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HomeMy WebLinkAboutEHPR-09-2022-42349.tif %11111b.• THIS 1S NOT A PERMIT Case# El IPR-09-2022-42349 t CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES l8 - SI Environmental Health Plan Review-OSWP ABANDONMENT Applicant *BLUEFIELD BUILDERS,LLC (THOMAS ARNDT), 127 PROMENADE DR SUITE B,MOORESVILLE NC 28117 B:7047463536 C:7046587674 DHARDYiARHOMES.COM Owner KEITH MOYE,580 WALNUT ST,CINCINNATTI OII 45202 Paid By BLUEFIELD BUILDERS,LLC (DAWN HARDY), 127 PROMENADE DR,MOORESVILLE NC 28117 C:7047463536 DHARDY@ARIIOMES.COM NAME TO APPEAR ON PERMIT *Bluefield Builders, LLC (Thomas Arndt) SITE ADDRESS: 9101 CLEMENT CIR,TERRELL NC 28682 PIN # 462705089729 NAME of SUBDIVISION: Lot# 13 Section/Block PROPERTY SIZE: Square Feet 27,442.80 Acres 0.63 DIRECTIONS: E NC 150 hwy right Greenwood Rd left Clement Cir property on right toward end PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: well abandonment 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? No 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? APPLICATION FOR: STRUCTURE TYPE: *•NO STRUCTURE SELECTED** DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 8 OF OCCUPANTS: PROPOSED CONSTRUCTION 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: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: ellappIteati m 09/23/2022 14:35 Page I of7 ip CATAWBA COUNTY Case# EHPR-49-2422-42349 j Public Health Department Subdivision y Environmental Health Division PIN# 462705089729 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: Site Address: 9101 CLEMENT CIR,TERRELL NC 28682 Property Size: Square Feet 27,442.80 Acres 0.63 Directions: E NC 150 hwy right Greenwood Rd left Clement Cir property on right toward end 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 t30 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: Signature of Applicant or Agent If you need further information or assistance please call 828-465-8270 AREAS FEENAME DATE FEE AMOUNT Well Abandonment Fee 09/23/2022 $100.00 TOTAL FEES $100.00 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) h;q>pht.uion 09/23/2022 14:35 Page 2 of 7 f ` 1 ( 6II a&t2rQiiYei'J __ IO I C/erne() C i if TeY 'el ( C aW(rz- cat wba. county q )3qq Application for Environmental Health Sere ices•I;H • IS \Ol A PER\ii'1' ilC6 Application is Cur: New('nnslruction ❑ Exiting Facitit) Li- improvement Permit ❑Anthnri,atiun to Cun,truct ❑ No, Septic ]Septic RepairiNtalfunciinn ❑Septic Relocation 0 Septic Expansion L Evi,tiap:Sp+Ictn Inspection or Reconnectinu rLi e'en Well Li Replacement Well Well Abandonment ❑Well }Repair Properly lddii►t a _C _ �' C 1[_"' 111`e1,�� v�,t I 1 oG ��� toes„Lp_3_-- Sn idil ision e' _i I1(.(1_6c1.4._ _- I�__,Ct i_{_t-_ ________ _ Lut#-_1,3_ - -- — Driving l))ircctiunz In Pri pet-1 De,crihe uurk ------- - -=---____ - 1pplicstnt 11ue' 1 U1. fill.,�-C. __ ---- -..._-. I Applicant Address pc...c r_moy651/441 v._ i3 cc.i.i n 1'hat)c cep Phone Owner Name d 4 4 Q�1__- U�.ucr Addr�s . �' s n i. Phone _ Cell Phone !__tractor Nun)e-TQ _ r RI We 14 . A-Trf _n_ _ _ License li -112 i'j-- CuniractclrAddress ia 1 Pk.)men .-_"Ill_ • c5 1n —_.._-- [ phone 104 —AD >5 —_ Cell Phone 104 (p5 1101'4 -- _- Nante to Appear no Permit" ❑(weer D Applicant f common: Whip o ill he the Primer Contact? ❑+hirer ❑Applicant , t'onllaci n Proposed New Canstrui:tiun_Residential Prinlnr:i Residence ❑ Neu. Residence ❑ .. ddiIUlri to Re4dcricc or Nov Iiedtunlii'6J `oft 14ents'iiits—_ - I Pt oleo Ikatnptiuil Soticlu,e I)iur.14nus.Aso;racily dimensions of de ks k la+rcilc. Ilatietimil ❑Yc, ❑ No lia.ement Plumbing ❑Yes [l ?tit, Accesnry Dwelling' :i of New liedfNlin's"f is of Occupuut, 5uuvnuc I)im.n.,inn' ._. _ !lawmen' ❑ Yes ❑ NO ilimelnNOnt Plumbing ❑Yes ❑ N .;cecssnr% Structurets)1)crcrihc_ -------_. ._ titrti net:(.)I)unew,inns - I'hnnh:ng ❑Yes ❑No l h.et the Pltnnhrne Needed • _ _.—._ \lulti-Fundk Residence r of Apo:tlurat,. -_OA Itedrotqns p ei.•' pniimeol'r . .___ I coal 4 licilrunms in tinnenrre"')_b nl t7:curunl+ . Sin,:lure Din tension-, `_ _ _ Ilaset'l:nt :._.t 5 e. ❑ No Ilawmtert Numbing ❑Yes ❑ No 41'cll ConstruetiuniAbandnnnientiRepuir _ Plnptl,ed 11'cll 1 f luthslduxl Well - 0 ti.nn-fwIr 14eii ❑t.'nilntruaily Well Ahaudauriienl Type L.J I).illed ❑ linrul ❑ mg 1:n6uuwir Well Reran Itquested ❑Ye: ❑ No I)esclilie Il Will Ceintird Well C•onn.mot- Inman WooI me nr I•ied:ical I me from Well l Icad In Pressure lank''❑ Yc. ❑ Nn cato.1v1hacoillitync.tiov Envirolnmental lienitli ..,Ir ..1. .. • l):Y,:i :I! t . .!! P.. , . . i :1:d1 it, 1• L .t,.r :! . ,r! 1: : : '..',J t • • Existing Structures on Site Describe Structure Dimensions #of Bedrooms ' #of Occupants Basement ❑Yes 0 No Basement Plumbing ❑Yes ❑ No Existing Water Supply ❑Individual Well 0 Shared Well—Number of Connections ❑Community Well 0 County/City/Township Water Line is a public water supply available?** ❑ Yes 0 No 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 0 No #of Children #of Employees per Shift #of Shifts Commercial Kitchen 0 Yes ❑No Residential Kitchen ❑Yes 0 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. lithe answer to any question is"yes",applicant must attach supporting documentation. Cl Yes 0 No Does the site contain any jurisdictional wetlands? ❑Yes 0 No Does the site contain any existing wastewater systems? ❑Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? O Yes 0 No 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 your preference) ❑Accepted 0 Alternative 0 Conventional ❑Innovative 0 Other 0 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. )IETRIP TO TIIEJROPERTY AND/OR SYSTEM REDESIGN WILL INCSJRAN ADDITIONAL CHARGE(SEE FEE SCHEDULE) 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 prop egal a at . the owner. a Owner or Legal Agent vt Date -I-ZZ-u- Signature of g g - Printed Name of Owner or Legal Agent'(,(Y) 0d4— - CUSTOM DESIGN FOR Keith & Karen Moye • "'°'° ""' BLUEFIELD BUILDERS, LLG File#98-Moye-C 1740E-2M-01--C' ICI } >< - o L f, , Td-9 4Lj.L Y . _- 1-0 & ww I 11 , r • i L ,1A \ \ ei 4d �-s • SQUARE FOOTA6E5-SITE •.ot.SC 4630 DCNEMY TO PROM L'NE 27_+5 ..ErXdl0U9 1 W,U TOTAL LOT AREA :9633 Grn;whic Scale 1'_ 20' c .,4F Mi�lnlrr 'v za 40' BO' BO• .` H O �� E S I n .p..pl1.n ..t It. p Oil/lap.t4Oil/ wN r. l4. q.Io rrrnpr04J .-,, or r.. olicelle.nl fr.rt..too soy...wow .lI,.r ob.6nfulr.p r..,.A6 Hem.'p.0....nunaro be.... 4%Oka,r,.~...t.t WNW.11t.le 1.1 .Wgn.lteplryNwl only Cone.Item.mot be changed al p..MKtloo Otago CMe.D4/711 CI...MY Catawba County Environmental Health po):711 136.00 tti � Q- A_C (L� P G 3�CP ME_°° 43,13 39.15 40.00 254.30 ti� .9105 LIN IN 11'". `g .9097 .9101 0 (D5• co 1C:3: 15'CP .a $ 47.70 0 asagetwarimaii Parcel: 462705089729, 9101 CLEMENT CIR 1 in=50ft TERRELL, 28682 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 2021 Catawba County NC 09/22/2022 i Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 462705089729 Owner: MOYE KEITH CLAXTON Parcel Address: 9101 CLEMENT CIR Owner2: MOVE KAREN F City: TERRELL, 28682 Address: 9101 CLEMENT CIR LRK(REID): 9273 Address2: Deed Book/Page: 3131/0888 City: TERRELL Subdivision: State/Zip: NC 28682-9719 Lots/Block: 13/ Last Sale: School Information: School District: COUNTY Plat Book/Page: 72/19 Elementary School: SHERRILLS FORD Legal: PLAT 72-19 Middle School: MILL CREEK Calculated Acreage: .630 High School: BANDYS Tax Map: 009AX 01013 School Map Township: MOUNTAIN CREEK State Road #: 1944 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-30 Building(s) Value: $19,300 Zoning2: Land Value: $310,900 Zoning3: Assessed Total Value: $330,200 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: I Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permit Address Search for this parcel. Firm Panel #: 3710462700K If available, Building Permits for this parcel. Septic 2010 Census Block: 5000 links are not permits. 2010 Census Tract: 011504 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: WS-IV Critical Area Voter Precinct: P41/Voting Map Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report 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 shell 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. ©2022, Catawba County Government, North Carolina.All rights reserved. CATAWBA COUNTY 100A SOUTHWEST BLVD 1 a NEWTON,NORTH CAROLINA 28658 RECEIPT V 14 0PHONE:828.465.8399 Friday,September 23, 2022 r 8 4 2 SM www.catawbacountync.gov PAYOR: Bluefield Builders, LLC Bluefield Builders,LLC(Hardy,Dawn) PAYMENTS TRANSACTION NUMBER: TRC-47775 1 1 1-23-09-2022 PAYMENT DATE: 09/23/2022 PAYMENT TYPE: Credit Card 295427420 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 09-22-412671 110-580200-663000 Well Abandonment Fee $100.00 TOTAL PAYMENTS: S100.00 EHPR-09-2022-42349 CASE TYPE: Environmental I Iealth Plan Review WORK CLASS: OSWP SITE ADDRESS: 9101 CLEMENT CIR,TERRELL NC 28682 Applicant *BLUEFIELD BUILDERS,LLC, 127 PROMENADE DR SUITE B,MOORESVILLE NC 28117 B:7047463536C:7046587674 DHARDY@ARHOMES.COM Owner KEITH MOYE,580 WALNUT ST,CINCINNATTI OH 45202 Paid By BLUEFIELD BUILDERS,LLC, 127 PROMENADE DR,MOORESVILLE NC 28117 C:7047463536 DHARDY@ARHOMES.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 09/23/2022 14:34 Page 1 of I