " r ®833 ii !I 92.75 L ss • 84.70 * 3s 4 49 LI B i e4 1, . i1 . ,y ,li,l . Miltill' I 111 1 11149 o i 45.73 N. 1— 1 0 117.9 11. 39 C71 (s.\\\N't co Parcel: 361702567565, 3421 SWEETGUM LN 1in=50ft LINCOLNTON, 28092 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 09/12/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 361702567565 Owner: BENFIELD RONALD D Parcel Address: 3421 SWEETGUM LN Owner2: City: LINCOLNTON, 28092 Address: 4895 HICKORY LINCOLNTON HWY LRK(REID): 700472 Address2: Deed Book/Page: 2721/0030 City: LINCOLNTON Subdivision: BLACKBURN RIDGE PH 2 State/Zip: NC 28092-5803 Lots/Block: 21/ Last Sale: School Information: School District: COUNTY Plat Book/Page: 47/39 Legal: Elementary School: BLACKBURN Middle School: JACOBS FORK Calculated Acreage: .820 High School: FRED T FOARD Tax Map: Township: JACOBS FORK School Map State Road #: 2134 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $20,100 Zoning3: Assessed Total Value: $20,100 Zoning Overlay: ED-O Year Built/Remodeled: / Small Area: STARTOWN Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710360600J Building Details 2010 Census Block: 1042 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P3 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=361702567565&typ=P 9/12/2016 (g)-A CATAWBA COUNTY IOOA SOUTHWEST BLVD YYY NEW TON,NORTH CAROLINA 28658 RECEIPT r ioirPHONE: 828 465.8399 TJ��as� Monday, September 12, 2016 842 snt www.catawbacountync.gov PAYOR: Rusu, Flavius PAYMENTS TRANSACTION NUMBER: TRC-830092-12-09-2016 PAYMENT DATE : 09/12/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332570 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EI-IPR-09-2016-24707 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3421 SWEETGUM LN, LINCOLNTON NC 28092 Applicant FLAVIUS RUSU, 1242 HUCKLEBERRY DR, LINCOLNTON NC 28092 C:8286391006 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner RONALD BENFIELD,4895 HICKORY LINCONLTON 1-1, LINCOLNTON NC 28092 receipt 09/12/2016 14:48 Page 1 of 1