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Home My WebLink AboutRBPR-05-2022-40899.TIF 411;10 THIS IS NOTA PERMIT Case# RBPR-05-2022-40899 ET tilt 6'i CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES N 842 sM Residential Building Plan Review- Manufactured Home EXS_SYSTEM (19 )3 D_3w.... Ai 1 sic Applicant *CLAYTON HOMES OF CONOVER#81 (UNLICENSED GC-BILLING ACCT), 1230 CONOVER BLVD W. CONOVER NC 28613 B:8284653450 C:8282057855 HC08I a CLAYTONHOMES.COM Owner RSH PROPERTIES FAMILY LTD PARTNERSHIP (RICHARD HARWELL), 1381 GRANDS OAKS LN, HICKORY NC 28602-8800 11:8283244455B:8288553040 HOME:8283244455 NAME TO APPEAR ON PERMIT *Clayton Homes of Conover#81 (unlicensed GC- billing Acct) SITE ADDRESS: 1844 MESA DR.VALE NC 28168 PIN# 266901456335 NAME of sumivISION: WESTON Lot# 13 Section/Block PROPERTY SIZE: Square Feet Acres 0.52 DIRECTIONS: Right on Hwy 10 W,Right Providence Church RD,Left Old Shelby RD,Right Brittan RD, Left Mesa Dr PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLO DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK 6/23/23 REVISED TO 32X60 HOME WITH 6X6 FRONT AND REAR DECKS WITH SITE PLAN PREVIOUS DESCRIPTION: New 3 bedroom Double Wide Manufacture Home w/6x6 front&back decks 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 vacant lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 _—".. ....._ _.� PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 32 x 60,6x6 front&back decks #OF NEW BEDROOMS:: 3 Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: ehappl:cation 06/23/2023 12:25 Page 1 of3 $: CATAWBA COUNTY Case# RBPR-05-2022-40899 (...... t,� ,.4 Public health Department Subdivision WESTON 1.d Environmental Ilealth Division PIN# 266901456335 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: *CLAYTON FIOMES OF CONOVER#81 (UNLICENSED GC-BILLING ACCT) ( ), 1230 CONOVER BLVD W. CONOVER NC 28613 *Clayton Homes of Conover#81 Site Address: 1844 MESA DR,VALE NC 28168 Property Size: Square Feet Acres 0.52 Directions: Right on Hwy 10 W,Right Providence Church RD,Left Old Shelby RD,Right Britian RD,Left Mesa Dr 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 issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on 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 of 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: —)3- )--) Signature of Applicant or Agent J A� _/X,1,� If you need further information or assistant please 8-465-8270 AREA1 ************************************************************************************************************ FEENAME DATE FEE AMOUNT Existing Tank Check Fee 05/02/2022 $80.00 TOTAL FEES $80.00 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) cliapplication OG/23/2023 12:25 Page 2 of 3 leaCatawba- county Geospatial Real Estate Search Information Services 111.95 78658 o N V 00 o) 81.84 198.73 45.49 `1 'i ix Q v cv 01P 64.54 ( (J s p121 v f i 43.87 200.00 156.26 r o 00 0 /ys 0 o i 0 152.49 200.00 we 1 in=60ft s Parcel: 266901456335, 1844 MESA DR VALE, 28168 Owners: RSH PROPERTIES FAMILY LTD PARTNERSHIP, Owner Address: 1381 GRAND OAKS LN Values - Building(s): $0, Land: $21,500, Total: $21,500 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 2023 Catawba County NC na19.71•7m1 catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction ❑Existing Facility ❑ Improvement Permit authorization to Construct ❑New Septic ❑ Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion EA-lasting System Inspection or Reconnection ❑New Well ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair Property Address ��} f /UL ( 1 (._o Acres . Subdivisi L t# Driving Directions to P perry a 6 t i 5y" LV D 6Mt C ei d/C>�III CE CrfUltCl-1 1217, C5tV d 1-o StlEz,6t7 leo OM7) ,2. TI v0201 T d1��D 1 �19- lj Describe work /V) t 5ui ( A)/1 / 'h c C OIJYT C1-7 O)JJ Applicant Name C 9, Itinf,S a F- r pN/f Applicant Address CppvZf //t 14 , ( / AK__ /3 Phone S- LJ(p j - 3 i0 O Email Owner Name S7--) 04 Owner Address Phone Email Contractor Name Contractor Address Phone Email Name to Appear on Permit? ❑ Owner ❑A plicant ❑Contractor Who will be the Primary Contact? ❑ Owner Q Applicant ❑Contractor Proposed New Construction-Residential Primary Residence [ 'New Residence ❑ Addition to Residence #of New Bedrooms*t JJ #of Occupants ZP Project Description Ui' DW l-{t) hE_ Structure Dimensions,also speqy dimensions of decks&porches ( ( VD U-A S (Choose One) 0 Basement Cra0---NO Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes0---NO�]N Retaining Wall>2' 0 Yes o Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑�Cr Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes D No Retaining Wall>2' ❑ Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing ❑Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Typedividual Well ❑ Semi-Public Well ❑ Community Well Q Abandonment Type Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? ❑ Yes ❑No Environmental Health Catawba County Government Center, 25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828) 465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site Describe Structure Dimensions #of Bedrooms * #of Occupants Basement ❑Yes ❑ No Basement Plumbing ❑Yes ❑ No Existing Water Supply El Individual Well ❑Shared Well-Number of Connections ❑Community Well ❑County/City/Township Water Line Is a public water supply available? ** El Yes IEKo Commercial ❑Proposed New Construction ❑ Existing/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes El No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen El Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) 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 t e answer to any question is"yes",applicant must attach supporting documentation. ❑yeso Does the site contain any jurisdictional wetlands? 0/Yes 0 No Does the site contain any existing wastewater systems? ❑ es L9'No Is any wastewater going to be generated on the site other than domestic sewage? lles 0 N Is the site subject to approval by any other public agency? ❑Yes 0'No Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of yo reference) ❑Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other Any *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 floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. **If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to: underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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,issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on 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 of 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 o egal agent of the owner. Signature of Owner or Legal Agent Date (.P`01-a-3 Printed Name of Owner or Legal Agent -) t U IPV