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Home My WebLink AboutEHPR-3-10-4175 (2).TIF A C THIS IS NOT A PERMIT Case # EHPR-3-10-4175 CATAWBA COUNTY HEALTH DEPARTMENT v ^C Plan Review Application for Environmental Services I g 42 5M Environmental Health Plan Review - Septic Malfunction SEPTIC MALFUNCTION APPLICANT OWNER CONTRACTOR BETTY STOREY SPKINGSIDE MOBILE HOME PARK LLC PO BOX 436 1417 E MAIDEN RD MAIDEN NC 28650- MAIDEN NC 28650- (828)428-8682 (828)428-8682 NAME TO APPEAR ON PERMIT BETTY STOREY Pin#: 365605293835 SITE ADDRESS: 2278 S WITHERS RD, Maiden, NC DIRECTIONS: HWY 321 S - TURN LEFT ONTO MAIN STREET IN MAIDEN - TURN LEFT ONTO PROVIDENCE MILL RD - TURN RIGHT ONTO EAST MAIDEN RD - TURN RIGHT ONTO WITHERS RD - TURN LEFT INTO MOBILE HOME PARK 2ND RD - NAME of SUBDIVISION4TiNS11E~~IHT Lot # 7 & 8 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.21 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure 14 X 60 Bedrooms 4 Basement: No Water Using Fixtures in Basement:No No. in Family 5 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 0.00 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 Ist 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? 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 norrexpiring 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 V An Environmental Health Specialist will contact you within 2 worki days of applica ionlflate. If you need further information or assistance please call 828-466-7291 AREA1 (FOR OFFICE USE ONLY) Zoning Approval: _Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Authorization to Construct (Repair) F,03/04/2010 $425.00 Rear TOTAL FEES $425.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/04/10 13:26 THIS IS NOT A PERMIT wcs-7~_ 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 ❑ I . Name to Appear on Permit 1 ' T 2. Permit Requested By " -1- c` Bu Phone Address .1c..• ! it cj ~i~ »e Phone _1 F z U J 3. Property Owner -c, o n } t, Business Phone Address ti - - t Hota° cwone 15'' C? 0] 140 4. Name of Subdivision , AJ c_ ° - -4 k Lot # Section/Block/Phase Property Address E> e r /4 Directions to Pro erty: i k-A ET e r f j c t r r;t u_ r,.7 A_~ 5. Property Size:' Square Feet Acres Date Platted/Re orded 6. TYPE OF FACILITY: House Mobile Horne-,.' Dimension of Structure 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 11 Limber of bedrooms wiII be confirmed by rooms identified on house plans as bedroom at the time of building permit issuance. This may prevent the geed for system size increase in the future. Basement: yes/~io Water Using Fixtures in Basement: yes/ b No. in Family S Whirlpool Tub yes no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Uni 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 o If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes No 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 proper . Yes / No Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Pen-nit must be iss with the Septic Permit.** 11. Well Type Applying For: [ dividual 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 3- / L Signature of Owner or Agent f . l i : , Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accaracv of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable jor amv and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map product or the use thereof by anv person or entity. Legend Selected Parcel Number: 3656-05-29-3835 1 inch = 100 feet Prepared for: air o 2a2.6a Plat.52-190. 4353 w 27 09~ ly 2278 15200 m rn 289.72 tl X250 00 cb r- U 1.38A t_i E] 3164 0 271 g2 ~ ~ t 2 3.42A 0 2 1~ 5070 n g9 06 ~U _ ^s 1 l> 1_.21 A °o i t 3835 ° 3a~g6 2 260 w Plat 6-80 0) 1s--l, N qj N 6711 1,--_4770 1 0 ` 40 2231 j; r`J l THIS IS NOT A LEGAL DOCUMENT , Thu, March 04, 2010 12:57 PM ~Cr t CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3656-05-29-3835 Name: SPRINGSIDE MOBILE HOME PARK LLC Name2: Address: 2278 WITHERS RD Address2: City: MAIDEN State: NC Zip: 28650-0436 Account: 159740838 Calc Acreage: 1.21 Tax Map: LRK: 200291 Deed Book: 2912 Deed Page: 0110 Subdivision Name: Subdivision Block: Lots: Plat Book: 37 Plat Page: 162 Building Number: 2278 Street Name: WITHERS RD Site Zip: 28650 Township: CALDWELL Fire Code: MAIDEN RURAL City Code: COUNTY State Road: 1868 Total Bldgs Value: $9,500 Land Value: $15,800 Total Value: $25,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 113 Watershed: WS-II Protected Area Watershed Split: NO Voter Precinct: P9 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: MAIDEN Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: MAIDEN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011600 Census Block 2010: 5005 Small Area Plan: Agricultural District: Printed: Thu, March 04, 2010 12:58 PM 'A Cpl CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT r ] Newton, NC 28658- (828)465-8399 Thursday, March 4, 2010 18 4 Z sm www.catawbacountync.gov Plan Case: EHPR-3-10-4175 Invoice Number: INV-3-10-260076 Environmental Health Plan Review Invoice Date: 03/04/2010 Site Address: 2278 S WITHERS RD, Maiden, NC APPLICANT OWNER BETTY STOREY SPRINGSIDE MOBILE HOME PARK LLC PO BOX 436 1417 E MAIDEN RD MAIDEN NC 28650- MAIDEN NC 28650- (828)428-8682 (828)428-8682 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $425.00 Total Fees Due: $425.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/04/2010 Check 1058 $425.00 $0.00 Total Paid: $425.00 Payer: BETTY STOREY Total Due: $0.00 plan receipt;JbcGJ c-d7Sb-4e )3-5h'6-3cl~la0c3R?hi;.rpt 03/04/2010 13:25 CATAWBA-LINCOLN-ALEXANDER DISTRICT HEALTH DEPARTMENT HICKORY, N. C.-NEWTON, N. C.-LINCOLNTON,'N.- C-TAYLORSVILLE, N. C. i Phones 328-2561 464-2011 735-3001 632-3101 4 PERMIT TO INSTALL SEPTIC TAN PERMIT N t i PERMIT DATE Owner..... J GEP.`~.... .........................Address........ Tenant........ Address . Installed by . . . a. ' . . . Address Location of Property, > • ..O•'r-' r{.{....:.° Kind of tank Sae Length of trench ....4 NOTIFY HEALTH DEPARTMENT AT LEAST EIGHT HOURS BEFOR TANK IS TO BE INSPECTED Final Inspection_ .................y/.,....6.................19.... Approved ( Disapproved ( ) Remarks: First five feet of line from outlet house should be of cast iron soil pipe. r t Sanitarian. Sketch of tank and line showing distance from dwelling and well on subject property and an adjoining property.--