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Home My WebLink AboutEHPR-4-11-10315.TIF ��' C p� _ T,HIS IS NOT A PERMIT Case # EHPR-4-1 1-10315 � ��..�� ' _��. a CATAWBA COUNTY HEALTH DEPARTMENT c.7 ,� .�,e '�' Plan Review Application for Envirorunental Services I8�}2 SM Environmental Health Plan Review - OSWP EXS SYSTEM NAME TO APPEAR ON PERMIT KIMBERLY MATSON s�TE A��RESS: 3040 N OLIVERS CROSS RD, Newton, NC Pin#: 366803120598 NAME of SUBD{VISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Peet Acres 0.91 DIRECTIONS: 16 S/ RT PROVIDENCE MILL RD/ LEFT OLIVERS CROSS RD/ GO TO ADDRESS 3040 APPLICANT OWNER CONTRACTOR KIMBERLY MATSON KIMBERLY MATSON CAPOTE BUILDERS & DEVELOPMENT 3040 N 3040 N COMPANY NEWTON NC 28658 NEWTON NC 28658 5426 CAPOTE RDMAIDEN NC 28650 828-428-8019 828-428-8019 (704)400-5481 TONY tr CAPOTEBUILDERS.COM PRIMARY CONTACT: Contractor APPLICATIOI�� DIM EXISTING STRUCTURE: 14 X 70 EXISTING FACILITY TYPE: Mobile Home NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 4 EXISTING WATER SUPPLY IN USE: Public Water CALCU�ATED DESIGN FLOW: Public water IS available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: ????????MODULAR DWELLING DESCRIPTION OF SINGLEWIDE EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION PRIMARY RESIDENCE NEW RESIDENCE? New Residence # OF NEW BEDROOMS: 0 # OF STRUCTURE OCCUPANTS: PROJECT DESC: MODULAR DWELLING PROJECT DIMENSION: 32 X 56 BASEMENT? No BASEMENT FIXTURES? No 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 sCructure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: �/ Signature of Applicant or Agent . �^ G� C An Environmental Health Specialist will contact you within 2 working ays of application date. If you need further information or assistance please call 828-466-7291 AREA1 �*��*�*******�**********************************�******�**********�*********************�*****�*��***�*************** Minimum Setbacks Front: 80 Side: 15 Rear: 30 Side St: Max Height: 04/08/1 ] 1 I:l 1 � � CATAWBA COUNTY Case # EHPR-4-11-10315 Q - G Public Health Department . . Subdivision �" ' �j Environmental Health Division - Plan Review v 4�"►� '�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot# �H4 '" P�N# 366803120598 ApplicantlOwner KIMBERLY MATSON, 3040 N, NEWTON NC 28658 Site Address: 3040 N OLIVERS CROSS RD, Newton, NC Property Size: SF 0_91 ACRES Directions: 16 S 1 RT PROVIDENCE MILL RDi LEPT OLNERS CROSS RD/ GO "1'O ADDRESS 3040 FEE NAME DATE AMOUNT BALANCE DUE Exist Tank Che ck Fee 04/0 $80.00 TOTAL FEES $80.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 04(08/ 1 l l l: l l THIS IS NOT A PERMIT WLS # CATAWBA CO�(1NTY HEALTH DEPARTMENT Application for Environmental Services IP AC S. T. Rpr. Exist. S. T.�_Well Prmt. Replacement Well 1. Name to Appear on Permit �`' � D�Z - � 2. Permit Requested By +� �.�vi a �.�� , � d� ��`'LG��s ° Business Phone t?z! O�.'�,S`�G - Address $�'�2(o Cl��O�t� d�� 1cci`�� ,lJG �. �� ,r� Home Phone �r2��-- �j'Z,r - �t3L' � 3. Property Owner �C, � IYl��Jcs--t Business Phone Address �Oyr9 /il (� `ive;;l C/��rs.S �l, rt/�.,�.'�� .�/G. �-k6-j�r Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address _��,� .� U (�ys ��.s �`Z, , �l/C�� •�� 2. � � Directions to Propert_y: I�, S `� �-r-e-�� .12< °�"� G fo D�i�e-� C�,/.r /' �J c.� Vd �(i �ia,��`YJ ,S �� ' D 5. Property Size: Square Feet Acres ��-� �lv.�, Date PlattedfRecorded �// Z 3 �� d 6. TYPE OF FACILITY: House �, Mobile Home Dimension of Structure 3 Z.yC �� Bedrooms* *Any room that wil�l be intended for sleeping at the time of construction or for future consid�ration should be noted as a bedroom and counted on all applications. The number of bedrooms wil'l be confirmed by rooms identified on house plans as a bedroom at the time oE building permit issuance. This may preven�t Che need f.or system size increase in �tbe future. Basement: yes�' Water Using Fixtures in Basement: yes/� No. in Family �� Whirlpool Tub yes/`�io Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Acea _Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees lst _ 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? Yes / If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes /�o 10. Is a public water supply available on or adjacent to the above property? es 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 /� # 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 far evaluation purposes. I certitiy 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 d�ate, but may be revoked if Chis information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to construct issued by this dep�irtment 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 CHARGE.** Date �'/, '-] -`� Signature of Owner or Agent ��- �i�'j'� �*x:��:r (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 N This map producl was prepared fi�om !he Cu�awba Cot�nry, NC, Geographic Injamation Svstem. Calaw6a Counry has mnde svbs�nntral eJfarrs to ensure the accuracy ojlocation and labeling informntion contained on this mnp. Catawbu Counry proinotes and recommends the rndependent verrficnlron oJany data conlained on this map product by the user. The Covnty of Catawba, its employees, agents nnd personne/ dise/arm, and sl�al/ not be held linble for any and all damages, loss or /iabiliry, whether direct, indirect or consequential which arises or may arise from thrs map produc! or d7e use the�eo by any person or entiry. L2g211d Selected Parcel Number: 3668-03-11-0598 1 inch = 60 feet Prepared for: �„�,..._'` ��.��-.'...."""'..�..�, ,_.. �. � �� m� �,��a� 4 � �--�--�=�=�m� � o.o� � � � __.� � �� .� -�- ..� '��.,' ► �� ,., 1 -�~�. ,,.�v • w -......-- � �� `� r-..,,,,.,"'""'-^^" �� {� / ��, �.---� � �I . .�•3 � �( � 7 . 2`2 G �. , � � � � � , � � (��` . l� • ,�._._,..�_ _ . � ��/� _ _ � v��7' � °� � �=�,,°� v • v r ti, �`'-,, "4... `�. _ a �__._._�..� _._ --____.---.--.-------�..- _�_ � : i - __ ..___ _ _.. _�___.�._--. _..__ �-ry... _ - �/ � 1 __.�___ ___._ �_ � , � ��------_-_�._.._._.. 1�.29A � _ �_/ , . �__.. �,,�...�----.�.�.--�.-�--- (y . �-.\ �-'�--�.�....�..��,...... f � � 1 ^ � ""`�.-. �64� �; �: �. � � � � � �. �'�� ` � � r - � � 2.1 � � � � � � �`$ � -�-_- �=— a�=� � _ 2 5 �, `°�� ``�� . � i ' ; �. ��.� � i ��, � _ -_ - � .� . � - - _�'� -. `� � , ; � � � � , , � 16 �. .. ,, 9 . , ) ,, � , . � , � � ,�..� �� , f �� ::�,,- -..,.� � , �1.c�� "� THIS IS NOT A LEGAL DOCUMENT ��`""~-- Frida , A ril 08, 2011 11:14 AM � . , �, � Y P � : �` . ~� �" "�--.�,_ CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) � ' ParcellD: 3668-03-12-0598 Name: MATSON KIMBERLY S Name2: Address: 3040 N OLIVERS CROSS RD Address2: City: NEWTON State: NC Zip: 28658-8276 Account: 159764002 Calc Acreage: 0.91 Tax Map: 004 K 07017A LRK: 3674 Deed Book: 3034 Deed Page: 1098 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 3040 Street Name: N OLIVERS CROSS RD Site Zip: 28658 Township: CALDWELL Fire Code: BANDYS City Code: COUNTY State Road: 1858 Total Bldgs Value: Land Value: $12,500 Total Value: $12,500 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-{I Protected Area Watershed Split: NO Voter Precinct: P1 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: TUTTLE Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011600 Census Block 2010: 2006 Small Area Plan: BALLS CREEK Agricultural District: PROXIMITY Printed: Friday, April 08, 2011 11:14 AM �� CATAWBA COUN'�Y HEALTH DEPARTMENT PERT�IIT # 03575 CONSPLETION PERMIT OWNER OR CONTR.ACTOR: ,, ,; , i �,� y 6��= ;; DATE: ,�t� k,� �� j"� 1 � a Z-i: �.�i'r �'� ADDRESS ��,-� ,C` • � � '�"/y� ✓'1 �;:_��,� �. o��"�� PHONE : . � Y � �. . ' �. ' � / ... � ' , LOCATION: " c" ��. i ' :�- , „�..,;.�; -z:; ..,. y, r .�_ _,�` �� _. ✓� ` � �,. Y.�-T.r"'�it.S"'�,��..1' 6 �'d T F 4'� ��%>,r//.% if;✓�`:N l r�i'e✓L . L':. ,G R^��.n _ (-� J T" � �/ �l,"?:. >y— � � �<� — r �✓ � j r - �d " _ _ SUB IVISION: LOT: SECTION OR BLOCK LOT SIZE: House ( ) Mobile Home ( c..-�Business ( ) Other ( } Flow Rate: gpd Bedrooms: �� Bathrooms:-� Special Fixtures: Other: Basement - Yes () No (�ixture in basement-Yes No ;��_ ---------------------------------------------------------------------------------------------- Garbage Disposal Unit: Yes () No ��-- Water Supply: Private ( c�--,I�P�blic ( ) TANK SIZE: ��-�� gallons Distance from septic tank or nearest source of IVITRIFICATION FIELD: pollution: �,',�:A��r'f=� /;�� ir.�.��; 41 1�1J_./ Ntunber o lines: ;`.� FINAL APPROVAL OF THIS SEPTIC TANK SYSTEM SHALL IN Length and width of lines NO WAY BE TAI�N AS A GUARAN'TEE THAT THE SYSTIl�I WILL (a) Bed System FUNCi'ION SATISFACTORILY FOR ANY GNEN PERIOD OF (b) Trench Systen 36" x�� TYME. ar Treneh Sys . 30" x DATE INSTALLED: ; .?y,� 1 ,., �-.r�-_,�� _�.= f°'� Total Sq. Ft. �;?x,� Depth a Ston� ,:�x " INSTALLED BY: ;�,�,.� ;��-�; ,;� �iA�'�C� : SANIT.ARIAN : � :' ,� ,: , � �.� - � SITE AND SEF'TIC TANK LAYOUT ;+ � � 1 N�.e�S �� ; �x 1S n� \ c.�i � � J t� ` � _ � ---------__ ' � _, � �ec, � � �,�,_ , � m . � - ` �� 4n � � ./ O�--JE::I�Fi�'/— ,.__._.� _�s � �I-� � � 2�C � � t, ��z�,.,.�� ' �� - � � � a �_ j �`� �;.v, � _ 'L�= = :_.�� rry,.� i - -- �� -- -- I _� ,. ��`_ �_ �- - -- --- __�� a F �- � ; . ,-, _ �" -- � _. ` - - --. ._. _ �-�_, .�� . ��,t _ w_ .. �_ i �. , , � __ 1 � ,.� __. —�ti , �� ra t „`'^�7"/ / ' � � i � ..�. � �.. _�_ __ _.—� ii � --' • _ _,� .�; I ,,�� {, __-_.__.�_.�� , ��7;� HEALTH DEPARTMENT COPY •