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Home My WebLink AboutEHPR-11-09-2532.TIF THIS IS NOT A PERMIT Case # EHPR-11-09-2532 4 CATAWBA COUNTY HEALTH DEPARTMENT U C;;O `C Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP APPLICANT OWNER CONTRACTOR SHAW, ROBIN T. ROBIN SHAW Abernathy Park Limited o b, J 5038 STEAMER PLACE 2945 Buena Vista RD GRANITE FALLS NC 28630 Winston Salem NC 27106 a C, k-0 r N 8283967552 gag- a q L1 _ & 3S ~ NAME TO APPEAR ON PERMIT SHAW, ROBIN T. ROBIN SHAW Pin#: 279012972234 SITE ADDRESS: 5162 ORCHARD PARK DR, Hickory, NC DIRECTIONS: BETHEL CHURCH RD TO PITTSTOWN RD/ LFT ON PI'ITS TOWN/ LFT ON ABERNETHY PARK DR/ RT ON ORCHARD PARK DR/ LOT #60 NAME of SUBDIVISION: ABERNETHY PARK PH 7 Lot # 60 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.529 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure Bedrooms 4 Basement: Yes Water Using Fixtures in BasementYes 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 I st 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? 50 FT SE Type of Water Supply: Individual Well Community Well Municipal X 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 ou of ho .e pr structure location should conform to applicable setbacks, Date: 1 / s 0 r( Signature of Applicant or Agent 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 AREA 2 (FOR OFFICE USE NLY) Zoning Approval: _Yes No "Zoning Approval #:Zj O V017 UDO Zoning Form A Minimum Setbacks Front 20 FEE NAME DATE AMOUNT Side 6 Authorization to Construct Fee (New/. 11/05/2009 $275.00 Rear 12 TOTAL FEES $275.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 1 1 /05/09 09:41 I 00T THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit Ql Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ I . Name to Appear on Permit T ~ A "U 2. Permit Requested By Business Phone Address y// 9-s fAc_ leJ 9 1,4-A if Home Phone ~5k 9!/- 3. Property Owner Business Phone Address Home Phone 4. Name of Subdivision J Lot # Section/Block/Phase PropertyAddress v~ y ao ~L (040'? Directions to Propert: r_ 4L A-.~i ~ e 6GA } P `r► C'Z - 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House _L_~-' Mobile Home Dimension of Structure "70 y 5/9 Bedrooms* :3 *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 system si 'ncrease in the future. Basement: 0/no Water Using Fixtures in Basement: ,ye /q No. in Family Whirlpool Tub 0/no Gallon Capacity S'b 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, of ad ition of soil been done to this property? 2Cu/ No If so, describe: 9. Are there easements/right-of-ways recorded on this property? 0/ No 10. Is a public water supply available on or adjacent to the above property? ea / No Check type that is available: [ ] Community well [ ] Semi-public well [tI]C ounty/City/Township water line **If No, a Well Pen-nit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well 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 valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An 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. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROP RTYJHERE I AN ADDITIONAL CHARGE.- Date y ! Signature of Owner or Agent Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catcnrba 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 data contained on this map product by the user. The Countv 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 frmn this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 2790-12-97-2234 1 inch = 60 feet Prepared for: c~ d- w 052 tL0 s '1434 7~6 4414 190.37 moo. cr - 00 J\ O r r4o 071 N 4 83 7 4313 61 1,~4~ e 61 SE s ~~J _ ► at 66-10"E ~u N 3246 0 co 223- 59 a 60 a 21g 24 59 SE! 60 S E~ I y f i' f , t t THIS IS NOT A LEGAL DOCUMENT # Thursday, November 05, 2009 09:17 AM " Plat E CATAWBA COUNTY PERMIT ZONING AUTHORIZATION R New Dwelling 1'. 0. Rox 389 PERMIT NO: ZONIZ-11-09-2427 rr~►~ IOOA Southwest Blvd APPLIED: 11/05/2009 Newton. North Carolina 28658 ISSUED: 11/05/2009 Ig 4~ SM Phone: 828-465-8380 [:NITRES: 05/0-1/2010 PAX: 828-465-8962 www.cataa~bacountvnc.sov APPLICANT OWNER CONTRACTOR SHAW, ROBIN T. ROBIN SHAW Abernathy Park Limited ROBIN T SHAW 5038 STEAMER PLACE 2945 Buena Vista RD 4619 S NC 127 HWY GRANITE FALLS NC 28630 Winston Salem NC 27106 HICKORY NC 28602 PROPERTY ID#: 279012972234 CENSUS TRACT: STREET ADDRESS: 5162 ORCHARD PARK DR, Hickory, NC LOTil 60 PROJECT DESCRIPTION: SINGLE FAMILY DIRECTIONS: COMMENTS: SINGLE FAMILY DWELLING FLOOD ZONE? OWNER TYPE: Residential (Private) REQUIRED SETBACKS 100 YEAR FLOOD ZONE PLAIN? No LAND OWNER: FRONT: 20.00 SIDE: 6.00 FLOOD PLAIN, STRUCTURE? No MAX HEIGHT: 45.00 REAR: 12.00 SIDE' I: VALUE: 0 CORNER: SIDE 2: L 13C lore all inspection can hC made by the Building Inspection Office, the applicant must pull a string to designate the side anti rear property lines where the SO"UCture is hemp placed or constructed. 2. I tome shall be placed on the lot in harmony with the site-built sU-uctures_ Or have the front door face the road frontage. FEE DESCRIPTION DATE FEE AMOUNT Residential Zoning Fee 11/05/2009 $25.00 TOTAL FEES $25.00 The applicant hereby certifies that all information and attachments to this Certificate of Ionin(Conmiliance are true and correct and acknowledges that this permit Nyas issued on the basis of the information required herein. The applicant further acknowledges that any construction, alteration or addition which differs from this application shall be subject to removal or alteration so as to bring said St'uctLlrc into conli>rmance with the specifications and standards of the Catawba County Zoning Ordinance. Such corrective action shall he at the expense ol'the applicant. It is the responsibility of Applicant to comply with all existing deed restrictions pertaining to the propert)1. Issuance of this permit is not cerlilication of such compliance and does not relieve Applicant ol'the duty to comply. **"this Zoning Authorization Permit shall expire six months froniflae date-of•issaance-ltlless a bit ild,irig_j~etrmit is secured and remains active. AI'll LICANT NAiNI1-1 (1)RINF1'D) APPLICANT SIGNATURE ZONING APPROVED BY *****ZONING FEES ARE NON-REFUNDABLE, ('0\4PAN)' NAME Paac I of I CATAWBA COUNTY Rrhlicaiealth Department Case # WLS2007-00299 ..I ; Enviromi,ental Hadtli Division Subdivision ABERNETHY PARK PH 7 \ F / PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Sect/BL/Ph/Lot # \i (828) 465-8270 FAX (328) 465-8276 TDD (828) 465-8200 PIN4 PH 7 GU 911279008974976-60 Applicant/OwnerABERNETHY PARK jQ S _ Site Address: ORCHARD PARK DR LOT 60 ~QS~ t' Property Size: 23,267 SF ACRES Directions: BETHEL CHURCH RD TO PITTSTOWN RD/ LFT ON PITTS TOWN/ LFT ON ABERNETHY PARK DR/ RT ON C ORCHARD PARK DR/ LOT 960 Improvement Permit Permit Valid For: l=ive years No Expiration Q Facility (Residential): House House X Mobile Home Multi-Family Bedrooms _ 4 New? „'J~ Addition? Projected Daily Flow If J1-0 g.p.d Water Supply Private Well? Public?X( Semi-Public? Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures (explain): Proposed Wastewater System: ~~7~/~ll!' Type: Proposed Repair: 3 Permit Conditions: 1b N^'~ a fir' ~cc !p Q. • 5 Owner or Legal Representative Signature: Date: Authorized State Agent: -5 . Date: The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This perntft was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal &steins' (15A NCAC 18A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and addil.ional attachments ( ) Proposed Wastewater System: Type: Wastewater Flow g.p.d New Repair Expansion Soil LTAR: g.p.d.tft2 Type of Facility: Basement: N Basement Plumbing: N HotTub/Spa: _N Special Fixtures (explain): _Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfield: Total Area: sq ft Total Length: ft Maximum Trench Depth in Trench Width ft Minimum Soil Cover Minimum Trench Seperation ft Distribution: Distribution Box SericalIlDistribution Pressure Manifold LPP Other Additional Specifications: Authorized State Agent: Date: Permit Expiration Date: 1 have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: Form B rATide=rk\FomfVM Saon.rnr i C CATAWBA COUNTY V Cj ~L l0 V~~ C C~; -.s P rMlicl lealth Department i Se # 5200 0299 v Envimiwrentsrl Health Division C~ U 1 ivi ' n THY PARK PH 7 PO Sox 389, 100-A Southwe.R Blvd, Newton, NC 28658 ` Ph/Lot # PH 7 60 (828) 465-8270 FAX(828)465-8276 'rDD (828) 465-8'200 --U~ CX r # 911279008974976-60 Applicant/Owner ABERNETHY PARK F? Site Address: ORCHARD PARK DR LOT 60 I f Property S 23,267 SF ACRES Directions: BETHEL CHURCH RD TO PITTSTOWN RD/ LFT ON PITTS TOWN/ LFT ON ABERNETHY PARK DR/ RT ON ORCHARD PARK DR/ LOT 460 ® Improvement Permit Authorization 't'o Construct Well Permit SITE PLAN r Scale System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the site plan or site conditions are altered. 5;A~;t A;5 <c X06/07 Authorized State Agent Date Form C r.VidnnarkVormrV{Wavv.mr