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Home My WebLink AboutEHPR-04-2018-29032.TIF THIS IS NOTA PERMIT Case# EHPR-04-2018-29032 CATAWBA COUNTY HEALTH DEPARTMENT 0 `y`o •. 17/1(±) % PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1g;ifiS Ig 2/sx Environmental Health Plan Review-OSWP .1.,,13...4° I n ber ;lc/ IMPROVEMENT $azo 0 <rrrY Applicant CLAYTON HOMES (ELIZAIIH?N OSTERHOLZ).260 JORDAN BRANCH RD,MARS I(ILLS NC 28754 B:8284186374 C:8287750951 NAME TO APPEAR ON PERMIT Clayton Home JElizabeth Osterholz) SITE ADDRESS: 2115 MOSS FARM RD,HICKORY NC 28602 j PIN# 279114444226 NAME of SUBDIVISION:-- -'--- — Lot ,._ Section/Block PROPERTY SIZE: Square Feet _ 101,059.20 Acres 2.32 DIRECTIONS: NC 10 to US 321N to NC 127,left turn,right on Moss Farm Rd.site on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only for 25x60 off frame modular with 3 BR's-existing system cannot be found, but the new house location is further back 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 25x60 modular #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: tdapplia,ion 05,012018 13:46 Page I of • THIS IS NOTA PERMIT Case# EIIPR-04-2018-29032 G v �� H CAfAW BA COUNTY HEALTH DEPARTMENT 0 ' ''o {ll K PLAN REVIEW APPLICATION FOR ENVIRONMENIAL SERVICES v _ /8 "L r. Environmental Health Plan Review-OSWP IMPROVEMENT ❑' o o ' Applicant CLAYTON HOMES (II.IZAI3EII I OSI ERHOLL),260,JORDAN BRANCH RD.MARS 1111.1.5 NC 28754 E,8284186374 C:828775095 I NAME TO APPEAR ON PERMIT Clayton Homes (Elizabeth Osterholz) SITE ADDRESS: PIN tt 279114444226 NASIE orSIIRDIVISION: _ Lot H Section/Block PROPERTY SIZE: Square Feet 101059.20 Acres 2.32 DIRECTIONS: NC 10 tu US 321N to NC 127,left turn,right on Moss Farm Rd,site on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 380 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only for 25x60 off frame modular with 3 BR's-existing system cannot be found, but the new house location is further back 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 25x60 modular #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE. ANY. YES Other described. 1109 Pave Ieta „rco c:A1 wBA Conran' Dawe El IPR-04-2018-29032 ,m t in L Public Health Department Subdivision CAin E`J ^ Environmental l Health Division PIN% 279114444226 PO Box 389,100-A Southwest Blvd.Newton,NC 28058 NAME ON PERMIT: CLAVION HOMES (ELIZ_AB[TII OSTFRHOLZ).260 JORDAN BRANCII RI).MARS HILLS NC 28754 Clayton Homes (Elizabeth Oste Site Address: Property Size: Square lest 101059.20 Acres 2.32 Directions: NC 10 to US 321N to NC 127,left turn,right on Moss Farm Rd,site on left Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issuedfor septic repair is valid for 60 months(5 years).Permits may be revoked It the information an this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements 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 al all property lines and corners and making the site accessible so that a complete site evaluation can be performed The undersigned is the owner of the property or legal agent of the owner. / Date 41 ll, II ( Signature of Applicant or Agent (a. lellr`L& - fs'eFI r,X P/:A If you need further in formation or assistance please call 828-466-7291 (1 AREA2 .............................................................................................e............. FEENAME PATE FEE AMOUNT Improvement Permit Fee 04/30/2018 $150.00 TOTAL FEES .. S150.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) II epi, 04J331{IN 13 01 Para 2 orf • CATAWBA THIS IS NOT A PERMIT rt1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit Authorization to Construct❑ Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection(Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address -2-ll 5 Au'Sc Id /cJ Subdivision 11/2C4.1:11 , N C, Lss6.Cr, 2— Lot# Acres Z. •? "2— Section/Block/Phase SectionBlock/Phase Driving Directions to Property /VC - 0h ti"/3 Li oh to NC —1a7 , 0r-) , (1,1,-) on /C' S Gzililt /2.1t ,j L cFc o.t ) NAME TO APPEAR ON PERMIT? ❑ Owner ,ErApplicant ❑ Contractor Applicant Contact Information Name (XCuar,l i-? ,iLe' Address i 2- 3v cot c, ye e / /v.J i 2 C U' r 3 Phone S-7.55- _) 75 -Oct c1 e7;Zr% be K C Cell Phone Owner Contact Information Name PKC Lccj /n,rCRE:e'r— Address c3* ' -1 14aty /46 r/Lk llt w Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ,Applicant ❑ Contractor Description of Existing Structures on Site Vow-. #of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures a Yes ®No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. C Yes C)1 o Does the site contain any jurisdictional wetlands? -15-Yes 0 No Does the site contain any existing wastewater systems? IC Yes .D No Is any wastewater going to be generated on the site other than domestic sewage? fes ,$No Is the site subject to approval by any other public agency? ®Yes No No Are there any easements or right of ways on this property? Describe Existing water supply in use ,S—Individual Well Li Community Well [I Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑No If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other Any CATAWBA THIS IS NOT A PERMIT annry CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type a Primary Residence fNew Residence ❑ Addition to Residence #of New Bedrooms *t Project Description -ii- 0 p(E-{rr nut inL..cit6(di Structure Dimensions t5 (eil #of Occupants rf Basement ❑Yes _0'No Basement Fixtures ® YesAINo LI Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑No Plumbing ❑ Yes ❑No Describe Plumbing Needed U Multi-Family Residence#Units #Bedrooms per Unitet Total#Bedrooms *t Structure Dimensions LI Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts Li Other Facility Type Specify If Church#of Seats Kitchen ❑ Yes 9 No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well 9 Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes 9 No Describe Calculated Design Flow,Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the time ofconstructitn 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 time of building permit issuance. This may prevent the need for septic system size increase in the future. t If structure is plumbed but no bedrooms,calculated design flow is required **If No,a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE(SEE FEE 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 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. CC(L. fi9� 1/ 'sur fw Signature of Owner or Agent L N '(e4e (4:76-1. 4(C Date °f/ -;<,/l S Printed Name of Owner or Agent c7,4'.1 7Q i)€ <— d�,) Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279114444226 Owner: WEAVER RICKY CHARLES Parcel Address: 2115 MOSS FARM RD Owner2: City: HICKORY, 28602 Address: 5469 HAWTHORNE LN LRK(REID): 48198 Address2: Deed BooWPage: 3364/0277 City: HICKORY Subdivision: State/Zip: NC 28602-9433 Lots/Block: / School Information: Last Sale: $24,000 on 2016-09-28 School District: COUNTY Plat Book/Page: Elementary School: MOUNTAIN VIEW Legal: Middle School: JACOBS FORK Calculated Acreage: 2.320 High School: FRED T FOARD Tax Map: 133H 01011 Township: HICKORY School Map State Road #: 1194 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $0 Zoning2: Land Value: $22,900 Zoning3: Assessed Total Value: $22,900 Zoning Overlay: Year Built/Remodeled: / Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710279100J Building Details 2010 Census Block: 2009 WaterShed: 2010 Census Tract: 011101 Voter Precinct: P24 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/repon product was prepared from the Catawba County,NC Geospa0al 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 vent!cation of any data contained on rola 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/reporl product or the use thereof by any person or entity. Cr 2018, Catawba County Government, North Carolina.All rights resented. http://gis.catawbacountyne.gov/nomap/parcel_report.php?key=279114444226&typ=P 4/30/2018