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Home My WebLink AboutEHPR-9-10-7271 (2).TIF •�$ CM THIS IS NOT A PERMIT Case # EHPR - - 10 - 7271 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services \ , 842 sM Environmental Health Plan Review - OSWP IMPROVEMENT - NEW WELL NAME TO APPEAR ON PERMIT LITTLE CHARLES SITE ADDRESS: 5978 LOOKOUT HEIGHTS DR, Claremont, NC Pin#: 376504831050 NAME of SUBDIVISION:LOOKOUT HEIGHTS SUBDIV Lot # 4 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.19 DIRECTIONS: HWY 16 N - TURN RIGHT ONTO OXFORD SCHOOL RD - TURN LEFT ONTO RIVERBEND RD - TURN RIGHT ONTO PENLEY BLVD - LOT ON RIGHT BESIDE A -FRAME HOUSE APPLICANT OWNER CONTRACTOR LITTLE CHARLES LITTLE CHARLES 4603 ROCK BARN RD 4603 ROCK BARN RD CLAREMONT NC 28610 -8523 CLAREMONT NC 28610 -8523 828 - 234 -4769 828- 234 -4769 PRIMARY CONTACT: Applicant APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: EXISTING FACILITY TYPE: N/A NUMBER OF EXISTING BEDROOMS: SEWER TYPE: Septic Tank EXISTING WATER SUPPLY IN USE: N/A CALCULATED DESIGN FLOW: WELL TYPE: Public water is * *NOT** available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: IN TWO YEARS WILL BUILD A BASEMENT HOUSE AND PUT A STORAGE BUILDING - NOW WOULD LIKE TO PUT A WELL IN PROPOSED FUTURE ADDITIONS WILL BUILD BASEMENT HOUSE AND ALSO PUT STORAGE BUILDING UP IN OR IMPROVEMENTS: APPROXIMATELY 2 YEARS PROPERTY EASEMENTS: NO PROPOSED CONSTRUCTION PRIMARY RESIDENCE NEW RESIDENCE? New Residence # OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS: 1,360 PROJECT DESC: WANT TO BUILD BASEMENT HOUSE IN FUTURE PROJECT DIMENSION: 28 X 36 BASEMENT? Yes BASEMENT FIXTURES? Yes ACCESSORY STRUCTURES DESCRIPTION: WILL PUT STORAGE BUILDING UP IN FUT # OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 20 X 24 ACC DWELLING? PLUMBING? # OF STRUCTURE OCCUPANTS: APPLICATION FOR WELL CONSTRUCTION /ABANDONMENT /REPAIR PROPOSED WELL TYPE: ABANDONMENT TYPE: WELL REPAI REQUESTED? 09/10/10 16:13 � v,A • CATAWBA COUNTY Case 4 C Q . ,. P ublic Health Department EHPR 9 10 7271 t 2 Subdivision LOOKOUT HEIGHTS SUBD Environmental Health Division - Plan Review d " "' "' "% `' PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# 4 I8 . 2 sw PIN# 376504831050 Applicant/Owner LITTLE CHARLES, 4603 ROCK BARN RD, CLAREMONT NC 28610 - 8523 Site Address: 5978 LOOKOUT HEIGHTS DR, Claremont, NC Property Size: SF 1.19 ACRES Directions: HWY 16 N - TURN RIGHT ONTO OXFORD SCHOOL RD - TURN LEFT ONTO RIVERBEND RD - TURN RIGHT ONTO PENLEY BLVD - LOT ON RIGHT BESIDE A -FRAME HOUSE 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. n�� y.�� Date: / / 0 - i 0 Signature of Applicant or Agent �,,� 04.424 i2 - .l �-^-'Ci 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 AREA2 Minimum Setbacks FEE NAME DATE AMOUNT BALANCE DUE Front 30 Side 15 Improvement Permit Fee _ _ _ 09/10/2010 _ $150.00 __� $0_00 Rear 30 Well Permit & Inspection Fee 09/10/2010 $300.00 $0.00 Side __._ 4__ _.._..._____.____._..._._._.... __....... � _ _ -. - .._..:......____ _._._�_... _.___._..._ ._... .._..,,._...___.......,__.___.. Max Hght TOTAL FEES $450.00 $0.00 CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 09/10110 16:13 THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT k 'o `</ Application for Environmental Services Page 1 1 8 42�,M Improvement Permit / Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ViReplacement Well 7 Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre- Approval Required) ❑ Application is for New Construction ❑ Existing Facility Property Address S9 n LooKDuT HE/6/(7.s 64 - Subdivision LOdlaU Hete S Lot # V Acres Section/Block/Phase Driving Directions to Property 6t/ »Y) HWY /L 7 )R.l) Q t6 HT oN io ax xdk e.) i AAA �J 2 ∎,& iie. n Al OE12.f ti 0 t?1 kA; IG • Y v R A u iR I G i r 6itii 0 PENCE Y tifLA . Lor f:; ,f?G 5 t DC ,4 - fr Am f{c)v.Si c^4/ V ► le-N 1 a NAME TO APPEAR ON PERMIT? Owner U Applicant ❑ Contractor O Applicant Contact Information V Name CVOr le s14). :G F Address 3/4'06,3 lr :/i FA f k C1 , 4I2 E,410A/ Phone - y59. Cell Phone R 2' . 23 k /74 9 z Owner Contact Information Name a co_ (lNt /��.,,,� • Address � Q Phone Cell Phone ▪ Contractor Contact Information Name .3'fREmy `OcK /A Address = Phone Cell Phone F► • WHO WILL BE THE PRIMARY CONTACT? 0 Owner 2<pplicant ❑ Contractor Z Description of Existing Structures on Site Q # of Bedrooms *t Structure Dimensions # of Occupants l� Basement n Yes ❑ No Basement Fixtures E Yes ❑ No Planned Future Additions or Improvements (Building Permit NOT requested at this time) C C Describe &45( ME 07 p f)/0 6*C 4 ) u , ( / : - Proposed Future Structure Dimensions R .3C0.• # of Bedrooms *-� if applicable ,3 Are there easements or right -of -ways recorded on this property ❑ Yes Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes 70" Check type available ❑ Community Well ❑ Semi- Public Well ❑ County /City /Township Water Line Existing water supply in use U Individual Well U Community Well E Semi - Public Well n County /City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) te a' ,� c THIS IS NOT A PERMIT „ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Pro osed Facility Type Primary Residence VNew Residence IT Addition to Residence # of New Bedrooms *t to " 3 Project Description 3/1s 04C,v T Nc)u Structure Dimen)ions # of Occupants / Basement ❑'Yes ❑ No Basement Fixtures E Yes ❑ No ❑ Accessory Structure(s) Describe S7nx4G.E torLpi rl/S # of New Bedrooms *t if applicable Structure Dimensions ZG Jc 2 # of Occupants Accessory Dwelling n Yes n No Plumbing n Yes ❑ No Describe Plumbing Needed T Multi - Family Residence # Units #Bedrooms per Unit *t Total # Bedrooms *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space - Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Daycare Specify Occupancy Application for Well Const uction /Abandonment/Repair Proposed Well Type t7 Individual Well ❑ Semi - Public Well ❑ Community Well Abandonment Type ] Drilled ❑ Bored ❑ Dug [ Unknown Well Repair Requested — Yes n No Describe Calculated Design Flow, Commercial j' 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 of construction 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. tIf structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. 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. O CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN W ADDITIONAL CHARGE (SEE FEE SCHEDULE) ON I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand 0 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 transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for CO (5) five years from the date issued and is not transferable Signature of Owner or Agent �Cr i�,o p- ( .(.„ z Printed Name of Owner or Agent C <natz(as R L Date l - /v - /O Catawba County, North Carolina N This map product was prepared front the Catmvba County, NC, Geographic information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information • A contained on thus map. Catmvba 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 for any cud all damages, loss or liability, whether direct, in or consequential which arises or may arise from this Wrap product or the use thereof by any person or entity, Legend Selected Parcel Number: 3765 -04 -83 -1050 1 inch = 89 feet Prepared for: i ItJt`;•`y ■ 1..-------'—'—'''------------') \t, a s> \ CD ; � 4 s . 1 \ 1 O r , 1 1 .... j Q . L . 4J '– 1 - 5 j . ��-5� i ',50 97 ' S t � t ,. ' ~ ? I ? ' i 1 »O6 ........ 1 1 I] I t .. ............. ..........................��, ........ .... F 4 i t .... 15.8 c x-.. i ( ) 0 ' ; :: :::::: 561:::Q7 _: i I 1 :: ! . . .. . 1 ...1.. .. '^ { EE ? 4 W 1 f /.. 7 ' / / :. 4 : f Y_: i . :78 • ! 3. r 1 ' / / ,� r. ...t 1.2.1 A .....1. : i. :• o . / �: _ :. .. 1852 0 -...� ,f j / i 1 :1 X597.24 1 5 8,x 1 / 1 t 1 30A .2- ! !: . Imo- !/, , --- _fib / j : 18 f 1742 : 8 --- THIS IS NOT A LEGAL DOCUMENT ' •25 Friday, September 10, 2010 03:28 PM • t • • •• • —S •CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3765 -04 -83 -1050 Name: LITTLE CHARLES RONNIE Name2: Address: 4603 ROCK BARN RD Address2: City: CLAREMONT State: NC Zip: 28610 -8523 Account: 41809850 Calc Acreage: 1.19 Tax Map: 1012 01011 LRK: 44845 Deed Book: 1624 Deed Page: 0603 Subdivision Name: LOOKOUT HEIGHTS SUBDIV Subdivision Block: Lots: 4 Plat Book: 15 Plat Page: 56 Building Number: 5978 Street Name: LOOKOUT HEIGHTS DR Site Zip: 28610 Township: CLINES Fire Code: OXFORD City Code: COUNTY State Road: Total Bldgs Value: Land Value: $52,300 Total Value: $52,300 Year Built: Year Remodeled: Last Sale Date: 8/1/1989 Last Sale Amount: $15,500 Neighborhood: 67 Watershed: WS -IV Critical Area Watershed Split: NO Voter Precinct: P27 E911 District: COUNTY Zoning: R -40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC- O,WP- O,FPM -O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P &Z Case Number: Census Tract 2010: 010101 Census Block 2010: 1009 Small Area Plan: ST STEPHENS /OXFORD Agricultural District: Printed: Friday, September 10, 2010 03:28 PM �Cp CATAWBA COUNTY, NC �� ' + ; ' ,� 100 -A South West Blvd E -] Newton, NC 28658- PLAN RECEIPT �` IP Ora (828)465 Friday, September 10, 2010 /8474 sM www.catawbacountync.gov Plan Case: EHPR -9 -10 -7271 Invoice Number: INV - 9 - 10 - 266866 Environmental Health Plan Review Invoice Date: 09/10/2010 Site Address: 5978 LOOKOUT HEIGHTS DR, Claremont, NC APPLICANT OWNER CONTRACTOR LITTLE CHARLES LITTLE CHARLES 4603 ROCK BARN RD 4603 ROCK BARN RD CLAREMONT NC 28610 -8523 CLAREMONT NC 28610 -8523 828 - 234 -4769 828 - 234 -4769 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Well Permit & Inspection Fee Fixed $300.00 Total Fees Due: $450.00 PAYMENTS PAYER: CHARLES LITTLE Date Pay Type Check Number Amount Paid Chang( 09/10/2010 Cash - 1 $450.00 $0.00 Total Paid: $450.00 Total Due: $0.00 plan receipt 09/10/2010 16:12