HomeMy WebLinkAboutEHPR-07-2022-41756.TIF $A � THIS IS NOT A PERMIT Case# EHPR-07-2022-41756
CATAWBA COUNTY HEALTH DEPARTMENT
� �� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
g 2 sM Environmental Health Plan Review-OSWP
EXS_SYSTEM
Applicant RICHARD CRABTREE, 1241 CAT SQUARE RD,VALE NC 28168 CI bi(�7
C:8283814310 CRABTREE58RICK(r`t@,GMAIL.COM
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Contractor BLAKE KING,2149 WESTOVER RD,HICKORY NC 28602 ; g,a -Bei(y ` j S.j A yeti
C:8284090472
Owner JEFFREY SMITH,5809 HONEYSUCKLE LANE,MYRTLE BEACH SC 29588
NAME TO APPEAR ON PERMIT
Richard Crabtree
SITE ADDRESS: 6073 OGLESBY LN,HICKORY NC 28602 PIN# 278108992050
NAME of SUBDIVISION: J W SHUFORD FARM
Lot# 46 Section/Block
PROPERTY SIZE: Square Feet 177,289.20 Acres 4.07
DIRECTIONS: 1-40 Ashville,continue to exit 43-B,then take exit 121 toward Long View,turn right onto 33rd ST SW/Old Shelby Rd, ..
right on Oglesby Ln,property on the left
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 360 WATER SUPPLY: Private Well
C0ESCRIBE WORK: ,9/27/22 Revised to an Existing System Inspection
Previous Description: IP only
•
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: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 30x45
#OF NEW BEDROOMS:: 3
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?
EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES:
SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT):
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
cMamlicarion 09/27/2022 07:48 Page I of 3
(Ion nop signature verification:
•
�r`e CATAWBA COUNTY Case# EHPR 07-2022-41756
•{�. Public Health Department Subdivision J W SHUFORD FARM
, Environmental Health Division PIN# 278108992050
av w PO Box 389,100-A Southwest Blvd,Newton,NC 28658
NAME ON PERMIT: (RICHARD CRABTREE), 1241 CAT SQUARE RD,VALE NC 28168
( Richard Crabtree)
Site Address: . 6073 OGLESBY LN,HICKORY NC 28602
Property Size: Square Feet 177,289.20 Acres 4.07
Directions: 1-40 Ashville,continue to exit 43-B,then take exit 121 toward Long View,turn right onto 33rd ST SW/Old Shelby Rd, ^
right on Oglesby Ln, property on the 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 issued for
septic repair is valid for 80 months(5 years).Permits may be revoked if the Information on this applicatioNsite 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 ofidals are
granted right of entry to conduct necessary Inspections to determine compliance with applicable laws and rules. I understand that I am solery
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.
.L�j�/��y dodoop verified .
Dgd� d 09/27/2211:50 AM EDT .
Date: Signature of Applicant or Agent d PTEA-A910.0QMK-181D •
If you need further information or assistance please call 828-465-8270
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Improvement Permit Fee 07/25/2022 S150.00
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.n, .,.. a1' 1 f'�„rG:[�`',._l1. •� i.ei, .,�.lt.,.9.,Y... '"' .at-.•,tee+ - '• :,...4r:'.5a5 :P,.A.0:1 ?115.•y-',
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) •
•
ehapplicarion 09/27/2022 07:48 Page 2 of 3
catawba county
public health
AUTHORIZATION OF REFUND
Date: 10/4/2022
Case #: EHPR-07-2022-41756
Applicant: Richard Crabtree
Refund Amount: 570.00
Refund Reason: Revised to existing system inspection.
Authorizing Signature: 4)`
Received By Staff: tt` - ,yak
Date: ! 0/SI))
catawbacountync.gov
Environmental Health
Cctowbo County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
Catawba County, North Carolina - Disbursement Voucher
Vendor No. Date: 10/4/2022
Make Payment To: Cali Voucher No(s)
Richard Crabtree E✓ t $ ��
1241 Cat Square Rd it �
Vale, NC 28168
to 0 ;
/842
ATTACHMENT
Prepared by: Julia English
Description Amount
Revise application EHPR-07-2022-41756 to existing system inspection only $70.00
Sub-Total
Food Tax
Sales Tax
Total $ 70.00
For Accounting Use
Fund Cost Center Object Project Amount Only
110 580200 663000
Total
The undersigned hereby certifies that the goods or services specified above have been received
or performed. Payment has not been previously authorized and this expenditure is a proper
charge to the appropriation indicated. The above charge is certified to you for payment.
(SIGNATURE-APPROPRIATE OFFICIAL)
CATAWBA COUNTY
E-T 100A SOUTHWEST BLVD
j a NEWTON,NORTH CAROLINA 28658 RECEIPT
° PHONE:828.465.8399 Tuesday,October 4, 2022
I g 2 sM www.catawbacountync.gov
PAYOR:
Crabtree,Richard
PAYMEN"I S
TRANSACTION NUMBER: TRC-48442924-04-10-2022
PAYMENT DATE: 10/04/2022
PAYMENT TYPE: DV
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
07-22-409579 110480200-663000 Improvement Permit Fee ($70.00)
TOTAL PAYMENTS: ($70.00)
EHPR-07-2022-41756
CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP
SITE ADDRESS: 6073 OGLESBY LN,HICKORY NC 28602
Applicant RICHARD CRABTREE,1241 CAT SQUARE RD,VALE NC 28168
C:8283814310 CRABTREE58RICK@GMAIL.COM
**NO PEOPLESOFTACCOUNT ASSIGNED**
Owner JEFFREY SMITH,5809 HONEYSUCKLE LANE,MYRTLE BEACH SC 29588
Contractor BLAKE KING,2149 WESTOVER RD,HICKORY NC 28602
C:8284090472
receipt 10/04/2022 10:22 Page 1 of 1