HomeMy WebLinkAboutEHPR-3-11-10081 (2).TIF Ea�v�ro�m�nta� I��alt� Additio�al Fee Collection Notice �
The following additionai fees as che�ked below must be collected prior to further action
by our department: � .
0 Repair Permit Application � .
. ❑ Permit revision (re-draw) . . � ,
. 0 Well Permit � �
❑ Authorization to Construct (system upgrades, etc.) �
� Other (please explain below) � � .
/ ' .�
�,�'�l�II�C. lYl���,�� t'�� (2/� �Zv"t'r�1 .
EHS � Date - .
A
�� C p� THIS IS NOT A PERMIT Case # EHPR-3-11-10081
�
�` � CATAWBA COUNTY HEALTH DEPARTMENT
v �� ''C Plan Review Application for Environmental Services
1842 SM Environmental Health Plan Review - OSWP
� C� '' � � � IMPROVEMENT
� �. NAME TO APPEAR ON PERMIT
�� � ��� Cherie Bish
s�TE A��RESS: 3982 MILLER DR, Newton, NC Pir�: 361803042359
NAME of SUBDIVISION:G C PARK SUB Lot # ]� Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.46
DIRECTIONS: Hwy 10 West - Lf Hickory Lincolnton Hwy - RT Miller Dr - Gray trailer beside blue house
APPLICANT OWNER CONTRACTOR
Cherie Bish Cherie Bish
3982 Miller DR 3982 Miller DR
Newton NC 28658 Newton NC 28658
828-640-3315 82&640-3315
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 12 x 60 EXISTING FACILITY TYPE: Mobile Home
NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 3 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is **NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: Change out Mobile Home * Must have 36 SF Front Deck - Must be Vinyl Underpinned - Must have min 3
foot landing on rear door - must screen or remove towing tongue - must be paralle to road
DESCRIPTION OF mobile home ** to be removed and repalced with larger home
EXISTING STRUCTURES
ON SI7E (IF ANY)
P EASEMENTS: none
PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS:
PROJECT DESC: New Single Wide ** USing existing well
PROJECT DIMENSION: 16 x 72
BASEMENT? No BASEMENT FIXTURES? No
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 norrexpiring 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 properiy. Any representation by you of house or
structure location should conform to applicable setbacks.
Date: Signature of Applicant or Agent
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
AREAZ
**************************�*****�******************************�************�*********�*******�*�**************�******
04/06/11 10:50
� CATAWBA COUNTY Case # EHPR-3-11-10081
G Public Health Department
¢ �2. Subdivision (', C PARK SUB
� Environmental Health Division - Plan Review
� av '�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 L�� � 1
rg 2 s� PM# 361803042359
Applicant/Owner Cherie Bish, 3982 Miller DR, Newton NC 28658
Site Address: 3982 MILLER DR, Newton, NC
Property Size: SF 0.46 ACRES
DireCtions: Hwy 10 West - Lf Hickory Lincolnton Hwy - RT Miller Dr - Gray trailer beside blue house
Minimum Setbacks Front: 30 Side: 15 Rear: 30 Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Autharization to Construct Fee (New/Expansion) Fee 03/28/2011 $150.00 $0.00
Improvement Permit Fee 03/28/2011 $150.00 $0.00
TOTAL FEES $300.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
04/06/11 10:50
.��' Cp CATAWBA COUNTY, NC
�,� �,� '°°-A S°°t" West B'�d PLAN RECEIPT
� f.-] Newton, NC 28658-
V G�� � (828)465-8399 Wednesday, April 6, 2011
1$�Z sM www.catawbacountync.gov
P�an case: EHPR-3-11-10081 �nvoice Number: INV-3-11-273482
Environmental Nealth Plan Review Invoice Date: 03/28/2011
Site Address: 3982 MILLER DR, Newton, NC
APPL�CANT OWNER CONTRACTOR
Cherie Bish Cherie Bish
3982 Miller DR 3982 Miller DR
Newton NC 28658 Newton NC 28658
828-640-3315 82&640-3315
Fee Name Fee Amount
Improvement Permit Fee Fixed $150.00
Authorization to Construct Fee Adjustable $150.00
(New/Expansion) Fee
Total Fees Due: $300.00
PAYMENTS
PAYER: Cherie Bish
Date Pay Type Check Number Amount Paid Change
03/28/2011 Cash -1 $300.00 $0.00
04/06/2011 Refund -1 ($150.00) $0.00
Total Paid: $150.00
Total Due: $0.00
plan receipt 04/06/2011 10:50
" : . , . . . , . '77 � _..,,
� Catawtia Coun North:Carolina - Disbu:rsement�Voucher . `
Vendor No. Date 04/06�11
Make Payment To: � �'O� Voucher No(s).
Cherie Bish �.., t �` 'Z
3982 Miller Dr Q �
v "�'� �
Newton, NC 28658 ?g��
ATTACHMENT
Description Amount
Permit found for 3 bedroom system expansion no longer required 150.00
credit AC
Sub-Total $ � so.00
Food Tax
Sales Tax
Total $ 150.00
: ; . . � . . - For Accounting
Account Fund. Organ.: � � Project - .: Use Only °:. :
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)
E�av�ro�me��a� H�alt� Additio�a� Fee Collectioa� Notice
The following additional fees as checked below must be collected prior to further action
by our department: � .
.0 Repair Permit Application � .
. ❑ Permit revision (re-draw) . ,
. ❑ Well Permit � �
❑ Authorization to Construct (system upd ades, etc.) �
� Other (please explain below) � � .
/•
(��'�i�. rr��",�c� c�d � �
EHS � Date � � .
� F ' A C� THIS IS NOT A PERMIT Case # EHPR-3-ll-10081
�" � CATAWBA COUNTY HEALTH DEPARTMENT
v ��: ''�' Plan Review Application for Environmental Services
1842 sM Environmental Health Plan Review - OSWP
C� '� � � i IMPROVEMENT
NAME TO APPEAR ON PERMIT
`����� Cherie Bish
SiTE a��Ress: 3982 MILLER DR, Newton, NC Pin#: 361803042359
NAME of SUBDIVISION:G C PARK SUB Lot # 11 Section/Block/Phase
PROPERTY SIZE: Square Feet Acres 0.46
DIRECTIONS: Hwy 10 West - Lf Hickory Lincolnton Hwy - RT Miller Dr - Gray trailer beside blue house
APPLiCANT OWNER CONTRACTOR
Cherie Bish Cherie Bish
3982 Miller DR 3982 Miller DR
Newton NC 28658 Newton NC 28658
828-640-3315 82&640-3315
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 12 x 60 EXISTING FACILITY TYPE: Mobile Home
NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE: Septic Tank
NUMBER OF EXISTING OCCUPANTS: 3 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is **NOT** available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRIBE WORK: Change out Mobile Home * Must have 36 SF Front Deck - Must be Vinyl Underpinned - Must have min 3
foot landing on rear door - must screen or remove towing tongue - must be paralle to road
DESCRIPTION OF mobile home ** to be removed and repalced with larger home
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMENTS: none
PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS:
PROJECT DESC: New Single Wide ** USing existing well
PROJECT DIMENSION: 16 x 72
BASEMENT? No BASEMENTFIXTURES? No
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 norrexpiring 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.
Date: Signature of Applicant or Agent
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
******************�****�*�********************************************************************************************
04/06/11 ]0:50
� CATAWBA COUNTY Case #
y � G Public Health Department EHPR-3-11-10081
�' � Environmental Health Division - Plan Review Subdivision G C PARK SUB
v a'�'v "�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot#
11
Ig 2 5� PIN#
361803042359
Applicant/Owner Cherie Bish, 3982 Miller DR, Newton NC 28658
Site Address: 3982 MILLER DR, Newton, NC
Property Size: SF 0.46 ACRES
DireCtions: Hwy 10 West - Lf Hickory Lincolnton Hwy - RT Miller Dr - Gray trailer beside blue house
Minimum Setbacks Front: 30 Side: 15 Rear: 30 Side St: Max Height:
FEE NAME DATE AMOUNT BALANCE DUE
Authorization to Construct Fee (New/Expansion) Fee 03/28l2011 $150.00 $0.00
Improvement Permit Fee 03/28/20ll $150.00 $0.00
TOTAL FEES $300.00 $0.00
CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
04l06/11 10:5�
�$A � caTAwBa covrrTY, Nc
�� �,� 1°°-A S°uth West B'�d pLA N RECEI PT
� � Newton, NC 28658-
U ��� � (828)465-8399 Wednesday, April 6, 2011
�►
1842 srn www.catawbacountync.gov
p�an case: EHPR-3-11-10081 �nvoice Number: INV-3-11-273482
Environmental Health Plan Review Invoice Date: 03128/2011
Site Address: 3982 MILLER DR, Newton, NC
APPLICANT OWNER CONTRACTOR
Cherie Bish Cherie Bish
3982 Miller DR 3982 Miller DR
Newton NC 28658 Newton NC 28658
82&640-3315 828-640-3315
Fee Name Fee Amount
Improvement Permit Fee Fixed $150.00
Authorization to Construct Fee Adjustable $150.00
(New/Expansion) Fee
Total Fees Due: $300.00
PAYMENTS
PAYER: Cherie Bish
Date Pay Type Check Number Amount Paid ChangE
03/28/2011 Cash -1 $300.00 $0.00
04/06/2011 Refund -1 ($150.00) $0.00
Total Paid: $150.00
Total Due: $0.00
plan receipt 04/06/2011 10:50
� �A �
� �� CATAWBA COUNTY
c� `y��'• '`C'
P O Box 389 - Newton, North Carolina 28658 -(828) 465-8270 - Faac (828) 465-8276 - TDD (828) 465-8200
1g,�2 5M Public Health — Environmental Health Division
AUTHORIZATION OF REFUND
Date `�
Case # � ����, - �' � � - ��f� � �
A licant ` ��,�i ' ����
rr
Refund Amount ��� Q. Q G�
Refund Reason un , L � ► ` , � Q S �S �
Authorizing Signature
Received By Permit Center Staff "` ��-�' +�
Date `� ��' � � �
; �
. . . . . .. , : _ .
Catawba County; North �Carolina -�Disbursement�Voucher , `
Vendor No. Date 04/06/11
Make Payment To: �� C O� Voucher No(s).
Cherie Bish H� t � 'Z
3982 Miller Dr � y
J� �
Newton, NC 28658 jg�2
ATTACHMENT
Description Amount
Permit found for 3 bedroom system expansion no longer required 150.00
credit AC
Sub-Totai $ 150.00
Food Tax
Sales Tax
Total $ 150.00
. ,. _. �
� For Account'ing , ,.
Account Fund. �, � Organ.: Project � _: Use Only
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)
� � THIS IS NOT A PERMIT Case # � EHPR-3-11-10081
�' � CATAWBA COUNTY HEALTH DEPARTMENT
v :;; ''C Plan Review Application for Environmental Services
Ig�2 sM Environmental Health Plan Review - OSWP
(� 1'I S� � �r�n��?' EXPANS/ON
.-�� � L�.�• ��((v�j NAME TO APPEAR ON PERMIT
���r� Sherie Bish
SITE ADDRESS: 39$2 MILLER DR Newton, NC Pirr�: 361803042359
NAME of SUBDIVISION:G C PARK SUB Lot # ll Section/Block/Phase
PROPERTY SfZE: Square Feet Acres 0.46
DIRECTIONS: Hwy 10 West - Lf Hickory Lincolnton Hwy - RT Miller Dr - Gray trailer beside blue house
APPLICANT OWNER CONTRACTOR
Sherie Bish Sherie Bish
3982 Miller DR 3982 Miller DR
Newton NC 28658 Newton NC 28658
828-640-33 l 5 828-640-3315
PRIMARY CONTACT: Owner APPLICATION FOR: New Construction
DIM EXISTING STRUCTURE: 12 x 60 EXISTING FACILITY TYPE: Mobile HQ ne
NUMBER OF EXISTING BEDROOMS: 2 SEWER TYPE. Sept�c ank_�
NUMBER OF EXISTING OCCUPANTS: 3 EXISTING WATER SUPPLY IN USE: Private Well
CALCULATED DESIGN FLOW:
Public water is *'`NOT*" available for this property.
PUBLIC WATER TYPE AVAILABLE: N/A
DESCRISE WORK: Change out Mobile Home * Must have 36 SF Front Deck - Must be Vinyl Underpinned - Must have min 3
foot landing on rear door - must screen or remove towing tongue - must be paralle to road
DESCRIPTION OF mobile home ** to be removed and repalced with larger home
EXISTING STRUCTURES
ON SITE (IF ANY)
PROPERTY EASEMENTS: none
PROPOSED CONSTRUCTION
PRIMARY RESIDENCE
NEW RESIDENCE? New Residence
# OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS:
PROJECT DESC: New Single Wide ** USing existing well
PROJECT DIMENSION: 16 x 72
BASEMENT? No BASEMENTFIXTURES? No
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 nor}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.
Date: Signature of Applicant or Agent
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
********************�**********�***�****************�*************************�***************************************
03/29/11 09:05
� $A �G
� � � CATAWBA COUNTY
v '�' P O Box 389 - Newton, North Carolina 28658 -(828) 465-8270 - Fax (828) 465-8276 - TDD (828) 465-8200
1842 SM Public Health — Environmental Health Division
AUTHORIZATION OF REFUND
Date `�
Case # � ���� -���'� � - �1��?� �
�
Applicant � � [?.�`, ', l.-�� s�
Refund Amount � � ��� aG�
Refund Reason � un , C � � ` , � Q S �5 �
Authorizing Signature
Received By Permit Center Staff '`��'�-�' ^�
Date � ���' l 1
,�
't
... � . �
CATAWBA COUNTY'�HEALTH DEPARTMENT
NEWTON, NORTH CAROLINA
COMPLETION PERMIT FOR SEPTIC TANKS
PERMIT N- � � � r �
+ � DATE:
1
OWNER � r � � , .G C, �ADDRESS
. �
BUILDING CONTRACTOR SUBDIVISION
LOCATION LOT ��
LOT SIZE BLOCK OR SECTION
HOUSE ( ) MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( )
SEPTIC TANK: (SIZE GALS) WATER SUPPLY:
N0. BEDROOMS NO FIXTURES INDIVIDUAL PUBLIC
GARBAGE DISP�AL UNIT:YES (� NO () IF WELL, TYPE: B RED DR LLED DUG
AUTO WASHING MACHINE: YES () NO () DISTANCE FROM SEPTIC TANK OR NEAREST
NITRIFICATION FIELD: SQ.FT. POLLUTION: FT.
1) NUMBER OF LINES SEPTIC TAN .
2) LENGTH AND WIDT IN�
E Z EE
a BED STEM CER�IFICATE C LET B:
b) TRENCH SYSTEM ( ) �
3) DEPTH OF STONE IN LINES REMARK :
ADEQUATE FALL (GRADE) O�i:
1) BUILDING (HOUSE) SEWER LINE:
YE S ( ) NO ( )
2) NITRIFICATION LINES: D E N T LL .
YE S ( ) NO ( )
SEPTIC ANK LAYOUT
H x
z �
a �
�
w
H
E .., o
o a
�
NEALTN DEPARTMENT COPY
, , ,�
I '
� A� �
.-,
CATAWB� CC�iT:QTY �HEr1LTH DEPARTMENT �' ; � � � 'S2
� � .
,� IME'ROVEMEti'T PERMIT FOR SEPTIC TANKS Pe it No.
� � p �
r1:'� OF OWNER � � � �'� � D!LTE � 9
ADDRES� OF OWNER PH�NE
NAME OF CONTRACTOR ADDRESS
r l - / -�
LOCATIO:V (� ! �tii - �c. � � � Gc�-v ' � ���� - 7 � ����
. � � �
/ e
SUBDZVISIOi� LOT N0. �l SECTIO;i OR BLOCK
LOT SIZE FHA, VA L0�1N eptic Tank Contractor must follow all
HOUSE O r:OBILE HOME (x) BUSINESS O OTHER O etails of this erm' (la out
Ir'0. BEDROOMS (�) N0. FIXTURES ((� SEPTIC T LAYOUT
GARBAGE DISPOSAL UNIT: YES () NO t`�'R
PLUTiBING UNDER BASEMENT FLOOR: YES � NO � �, U
SIZE OF TANK �Q O Q LIQUID GALLONS
NITRIFICATION FIELD .
1. Numher of lines �k'
2. Length and width o ine : �
a. Bed Sys tem .�°� X t. � (_
b. Trench system ft. '� �p Ni `�
3. TotaZ Depth of stone Z inches /
GROUNDWATER INTERCEPTOR DRAIN:
(IF REQUIRED)
kATER SUPPLY: PRIVATE �) PUBLZC ( ) �' �
OWI3ER NOTIFIED TO CHECK ZONING: YES OO NO O �' ^> �
OWNER AGREES WITH LAYOUT: YES (� NO () �
OT•di�TER AGREES WI'TH SPECIAL INSTRUCTIONS : YES �) Id0 O �
OWNcR OP. CO�iTRACTOR SIGNATURE $�
PERMIT FEE $ � 5����"''�-
PERhfIT VOID AFTER 36 MONTHS !� �
! FINAL APPROVAL Of TN►S SEPTlC TANK SYSTEM BY
I�W`PROVE�iENT PERMIT ISSUED __.._.-� J' ,�.' TNE HEALTH D£PARTMENT SHALI IN0ICATE 7HAT ?HE
�� � c'� SYSTEM HAS BEEN CONStRUCTED ACCORDIN(3 TO
SANITF�RI•AN � 1 THE STANOARDS 5E1' FORTH IN 7HE GATAWBr� COUNTY
SEWAL3E DISPOSAL R£QUL.ATIONS, BUT ly NO WAY
EALTEt DEPT . COPY S�LL 6E TAKEN AS A GUARANTEE THAT�E SYSTEh!
WILL FUNC N SATISFACTORIL FOR (�LY GIVEN
PER�,bD oF Tlr.� .
S OIL CLASSIFICATION: SUITABLE O PRUVISZONALLY SUITABLE O UNSIi�T�'I,E O
SITE Ft?CTORS
Z. SLOPE (%) S- PS - U 7. SOIL PERMEABILITY S- PS - U
2. SOIL TEXTURE (12-48 IN.) S- PS - l3 U\DER 60 .fiN. - OVER 60 MIN.
SE1.�DY� LOAMY, CLAYEY 8. OTHER S- PS - U
3. SOIL STRUCTURE (12-4$ IN.) S- PS - U (SPECIFY)
4. SOIL DEPTfI (IN.) S• - PS - U 9. SOIL SERIES:
5. RESTRICTIVE HOP.IZONS (IN.) S- PS - U A. CECIL () B. HIT7rlSSF.E ()
(IriPERVIOliS ST?tATA, ROC�) C. M.ADISON () D. �pPLI:vG ()
6. SOIL DRAINAGE - GROUND?dA'tER S- PS - U E. PACCLET () F. FLOOD PLAIN ()
(EXTEILtiAL - Ir;TERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY
— i
�5
� `� 5 �
/ �
% r� ° ,. ,
r