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Home My WebLink AboutEHPR-12-09-2989.TIF A C THIS IS NOT A PERMIT Case # EHPR-12-09-2989 W CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER CONTRACTOR Abernathy Park Limited Abernathy Park Limited ABERNETHY PARK LIMITED 2945 Buena Vista RD 2945 Buena Vista RD WINSTON-SALEM NC 27106-5724 Winston Salem NC 27106 Winston Salem NC 27106 336-724-2623 NAME TO APPEAR ON PERMIT Abernathy Park Limited Pin#: 279008971554 SITE ADDRESS: 5134 ORCHARD PARK DR, Hickory, NC DIRECTIONS: BETHEL CHURCH RD TO PITTSTOWN RD, LEFT ON PITTSTOWN, LEFT ON ABERNATHY PARK DR, RIGHT ON ORCHARD PARK DR NAME of SUBDIVISION: ABERNETHY PARK PH 7 Lot # 63 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.449 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 50 X 40 Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family 0 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: no Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? YES UT 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 you of house or structure location should conform to applicable setbacks. Date: 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 ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 20 FEE NAME DATE AMOUNT Side 6 Rear 12 TOTAL FEES Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/04/09 11:04 12/03/2009 12:57 3357240494 JOtIES ABERCIETHY ASLA PAGE 02/02 # THIS IS NOT A PERMIT W LS CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services IP 1. Name to Appear on Permit: Abernethy Park, Limited 2. Pen-nit Requested By Jones Abernethy, President Business Phone 336 7242623 office 724-0484 fax Address 2945 Buena Vista Road, Winston-Salem, NC 27106 Home Phone same 3. Property Owner Business Phone same Address same Home Phone same 4. Name of Subdivision Abernethy Park Lot 63reapplication Phase 7 Property Address: Orchard Park Drive Directions to Property: Bethel Church Road to Pittstown Road. Left on Pittstown; Left on Abemethy Park Drive, right on Orchard Park drive 5. Property Size: Square Feet Date Platted(Recorded 6. TYPE OF FACILITY: House Dimension of Structure 50 feet x 40 feet Bedrooms 3 Basement: NO Number in Family unknown Whirlpool Tub NO 7. Do you anticipate any additions to Facility? No 8. Has any grading, removal, or addition of soil been done to this properV? No 9. Ytre there easements/right-of-ways recorded on this property? Yea Utility and sidewalk easement on front SEE PLAT 10. Is a public water supply available on or adjacent to the above property? Yes County/City/Township water line 1 1. Monitoring Well Request? No 1 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 has no expiration 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 datc 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 Signature of Owner I gent _ ~k~.+.•a ~*xtxxxta~a*~, **xx~~•k a~~~*xxttr**wa*x *,tawxw* *~~cic,k*~i,oa~xtt~ka,4,r,4,k,t,kir~*~t,~,r+kt~oti.4,4wfx,et,tt#rta.ki..k,e,~kx k* (FOR OFFICE USE ONLY) Please Contact between 8 am and 9 am Phone Signature Date 12/02/2009 13:25 3367240484 JOhJES ABERNETHY ASLA PAGE 05/08 Pagel of] `riot Parcel Map . Real Estate ~gF~ Search QA%V"A COMM ~ d 3- Parcel Summary I Printed Ma Scale 1 inch 40ft Parcel ID: 279008971554 Parcel Address: 5134 ORCHARD PARK DR, HICKORY Owner: ABERNATHY PARK LIMITED Address: 2945 BUENA VISTA RD City: WINSTON SALEM Owner2: Address2: State/Zip: NC, 27106-5724 Building(s) Value: Land Value: $27,900 Total value; $27,900 oISCtJIIM rR: This map/report product was prepared from the Catawba County, NC Geospatial information Services, Catawba County has made substantial efforts to ensure the accuracy or location and labeling information contained on thiz 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, a0ents, and personnel, disclaim, and "i not be held liable for any and all damages, loss or liability, wherher direct, indirect or consequential which arises or may arise from this map/report product or the uce thereof by any person or entity. X* s- a S ,IJt(~ ~-e;/7 111 f~. j Gt d0~ o~ 'rA✓~ n e~ G / P ? ow 0-S - .,~...,n a,._r,-,.,ni~nr,r,n ,,r.ir.nr,n CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel 0: 2790-08-97-1554 Name: ABERNATHY PARK LIMITED Name2: Address: 2945 BUENA VISTA RD Address2: City: WINSTON SALEM State: NC Zip: 27106-5724 Account: 159750315 Calc Acreage: 0.45 Tax Map: LRK: 606221 Deed Book: 2962 Deed Page: 0697 Subdivision Name: ABERNETHY PARK PH 7 Subdivision Block: Lots: 63 Plat Book: 66 r C C~ Plat Page: 107 Building Number: 5134 0 r S Street Name: ORCHARD PARK DR Site Zip: 28602 Township: HICKORY Fire Code: MOUNTAIN VIEW City Code: COUNTY State Road: Total Bldgs Value: Land Value: $27,900 Total Value: $27,900 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 81 Watershed: WS-III Protected Area Watershed Split: NO Voter Precinct: P23 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK High School: FRED T FOARD School Split: NO P&Z Case Number: Census Tract 2010: 011801 Census Block 2010: 3005 Small Area Plan: MOUNTAIN VIEW Agricultural District: Printed: Friday, December 04, 2009 08:35 AM Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba 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 of anv J4 data contained on this map product by the user. The County of Cata,vba, 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 nap product or the use thereof by anv person or entity. Legend Selected Parcel Number: 2790-08-97-1554 1 inch = 40 feet Prepared for: r~ 64 SE ,t 1164 Pi-it 66-'107 1692 63 SE-J" e"'V / 0 63 f ,L y 1 15, 54 q ~ i _'O36 0'' 00 ~ 62`SE 00 k52 1434 co THIS IS NOT A LEGAL DOCUMENT l Friday, December 04, 2009 08:35 AM