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Home My WebLink AboutEHPR-11-09-2921.TIF A C~ THIS IS NOT A PERMIT Case # EHPR-11-09-2921 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 sM 90 Environmental Health Plan Review - OSWP EXPANSION APPLICANT OWNER CONTRACTOR CAROLYN WORLEY CAROLYN WORLEY (MOH SETUP) CLAYTON HOMES 981 /Cr CONOVER NC 28613 828-465-3450 (828)461-7119 (828)461-7119 r081@clayton.net NAME TO APPEAR ON PERMIT CAROLYN WORLEY Pin#: 379003348715 SITE ADDRESS: 6407 ALLEY RD, Catawba, NC DIRECTIONS: SHERRILLS FORD RD/ NEAR LOWRANCE RD/ TURN ON ALLEY RD/ CROSS RR TRACKS / ON LFT NAME of SUBDIVISION: HAROLD D MUNDY HEIRS UNREC Lot # 3 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 9.96 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 2 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? NO Type of Water Supply: Individual Well X Community Well 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. epresentatio by you of house or structure location should conform to applicable setbacks. Date: 1.2 y 40 ~ Signature of Applicant or Agent A Environmental Health Specialist will contact you within working d f application date. If you need further information or assistance ease call 828-466-7291 10 AREA 1 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Authorization to Construct Fee (Newf.12/04/2009 $220.00 Rear 30 Existina Tank Check Fee 11/30/2009 $80.00 Max Hght $300.00 TOTAL FEES *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/04/09 09:52 THIS IS NOT A PERMIT WLS # is ~,9~-~~'/) CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion Existing Tank Check E] New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ I . Name to Appear on Permit a 10L ~ ~ n "(r e a re, n -c r- 2. Permit Requested By C 1 ate, 6- t. 1-1-~ s Tv S. k-YA FrN A r ) Business Phone (~S 28) 9 G'S So Address 123 no .t 1., :.n ..ter rJ 2 a L, , Home Phone 3. Property Owner awe 1~, lA3u A Business Phone Address Lo9o-I Nileo RA. A3,- $ .0 0 9 Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address 64o'r Alkk-, Rd Cam-S< uric-- --L-%4.(;9 Directions to Property: NC - IU cn s AAurra !Jj S rr~1s ~a G o W ck- w^ ~d ],o n, bc fcl 5. Property Size: Square Feet Acres S 5 . Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Horne Dimension of Structure o26 X ~0 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 counted on all applications. The number of bedrooms will be confirmed by rooms identified on house plans asa bedroom at the time ,ofbuilding permit issuance. This may prevent the need for system size increase in the future. Basement: yes/0) Water Using Fixtures in Basement: yes/no No. in Family Whirlpool Tub yes/no 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 1 st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes / o If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Y / No If so, describe: t A, ~d r t--) V\ -el-" 9. Are there easements/right-o -was recorded on this property? Yes 10. Is a public water supply available on or adjacent to the above property? Yes / 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. 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 Pen-nit 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 T PROPERTY, HERE IS AN ADDITIONAL CHARGE." Date 12 y v Signature of Owner or Agent 4'A Cpl CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE Newton, NC 28658- V (828)465-8399 Friday, December 4, 2009 184 sM www.catawbacountync.gov . Plan Case: EHPR-11-09-2921 Invoice Number: INV-12-09-257753 Environmental Health Plan Review Invoice Date: 12/04/2009 Fee Name Fee Amount Authorization to Construct Fee Adjustable $220.00 (New/Expansion) Fee Total Fees Due: $220.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 12/04/2009 Check 677 $220.00 $0.00 Total Paid: $220.00 Total Due: $0.00 p4animiice;clRcc=18 -G9S --S:i?t-h oh-cl(i(bcda7 c;.rht 12/04/2009 09:50 THIS IS NOT A PERMIT Case # EHPR-11-09-2921 CATAWBA COUNTY HEALTH DEPARTMENT U q.: `C Plan Review Application for Environmental Services -1842 sM Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR CAROLYN WORLEY CAROLYN WORLEY (MOH SETUP) CLAYTON HOMES 981 /Cl' 6407 ALLEY RD 6407 ALLEY RD CONOVER NC 28613 CATAWBA NC 28609-8834 CATAWBA NC 28609-8834 828-465-3450 r08I@clayton.net NAME TO APPEAR ON PERMIT CAROLYN WORLEY Pin#: 379003348715 SITE ADDRESS: 6407 ALLEY RD, Catawba, NC DIRECTIONS: SHERRILLS FORD RD/ NEAR LOWRANCE RD/ TURN ON ALLEY RD/ CROSS RR TRACKS / ON LFT NAME of SUBDIVISION: HAROLD D MUNDY HEIRS UNREC Lot # 3 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 9.96 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 2 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? NO Type of Water Supply: Individual Well X Community Well 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. A y representation by you of house or structure location should conform to applicable setbacks. Date: 13e) 9 Signature of Applicant or Agent An Environmental Health Specialist will contact you within orking da s f a placation date. If you need further information or assistance ease call 828-466-7291 AREA 1 (FOR OFFICE USE ONLY) Zoning Approval: ,Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks FEE NAME DATE AMOUNT Front 30 Side 15 Existing Tank Check Fee 11/30/2009 $80.00 Rear 30 TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 1 l /30/09 11.16 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit CM A c rn c S el~w' n ~l~,r~ s 2. Permit Requested By -_TU 5 ' ._N Tr U'2, Business Phone (%_L&) y(cS -3950 Address Home Phone 3. Property Owner Cc u 1 u r~ U, oc i e .x Business Phone Address ULIri-i A11 e ock- Cc\.ko k.;b~ 'L 5S L; 09 Home Phone(82-S) q61 -31-11 4. Name of Subdivision Lot # Section/Block/Phase Property Address Lo46-1 at1t,4 EcA e-u,i~,ca tJL ~8Lu9 Directions to Property: 5. Property Size: Square Feet Acres 5, G Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Horne X_ Dimension of Structure aS x 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 tittle of building permit issuance. This may prevent the need for system size increase in the future. Basement: yes/( Water Using Fixtures in Basement: yes4 No. in Family c2- Whirlpool Tub yes/Gallon Capacity Units NA Total Number of Bedrooms N A Df1C~A-R~ Number of Children NA Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space PiI~B17SI Ntunber of Employees 1st 2nd 3rd 9+4ifrk-(Specify) 7. Do you anticipate any additions to Facility? Yes / o If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes /(S) If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes /(ao) 10. Is a public water supply available on or adjacent tot above property? 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 Sep is Permit.** 11. Well Type Applying For: /K 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 PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date - Signature of Owner or Agent sc -:LA - /11 4 r' Catawba County, North Carolina This map product u'as prepared from the Cmairho Comm-, NC, Geographic h formodmi Srslem. N Carcnrbo Comml has made subslantiol effa7s to ensure the accuracy of locotion and lobelhtg it formation contained on this nrop. Coian'ba Comity promoter and recommends the independem rerificotiOn ofonr dom contaimd on this map product br the user. The Counh' gfCatawba, its employees, agenis and personnel disclaim, and shall not be held liable for any and all domoges. loss or liabilim', whether direct, indirect or consequenliol which m'ises or may arise from this map product or the use thereof hr am: person or entitT Legend Selected Parcel Number: 3790-03-34-8715 1 inch = 60 feel Prepared for: 1.01A 1 Ckc- mac- D,z. 9 6 3 2930 f ~s l X41 7V C UUi 5577 THIS IS NOT A I,ECAL DOCUNIEN'1' Monday, November 30, 2009 10:48 AM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3790-03-34-8715 Name: WORLEY CAROLYN MUNDY Name2: Address: 6407 ALLEY RD Address2: City: CATAWBA State: NC Zip: 28609-8834 Account: 76705250 Calc Acreage: 9.96 Tax Map: 016 Y 01016C LRK: 92776 Deed Book: 1894 Deed Page: 1325 Subdivision Name: HAROLD D MUNDY HEIRS UNREC Subdivision Block: Lots: 3 Plat Book: Plat Page: Building Number: 6407 Street Name: ALLEY RD Site Zip: 28609 Township: CATAWBA Fire Code: BANDY'S,CATAWBA RURAL City Code: COUNTY State Road: 1823 Total Bldgs Value: Land Value: $45,000 Total Value: $45,000 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 126 Watershed: WS-IV Protected Area Watershed Split: NO Voter Precinct: P21 E911 District: COUNTY Zoning: R-40 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: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011502 Census Block 2010: 1004 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Monday, November 30, 2009 10:48 AM CATAWBA COUNTY, NC I00-A South West Blvd PLAN INVOICE Q+ F ] Newton, NC 28658- 0 (828)465-8399 Monday, November 30, 2009 jg 4'Z sM www.catawbacountync.gov Plan Case: EHPR-11-09-2921 Invoice Number: INV-11-09-257594 Environmental Health Plan Review Invoice Date: 11/30/2009 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/30/2009 Check 3797214 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 pIMIIIIWiCC, 72 --lay)-Ch16-4043-1) 161.9 It)5c'-8f14dh; rp1 11/30/2009 1120