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HomeMy WebLinkAboutRBPR-07-2017-26915.TIFo vG 1843, sm Contact Person Contractor Owner THIS IS NOT A PERMIT Case # RBPR-07-2017-26915 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICA'T'ION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured home EXS_SYSTEM *PROCESS MANAGHNIENT GROUP (STEVE OSTERHOLZ), 260 ,IORDAN BRANCI I RD, MARS NC 28754 C:8284186374 PROCBSSMGM'I'GROUI aGMAJL.COM *CLAYTON HOMES fl 81 /CMI -1 INC (UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 28 B:828-465-345017:828-464-0261 JWHOLDER@HO'I'MAIL.COM RICHARD BARGER, 1450 231ZD AVENUE PL NE, HICKORY NC 28601-1636 C:8283274653 NAME TO APPEAR ON PERMIT *CLAYTON HOMES # 81 /CMH INC (UNLICENSED) SITE ADDRESS: 4426 GRACE CI IURCH RD, NEWTON NC 28658 PIN # 360804518035 NAME of SUBDIVISION: Lot# 2 Section/Block PROPER'T'Y SIZE: Square Pec( Acres .570 DIRECTIONS: Hwy 10 W, left on Hky Llncolnton Hwy, right on Grace Church, 2 mi on right PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New, 28x48, doublewide, 3 bedrooms, 6x6 decks front and rear SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation Is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF old home burnt down EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Doublewide 28x48 w/ 6x6 front & rear decks # OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct) ACCEPTED. ALTERNATIVE CONVENTIONAL: OTHER: INNOVATIVE: ANY YES Other described I Q - ehapphcaln'u 07/24/2017 10 22 Page I ur4 CATAwBACOUNTr RBPR-07-2017 ?6915 CA case rrPublic I-Iealth DepaitmcntEnvironmental I Iealth Division Subdivlslon IINp360804518035 PU 13ox 3k9, IUU-A Southwest 131vJ, Newton. NC 28n9h sa NAME ON PERMIT: *CLAYTON HOMES # 81 /CMH INC (,UNLICENSED) O, 1230 CONOVER BLVD, CONOVERNC 28613 'CLAYTON HOMES # 81 /Ch Site Address: 4426 GRACE CHURCH RD, NENrTON NC 28658 Property Size: Square Feet Acres .570 Directions: Hwy 10 W, left on Hi Llncolnton Hwy, right on Grace Church, 2 mi on right improvement Permits Issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions An Authorization to Construct Issued by this department is valid for (5) five years from the date issued and Is not transferable; Improvement Permits and Well Permits are transferrable Permits may be revoked If the Information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the Information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper idenhAcation and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed Date Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days ofapplication date. Ifyou need further information or assistance please call 828-466-7291 aREA 2 i!l ilhlll{1'1„Irt^.n�liill.. lil'li I'P 'f'n n— �J°t{';'I,rt!^ f�In111I {llr,n:.. .,, ,__ _�..n In ^;l•t _ .itll { gJ.�__...,rw „PNi Ilinil9' i ', I !l+'iFEENAME �'Ji1a: : Iowa 'i{hi!�Illu:a. riii�I:��I��Iliilll .,_ ,w'�iii DATE i',{bf.:r FFE'AMOUNT Improvement Permit Fee 07/06/2017 $150.00 Existing Tank Check Fee 07/24/2017 $80.00 l�lf1�{y I l 1 ., 44. , IIr, 1 , 1 ; I 11 TOTAUFEES,52000 E{I) FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW NAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) h'i - rh:rpphcawm 07/24/2017 16 22 page 2 of 4 I kk ka ; d Contact Person Contractor THIS IS NOT A PERMIT Case # RBPR-07-2017-26915 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT 0 *PROCESS MANAGEMENT GROUP (S"f EVE OSTERHOLZ), 260 JORDAN BRANCH RD, MARS I NC 28754 0 8284 1 86374 PROCFSSMGM'I'GROUPnGMAIL.COM *CLAYTON HOMES 4 81 /CMI -I INC (UNLICENSED), 1230 CONOVER BLVD, CONOVER NC 286 B:828 -465-3450F:828-464-0261 JWHOLDERuHOTNIAIL.COM Owner RICHARD BARGER,145023RDAVENUE PLNU, HICKORYNC 28601-1636 C 8283274653 NAME TO APPEAR ON PERMIT *CLAYTON HOMES # 81 /CMH INC (UNLICENSED) SITE ADDRESS: 4426 GRACE CHURCH RD, NEW'T'ON NC 28658 PIN.# 360804518035 NAME of SUBDIVISION: _ Lut# 2 Section/Block PROPERTI' SIZE: Square Feet ere' 570 DIRECTIONS: Hwy 10 W, left on Hky Lmcolnton Wight on Grace Church, 2 mi on right PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New, 28x48, doublewlde, 3 bedrooms, 6x6 decks front and rear SITE INFORMATION Do any of the following apply to the property for which this application Is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF I old home burnt down EXISTING STRUCTURES ON SITE (IF AN DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Doublewide 28x48 w/ 6x6 front & rear decks # OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct)* ACCEPTED: ALTERNATIVE OTHER: INNOVATIVE. Other described. CONVENTIONAL ANY: YES 1.1)-r1npphcannn 117/14/2017 08 19 P,gc 1 ol4 s CATAWBA COUNTY Case a RBPR-07-2017-26915 Public Health Deparonent Subdieiaion Env irre onnnPIN# tal I lealth Division 6,'0 :% 360804518035 PO Boy 389, 100-A Southwest Blvd, Nekton, NC 28h58 NAME ON PERMIT: *CLAYTON HOMES `4 81 /CMH INC (UNLICENSED) O, 1230 CONOVER BLVD, CONOVER NC 28613 `CLAYTON HOMES # 81 /CMH INC (UNLICENSED) ( ) Site Address: 4426 GRACE CHURCH RD, NEWTON NC 28658 Property Size: Square Pcct Aciea .570 Directions: Hwy 10 W, left on Hky Lincolnton Hwy, right on Grace Church, 2 ml on right Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authonzahon to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 aREA 2 p('i ,''IIil I II)Mi'il"jr"'lino,?it r ! r:,r--_—n:; n 0FEENANiEt;�,lil�ilf!' r,��rNri+��!{11!l!;`(ffiII;IMItJl�i1!i�l .�I1f41,�((Jln,: 'illi ii!n i l�P uLT, DATE'LI�! —4j, �" ___- OUNT Improvement Permit Fee 07/06/2017 $150.00 ';'0,TOTALIFEES v°i,'fl'lii�!illi!!I�ilsdl'li,i'i)i:if�'It1,leII�N�I��`�Vf��i3' h':Ii�{ !i7. liill°'rietinh$15000;kf1 `;a t,_-- �f..;ll.�,!I�.lae.,:�. ',h.,l.,.,:�^ � „14Li1Wi11!Illlil!t:4WLILIli,lluLlL'il!IfIJIlhI'1.:dCI!P'.:,iJtih!�-.ut11!NIJILIJ:W!t1.Ili'aL.' FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) (';-c6.ip["'Cjwn 07/14/2017 OS 18 Page 2 o(4 S`BA 4► 1842 w Contact Person Contractor Owner THIS IS NOT A PERMIT Case # RBPR-07-2017-26915 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT *PROCESS MANAGEMENT GROUP (STEVE OSTERHOLZ), 260 JORDAN BRANCH RD, MARS I NC 28754 C:8284186374 PROSCESSMGMTGROUP n GMAIL.COM *CLAYTON HOMES # 81 /CMI I INC (UNLICENSED). 1230 CONOVER BLVD, CONOVER NC 286 B:828 -465-3450F:828-464-0261 1WHOLDER a FIOTMAIL.COM RICHARD BARGER, 1450 23RD AVENUE PL NE, I1ICKORY NC 28601-1636 C:8283274653 NAME TO APPEAR ON PERMIT *CLAYTON HOMES # 81 /CMH INC (UNLICENSED) SITE ADDRESS: 4426 GRACE CHURCH RD. NEWTON NC 28658 PIN # 360804518035 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Fect Acres DIRECTIONS: Hwy 10 W, left on Hky Lincolnton Hwy, right on Grace Church, 2 mi on right PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New, 28x48, doublewide, 3 bedrooms, 6x6 decks front and rear SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF old home burnt down EXISTING STRUCTURES ON SITE (IF ANY DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Doublewide 28x48 w/ 6x6 front & rear decks # OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED ALTERNATIVE. CONVENTIONAL OTHERINNOVATIVE: ANY: YES Other described: E9 - chapplicauon 07/06/2017 13 27 Page 1 of 4 eA CATAWBA COUNTY Case # RBPR-07-2017-26915 ¢ Z Public Ilealth Department Subdivision Environmental I lealth Division ' ao -K PO Bos 389. 100-A Southwest Blvd. Newnon, NC 28658 PINK 360804518035 7 2 NAME ON PERMIT: *CLAYTON HOMES # 81 /CMH INC (UNLICENSED) O, 1230 CONOVER BLVD, CONOVER NC 28613 *CLAYTON HOMES # 81 /CMH INC (UNLICENSED) ( ) Site Address: 4426 GRACE CHURCH RD, NEWTON NC 28658 Property Size: Square Feet Acres Directions: Hwy 10 W, left on Hky Lincolnton Hwy, right on Grace Church, 2 mi on right Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation c__arb��eperformed Date: 7 � I-7 Signature of Applicant or Agent Yew/d7 /Xi7neO �/ F(,G'Gai/t � ��� An Environmental I-lealth Specialist will contact you within 5 working days of application dage. If you need further information or assistance please call 828-466-7291 r FEENAME .t ` DATE FEE AMOUNT Improvement Permit Fee 07/06/2017 5150.00 TOTAL FEES 5150.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9 - chapplicarion 07/06/2017 1327 Paac 2 of 4 CATAY V 1JA THIS IS NOT A PERNIFF COUNTY CATAWBA COUNTY HEALTH DEPARTMENT —\ Application for Environmental Services Page I Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing Systenn Inspection (Pre -Approval Required), Application is for New Construction El Existing Facility Ll'Property Address 144"�P G ✓�6GC, C�rcX l&-' Subdivision Lot# Acres 1 tion/Block/phase Driving Directions to Property %0 f✓ U �;1 0r1 ml �(D NAME TO APPEAR ON 13F,R11'►IT? ❑ Owner ,,Applicant ❑ Contractor Applicant Contact Information Name C��cIftl7) H01140 Address ! Z30 CnnaVeo 131VcJ t / (�0110V2✓ N (� Phone �ej) 41 g_ 03 7 Cell Phone Owner Contact Information Name Ma4ela ref 8a .el Address yc(eC, GIrC[Ce CCrC� /2�G( Phone BZQj-- 3 L 7 - x{(053 Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL 13E THE PRIMARY CONTACT? ❑ Owner KApplicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms T f Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ® No 5-7 The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. . ® Yes CJ KTO Does the site contain anyjurisdictional wetlands? 'Eryes ® No Does the site contain any existing wastewater systems? 0 Yes O -No Is any wastewater going to be generated on the site other than domestic sewage? ,Yes . No Is the site subject to approval by any other public agency? 0 Yes 'A2l"No Are there any easements or right of ways on this property? Describe Existing water supply in use X Individual Well ❑ Community Well Semi -Public Well -L�- ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ;� No If applying foran Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) �t"' 0 Accepted El Alternative F1 Conventional El Innovative XOther l UAltR� 0 Any CATrj�T B THIS IS NOTA PERMIT couCT,i Y M---�_ Lam. CATAWIiA COUNTY I-IEALTIi DLPAR`i'iV EN'I' `-� ,.No„;c'�� Application for Httviremnent:tl Services Page 2 Proposed Facility'ry'pe ` ,WPrintary Residence ❑ New Residence ❑ Addition to Residercic '# of New Bedigons *1 3 Project Description /uU^> l�tJ Structure Dimensions} X # of Occupants Basement ❑ Yes Ia�Nci Basement Fixtures 0 Yes UNo ❑ Accessory Structure(s) Describe # of New Bedrooms * j if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ 1'Iulti-Family Residence # Units #Bedrooms per Unit*f Total # Bedrooms *` Structure Dimensions ❑ Food Service Specify'rvpe # Seats Floor Space -Entire !'cod Service Facility(Sq F:) # Employees per Shift _ # of Shifts _ Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space_ # of Employees per Shil'i _ # of Sifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application f'or Well Construetion/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored i❑ Due ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calc:tiated Design Flog, Commercial Additional information may be required to determine design flow from certain facilities. 'rhis value will be determined during consultation with on-site staff. *An v room that will be intended for sleeping at the time of ccnst!uction or for future consideration should be noted as a bedroom and counted on all applications. 'the, number cf bedrooms will be confirmed by rooms identified on house plans as a bedroom at lire tirne o: building permit issuance. This may prevent rite need for septic system size increase in the future. j If structure is plumbed but no bedrooms, calculated design flow is required. ** IfNo, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FGF, SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is no' transferable; Improvement Pet Iitits and \Nell Permits are transferrable, Permits may be revoked if the information on ibis application, site plans o intended use changes for the leoposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules 1 understand that I am solely responsible for the laoper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed, Signattu•e of0t%,ner or Agent _ _�Ju4 /m � "q ��p"�/�`£��7 I1ult-7 Printed Name of Owner or Agent CP��-/� /4PrK,00 by eee,7CR �� �� 6225 r”" ^ fZ r Catawba County Environmental Health D30 -- Parcel: 360804518035, 4426 GRACE CHURCH 1in=50ft RD NEWTON, 28658 This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this 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, 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 06/29/2017 Parcel Report Parcel Report - Catawba County NC Parcel Information: Parcel ID: 360804518035 Parcel Address: 4426 GRACE CHURCH RD City: NEWTON, 28658 LRK(REID): 90208 Deed Book/Page: 2306/0926 Subdivision: Lots/Block: 2/ Last Sale: $16,000 on 2001-10-08 Plat Book/Page: 39/143 Legal: Calculated Acreage: .570 Tax Map: 006 J 01009A Township: JACOBS FORK State Road #: 2030 Tax[Value Information: Tax Rates(pdf) City Tax District: All in County County Fire District: PROPST Building(s) Value: $800 Land Value: $8,900 Assessed Total Value: $9,700 Year Built/Remodeled: / Current Tax Bill Miscellaneous: Building Permits for this parcel. Building Details Watershed: Voter Precinct: P3 Parcel Report Data Descriptions List all Owners Deed History Report Owner Information: Owner: BARGER RICHARD ALLEN Owner2: BARGER MARGARET H Address: 1450 23RD AVENUE PL NE Address2: City: HICKORY State/Zip: NC 28601-1636 School Information: School District: COUNTY Elementary School: BLACKBURN Middle School: JACOBS FORK High School: FRED T FOARD School Map Zoning Information: Zoning District: COUNTY Zoningl: R-40 Zoning2: Zoning3: Zoning Overlay: WMH- Small Area: PLATEAU Split Zoning Districts: / Zoning Agency Phone Numbers Firm Panel Date: 2007-09-05 Firm Panel #: 3710360800J 2010 Census Block: 4003 2010 Census Tract: 011802 Agricultural District: Proximity Assessment Report Page 1 of 1 This map/report product was prepared from the Catawba County, NC Geospatial Information Services Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this 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, 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 ansa from this map/report product or the use thereof by any person or entity © 2017, Catawba County Government, North Carolina. All rights reserved. Ir http://gis.catawbacountync.gov/iiomap/parcel_report.php?key=360804518035&tvp=P 6/29/2017 r NORTH CAROLINA CATAWBA COUNTY 008723 aooK 2260PAu 1869 ACCTXS AND MAINTENANCE AC8f;3;MEhT F4 4-QJ`t'T I ZLL THIS ACCFM A.N*D NWNTENANCE AGREEI U2iT trade this 22nd day of March, 2001, bZAM between BOBBY A. BENSON* and wife, DOROTHY E. BENSON, par y of the first pan; srAl TAMMY hIICHELLE BENSON, urtmaaiod, party of dee second par,; WI TN ES9ETH: WHEREAS, the party of the first part is the owner of Lots 1 and 2 as shown on a plat recorded in Plat Book 39, Page 143, and Deed Book 1976, Page 724, Catawba Cojwy Registty; and WHEREAS, the party of that secnnd part is the owner of Lot 3 as shown on a plat recorded in Plat Book 39, Page 143, and Deed Book 1976, Pags 726, Catawba County Regjstty; and WHEREAS, there now exists a well that is cetntnonly used by the parties; and WHEREAS, the parti:s agree that is wou'.d be for their mutual interest to establJ%t an am= and maintenance ag=maat for the common use of said well; NOW, THEREFORE, it is tnutuAly agreed that the cost and mporisibility of maintenance and upkeep of said joint well is to be shared equally by ace parties. W-TF.STMONY W$EREOF, said parties have hereunto set their hands and scats the day and year first above wtnte Y PARTIES OF THE FIRST PART P�ti� (SEAL) Bobby A. anson .� wri`� E. &--Nod (SEAL) FILED Dorothy E. Bettsba RUTH 11.,GKtE N11 HQR 2 Pil 3 53 PARTY OF TITS SECOND PART REG:STEIt OF DEEDS tip yyl. YI,, Pl1�r 1 L) CATAWBA Co.. ti.G. Tammy chdleBenson ` 1c ,77 � CATAWBA C6 NTY;HEALTH DEPARTMENT TeleP hone' 828 465- 7 DD: (828)465-8200 WLSH IPI AC �kpr. Print. Opr, rent _Sys. TypeWell Print, Replacement Well Well Rpr. Print. Owner/Agentef�tn P�— fin Phone l 6 S' ? Address Subdivision Section/Bloc/Phase Lo Lot Size s 7o-citze� Directions: 16 tJ /� &'7 Property Address ' �rt�-ep Facility: House Mobile home_ L/i3usiness_A7uhi-family_ .Other: Pin N'umbetiq Q_ o 4S /eo 3 r Other . Zoning Approval Nom_/=Q� � N Bedrooms �� N Seats N Employees . Application Rate s tPD Flow c? IIot Tub or Spa yes/6PSpecial Fixtures Basement yes(tof 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well. Public Semi -Public trrs!!rr##wawrias*at++++r+lrrrrrrrraaaaaiirrl:rlrrrrrraw+raairr+rtrtttlr+rr++rri*ars+rrrtiaaiaarrarrtrt++++lraa*rtrtrrra#++t++aaa Type of System: 'french t,'- Bed Pump_ Pump/Panel_ Panel LPP Other dmct X,S'T Septic Tank Size 1000 Pump Tank Size Nitrification Field: Total Square Fcct 4C6 Depth of Stone Bed Size Trench Width , ? Total Length of All l'renches �_3OQ Number of Trenches y� n Trench Length�C� /L/&/_/_/_ Feet on Center Maximum 'french Depth Distance of Nearest Weil /0D -DO NOT INSTALL SEPTIC WHEN WET- *NVELL RECORD REQUIRED AT COMPLETION# irsi!lirrrr###iaiaaaa+++ititii#4irtrrra}#4itiaiartr!lirittrtrtrrlrrrrr##a##rt##4ir+iiaiiiaarsrtisirrrrr##*rtrirrit}}ii#++rti}+!!#r Topo t % Slope Texture 0 Structure Clay M Clay Min. j71 � Soil Wetness ry fi " oil SoDepth SoilResa Hoz. at�E Available space no Overall Class S U I Comments: I ' Filler Required f1yy7,e Riser required when tank is more than 6 (/ inches deep. Ck --NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION-- ttist4444lr4it!#4}#}ttttr###aaraiiia}**airrtar Y4lrrtr}+#r44ltrii}iii#*ttrr}tt}at+rtirta++t}Mairttrrrrirrtiirtrr}#t44arrii}}##!44 -Improvement Permit has no expiration dale and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) Five years from date issued and is not transferable. Well Permit valid for 5 rears provided site conditions do not change. Well location, installation, and protection mutt meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put Into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guarantee[ t any site by the Health Department. �-S! Permit Date — i — Q / FHS �,e,relli Owner/A t yam, ,_� Septic Tank installed By/l.t�r.ot ��� DateU_a-1) L -HS �y-4—�� UWell Installed By t �Well Grout Approval Date t Well Head Approval Date Date Sample Collected Date of Results Results EHS vn,;.. - nm,, Rive - nnildine Ins w.ction oncration Permit Yellow - Owtiei/Agent" Green - Building Inspection Authorization to Conswct