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Home My WebLink AboutEHPR-10-09-2198.TIF A C I THIS IS NOT A PERMIT Case # EHPR-10-09-2198 c CATAWBA COUNTY HEALTH DEPARTMENT v 'C Plan Review Application for Environmental Services 84 2 sM Environmental Health Plan Review - OSWP IMPROVEMENT - AUTH CONST A P P1: I CA NT OWNER CONTRACTOR Hugh Rudisill Hickory Hollow LLC 1922 Wilson Ridge 211 Fairway DR Maiden NC 28650- Fayetteville NC 28305 (828)428-3138 NAME TO APPEAR ON PERMIT Hugh Rudisill Pin#: 376013147144 SITE ADDRESS: 3622 OLE COUNTRY LN, Claremont, NC DIRECTIONS: HWY 10 E/ RT BETHANY CH RD/ LT INTO COUNTRY VALLEY/ RT HANOVER LN/ RT OLD COUNTRY LN/ LOT 33-A ON LEFT NAME of SUBDIVISION: COUNTRY VALLEY PH 2 PL50-98 Lot # 33 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.6 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home Dimension of Structure 24 x 50 Bedrooms 3 Basement: Water Using Fixtures in Basement: No. in Family Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: Has any grading, removal, or addition of soil been done to this property? If so, describe Are there easements/right-of-ways recorded on this property? 0 Type of Water Supply: Individual Well Community Well X Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: 1111-5-10 f Signature of Applicant or Agent ~Pe v;1 An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks AMOUNT Front 30 FEE NAME DATE Side 1s Authorization to Construct Fee (New/ 10/19/2009 $150.00 Rear 30 Improvement Permit Fee 10/19/2009 $150.00 Max Hght TOTAL FEES $300.00 *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/24/09 13:14 THIS IS NOT A PERMIT WLS # &A R- L 6- d ~1 - Z 1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services IP AC S. T. Rpr. Exist. S. T. Well Prmt. Replacement Well 1. Name to Appear on Permit L- 12 t- d t s 2. Permit Requested By , '-k ; < < ( ( Business Phone ~}3 4 -0 kF fS Address (°i ->t'1" k -S o Al- CL J -d e- C Home Phone (f - 3 / ? 9, 3. Property Owner f M Business Phone Address i a ? -0 S kgA!J Vim= l I -t-!7 L~ C[arp~ /VC Home Phone 4. Name of Subdivision C~ Section/Block/Phase Property Address 6 a O le c,~ ~ L-a,e c 33- A C I. q, t1 C Directions to Property: w U ( O E - R; fi o ~ti f e l" ~4 K y rt u rcln d- L IL~( a CcttK'IY4 VQ (t'1y Q i C I a~tfa !-ili 0 er ~-rc t-- ! k+ 0','-fo c> t`P CCUKt~.7 Ln,v.2 - L of erg LQ -e fi, 5. Property Size: Square Feet Acres 10 0 Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home L/ Dimension of Structure Bedrooms* *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and Minted on all applications. The number of bedrooms will be conFirmed by rooms identified oil house plans as a bedroom at the time of building permit issuance. This may prevent the need for system size increase in the future. Basement: yes/ t& Water Using Fixtures in Basement: yes/& No. in Family----, Whirlpool Tub yes/n® Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / s 10. Is a public water supply available on or adjacent to the above property? fe J No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Monitoring Well Request? Yes / No # of wells _ Name of Site I understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $50 CHARGE." Date 10/( 7 to f Signature of Owner or Agent (FOR OFFICE USE ONLY) Please Contact between 8 am and 9 am Phone I have confirmed that no municipal water line exists adjacent to the above property if well permit is being issued.** Signature Date Catawba County, North Carolina This map product was prepared from the Catawba County, A'C, Geographic Information System. N Catmvba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification ofany J4 data contained on this map 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3760-13-14-7144 l inch = 60 feet Prepared for: :A 'R-20 r~ t 110 . 0 7 120 _r--~-- 8 , _ PLAT'-50-98 COUNTRY- 100 10.03 MONT' r= I R E O,y C LA R E M O N~T ~IQE RURAL FIRE 54A -~E JlOti CI 'T n~° L`a.°.°~~.- 1 A, C, LAr Ef~.'1 GP~~JT .074 `1E!vTOfJ FIR ~ zf OR L FIRS - RURAL f~RE ~:06A NEWTON FIRE .03/4 !E1A7(DH FIRE R- 0 8152 33 3 6 3 4 RE t n r PJ / THIS IS NOT A LEGAL DOCUMENT ##t!j j 1 Monday, October 19, 2009 10.56 AM CATAWBA•COUNTY NC- Parcel Report hformbrtio'n Regarding Selected Parcel(s) Parcel ID: 3760-13-14-7144 Name: HICKORY HOLLOW LLC Name2: Address: 211 FAIRWAY DR Address2: City: FAYETTEVILLE State: NC Zip: 28305-5571 Account: 159745319 Calc Acreage: 0.6 Tax Map: LRK: 301057 Deed Book: 2929 Deed Page: 0287 Subdivision Name: COUNTRY VALLEY PH 2 PL50-98 Subdivision Block: A Lots: 33 Plat Book: 50 Plat Page: 98 Building Number: 3622 Street Name: OLE COUNTRY LN Site Zip: 28610 Township: CATAWBA Fire Code: CLAREMONT RURAL,NEWTON RURAL City Code: COUNTY State Road: Total Bldgs Value: Land Value: $10,300 Total Value: $10,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P5 E911 District: COUNTY Matrix: STD 1 Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O,WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: CATAWBA Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 011400 Census Block 2010: 2032 Recorded Date: 4/24/2000 Lot Type: Small Area Plan: BALLS CREEK Printed: Monday, October 19, 2009 10:57 AM CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE Newton, NC 28658- 0 (828)465-8399 Monday, October 19, 2009 O 84 sM www.catawbacountync.gov Plan Case: EHPR-10-09-2198 Invoice Number: INV-10-09-256345 Environmental Health Plan Review Invoice Date: 10/1912009 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Authorization to Construct Fee Adjustable $150.00 (New/Expansion) Fee Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 10/19/2009 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 plan inv~~ice ;~~)h~a3c3-b9e9-'108d-hatl~-daldcld&26'r; rpt 10/19/2009 11:32