HomeMy WebLinkAboutRBPR-07-2014-19543.TIFContractor
THIS IS NOT A PERMIT Case # RBPR-07-2014-19543
CATAWBA COUNTY HEALTH DEPARTMENT IiNr, f❑°]
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES i
Residential Building Plan Review - Building New • T
IMPROVEMENT - AUTHI CONST - NEW WELL
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*HAYES CONSTRUCTION, LLC; BRENT (BRENT HAYES), PO BOX 577, CONOVER NC 28613-
B:(828)446-4793 C:828-446-4793 HAYCONLLC@CHARTER .NET
Owner SHEA SAMPLE, 1762 SUNFIELDS DR, NEWTON NC 28658
C:828-234-0634
NAME TO APPEAR ON PERMIT
Shea Sample
SITE ADDRESS: 1762 SUNFIELDS DR, NEWTON NC 28658
NAME of SUBDIVISION: SUN FIELDS Lot #
PROPERTY SIZE: Square Feet Acres 0.51
DIRECTIONS: 16S/ RIGHT ST JAMES CHURCH RD/ RIGHT SUNFIELDS DR/ LOT ON RIGHT
PRIMARY CONTACT: Contractor SEWER TYPE:
GALLONS PER DAY: 480 WATER SUPPLY:
DESCRIBE WORK: 2 story dwelling w/ attached garage w/ unfinished basement
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? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE:
FACILITY TYPE: Single Family Residence
DESCRIPTION OF VACANT LOT
EXISTING STRUCTURES
ON SITE (IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS:
PRIMARY RESIDENCE
OTHER DESCRIPTION:
PIN # 364816738822
9 Section/Block B
Septic Tank
Private Well
# OF OCCUPANTS: 2
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 60 X 60
# OF NEW BEDROOMS:: 4
BASEMENT? Yes BASEMENT FIXTURES? Yes
Desired system types (Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE:
OTHER: INNOVATIVE:
Other described:
PLUMBING REQUIRED? Yes
CONVENTIONAL:
ANY: YES
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
L1) - chapplicatiori 07/18/2014 11:39 Page 1 of 4
vy4A CATAWBA COUNTY Case # RBPR-07-2014-19543
Public Health Department Subdivision SUN FIELDS
v `+eso Environmectal Health Division PIN# 364816738822
PO Box 389, 100-A Southwest Blvd, Newton, NC 28658
18 2 W
NAME ON PERMIT: (SHEA SAMPLE), 1762 SUNFIELDS DR, NEWTON NC 28658
( Shea Sample)
Site Address: 1762 SUNFIELDS DR, NEWTON NC 28658
Property Size: Square Feet Acres 0.51
Directions: 16S/ RIGHT ST JAMES CHURCH RD/ RIGHT SUNFIELDS DR/ LOT ON RIGHT
Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An
Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well
Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility.
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 coouct necessary i spections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the
proper identifica n and labe ing of II property lines and corners and making the site accessible so that a complete site evaluation can be performed.
Date: Cde/1 "L— Signature of Applicant or Agent
An Environtrfental Health Specialist will contact you within 2 working days of application date.
If you need further information or assistance please call 828-466-7291
AREA1
MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT:
FEENAME DATE , FEE AMOUNT
Authorization to Construct Fee (New/Expansion) 07/18/2014 $300.00
Fee
Improvement Permit Fee 07/18/2014 $150.00
Well Permit & Inspection Fee 07/18/2014 $300.00
TOTAL FEES. $750.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
E9 - 6opplicalion 07/18/2014 11:39 Page 2 of 4
TATHIS IS NOT A PERMIT
HCl aTAWBA COUNTY HEALTH DEPARTMENT
Application for Environmental Services Page 1
Improvement Permit Authorization to Cons ruct Septic Repair ❑ Septic Malfunction Ll
Septic Expansion
El Well Permit Replacement Well ❑ Well Abandonment ❑
Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑
Application is for New Construction Existing Facility ❑
Property Address 544AIF14,05 0/2- Subdivision
AIF-rOAI IVC 2 rg6S8 Lot # Acres
Section/Block/Phase
Driving Directions to Property H W of j6 50�TH I OR O� 5T T,-#0 s 'rmI -ev g0
ONcI - /F( ez-9� �� /_07-0,V R 1, `,k' V
NAME TO APPEAR ON PERMIT? ,0 Owner ❑ Applicant 0 Contractor
Applicant Contact Information
I Name 13REN7 6WozF5 4_zl�
Address P0 e 0A1 d i/Ed2 /vG /5
Phone I Cell Phone 828, Z�6,479;
Owner Contact Information
Name SHEfj 544 P` C-7
Address Z Q Sfi? (f iLf%? RD
Phone '
Contractor Contact Information
Name I -1A y�$ C&iAje1Z ae',/D/V . GGc'
Address P d ,BaX S � (,'OmdrVeTz
Phone
NrtV-120A i a,- •z �s�
Cell Phone
A/c Z8613
I Cell Phone 9-�,6, 44 ,#,793
WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant 9 Contractor
Description of Existing Structures on Site
# of Bedrooms * j Structure Dimensions # of Occupants
Basement ❑ Yes ❑ No Basement Fixtures 0 Yes No
The Applicant shall notify the local health department upon submittal of this application if any of t.....,apply t ...
m' pp � he following apply to
the property in question. If the answer to any question is "yes", applicant must attach supporting documentation.
11 Yes KNo Does the site contain any jurisdictional wetlands?
Yes 1 No Does the site contain any existing wastewater systems?
* Yes 04 No Is any wastewater going to be generated on the site other than domestic sewage?
'Yes No Is the site subject to approval by any other public agency?
In Yes O No Are there any easements or right of ways on this property? Describe
4 �shn water-su._ 1. m use .'.Individual Well �u l Community Well � ❑ Se..i- l
Ex' g _ supply ' ❑ ❑ ry mi -Public Well
❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes 9 No
If a I ing for an Improvement Permit'or Authorization to Construc Please Indicate Desired S st _ , �.._.,,.....
PP Y� -" t, - y em Type(s):
(systems can be ranked in order of Your preference)
e)
❑Accepted ❑Alternative El Conventional
l ❑ Innovative s.�Y
._ �� ❑Other
,1 A THIS IS NOT A PERMIT
-COUNTA' _- -_ __. CATAWBA COUNTY HEALTH DEPARTMENT
�^^ma�yg, Application for Enviromnental Services Page 2
N1o2i Cnotno"'+L
Proposed Facility Type
Primary Residence 9 New Residence ❑ Addition to Residence # of New Bedrooms *t
Project Description IVt: IV S1A&e1-ZF F41h1tW t),V47,4/AV,
Structure Dimensions 60 x � O #sof Occupants 2
Basement & Yes ❑ No Basement Fixtures N Yes 0 No
❑ Accessory Structure(s) Describe
# of New Bedrooms *f if applicable Structure Dimensions
# of Occupants Accessory Dwelling ❑ Yes ❑ No
Plumbing ❑ Yes ❑ No Describe Plumbing Needed
❑ Multi -Family Residence #Units .�� _#Bedrooms per.11LUnit*�
-,i _, ..... G...._ ..o . --- ..._ ...s-�� _..�..
_ .: ....
Total # Bedrooms *t Structure Dimensions
,..Food Service . , ....,. .� .__.z...�.. --- - ..,,._-...z.,,...._._.... s,.._._.....,,..x._..,�........_.....-�� - v:._..,.,...._..,z:.�.......��._-.......`
e 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 Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy
Application"for Well Construction/Abandonment/Re air
Proposed Well Type Individual Well ❑ Semi -Public Well ❑ Community Well
Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown
Well Repair Requested ❑ Yes ❑ No Describe
Calculated Design Flow, Commercial t 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.
t If structure is plumbed but no bedrooms, calculated design flow is required
** If No, a well permit must be issued with the Authorization to Construct.
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE)
Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified
conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not
transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application,
site plans or intended use changes for the proposed facility.
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.
Signature of Owner or Agent �C , 4'4 Date -7118/%4
Printed Name of Owner or Agent
Catawba County, North Carolina
This map product was prepared from the Catawba County, NC, Geospatial Information System.
r(
Catawba County has made substantial efforts to ensure the accuracy of location and labeling information
contained on this map. Catawba 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 and all damages, loss or liability, whether direct, indirect
or consequential which arises or may arise from this map product or the use thereof by any person or entity.
Selected Parcel Number: 3648-16-73-8822
1 inch = 50 feet
Prepared for:
CATAWBA COUNTY NC - Parcel Report
Information Regarding Selected Parcel(s)
Parcel ID:
3648-16-73-8822
Name:
AMPLE SHEA B
Name2:
Address:
1762 SUNFIELDS DR
Address2:
City:
NEWTON
State:
NC
Zip:
28658-9513
Account:
Calc Acreage:
0.51
Tax Map:
101N 02009
LRK:
900117
Deed Book:
3173
Deed Page:
1105
Subdivision Name:
SUN FIELDS
Subdivision Block:
B
Lots:
9
Plat Book:
33
Plat Page:
82
Building Number:
1762
Street Name:
SUNFIELDS DR
Site Zip:
28658
Township:
NEWTON
Fire Dist:
MAIDEN RURAL
City/Tax:
State Road:
Total Bldgs Value:
Land Value:
$9,900
Total Value:
$9,900
Year Built:
Year Remodeled:
Last Sale Date:
Last Sale Amount:
Neighborhood:
113
Watershed:
Watershed Split:
NO
Voter Precinct:
P20
E911 District:
COUNTY
Zoning:
R-40
Zoning2:
Zoning3:
Zoning Split:
N
Zoning Overlay:
Zoning District:
COUNTY
Split Zoning Dist:
N
Split Zoning Dist(1):
0
Split Zoning Dist(2): 0
School District:
COUNTY
Elementary School: MAIDEN
Middle School:
MAIDEN
High School:
MAIDEN
School Split:
NO
P&Z Case Number:
Census Tract 2010: 011601
Census Block 2010:
1047
Small Area Plan:
BALLS CREEK
Agricultural District: Proximity
Printed: Friday, July
18, 2014 10:42 AM
OL9-64
Prepared by and After Recording Return to:
,/Kennedy & Wulfhorst, 3758 Highway 16 N, Denver, NC 28037
STATE OF NORTH CAROLINA
COUNTY OF CATAWBA
FILED G9tRdbe County
on A.ug 23, 20-14 at 04.:2x:00 pm -n
Excise Tax $0.00 (AT)
jN-zT. ;,13194
DONNA F1 CKS SPENCER,
Regiet{ar of Geode
9
L 0173-0175
SEPTIC LINE EASEMENT _ TENANCE AGREEMENT
THIS SEPTIC LINE EASEMENT AN + NANCE AGREEMENT (the "Agreement")
is made and entered into as of the day of A '" '`'`I20== ; by and between HUGH D. SAMPLE, JR. and
wife, ZAROLYYN h. SAMPLE (the "Grant r'n an HEA B. SAMPLE and wife, SHARINE M.
SAMPL E (the " xantee" )I.
LNw=
i.
OQ:a�n)tee is the owner of Lot 9 reco `tr: Z d Book 3240, Page 355 of the Catawba County
Wr
Register of Deeds -Of fice (referred to herein as roperty ), and Grantor is the owner of 76 acres,
recorde I in ee B -e k 31'13, Page 1105 of the C"� �i'= my Register of Deeds Office (referred to herein
as!"Gr antors Prope ty ). }5,;
Gra tdr's P : Dperty and Grantee's PE4L±W�ladjoining properties located on Sunfields Drive,
Newton NnrthCarolina—> ° x
C. The Grantee desires to place sept'c draagk*r� s upon the property of Grantor constituting an
encroachment on Grantor's Property as genera`46�n n the Schematic Diagram attached hereto as
Exhibit "A," and incorporated herein by this reference.
D. Grantor has agreed to grant an easement to Grantee for the purpose of permitting Grantee to
use and maintain the septic drainage line to be constructed across Grantor's Property, as generally shown on
the Schematic Diagram attached hereto as Exhibit "A"; provided, however, that the easement granted
hereunder for the use and maintenance of the sewer lines and septic drainage field shall be terminated by
Grantee within ninety (90) days' after public sewer service becomes available and Grantor's request.
E. Grantor and Grantee intend that the owners and their designees, licensees, invitees,
mortgagees, lessees, occupants and all other persons acquiring any interest in the Grantor's Property and
Grantee's Property shall at all times enjoy the benefits of, and shall hold, sell and convey their interest
subject to the agreements, covenants, conditions, restrictions, rights, easements and obligations herein set
forth.
NOW, THEREFORE, in consideration of Ten Dollars ($10.00), the above Recitals and other good
and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Grantor and
Grantee hereby covenant and agree as follows:
1. Grantor does hereby grant, bargain, sell and convey unto Grantee, their heirs, successors and
assigns, a nonexclusive, perpetual easement appurtenant to the Grantee's Property for the purpose of use and
maintenance of the septic drainage line described above, and Grantor further agrees that this easement shall
be appurtenant to and run with Grantee's Property.
2. Grantor and Grantee do hereby also agree that the cost of maintenance of the above described
septic drainage lines shall be borne by Grantee, at their sole cost and expense.
3. Grantor and Grantee agree that Grantor's Property and Grantee's Property shall be held, s0yJ 74
and conveyed subject to the provisions of this Agreement which shall constitute equitable servitudes, and run
with the land and be appurtenant to Grantor's Property and Grantee's Property, and shall be binding upon the
successors and assigns of the owners of said properties.
4. It being further understood and agreed that in the event the septic drainage lines described
above are no longer used by Grantee, their successors or assigns, for a continuous period of six (6) months,
the septic drainage lines are permanently disconnected by Grantee, or ninety (90) days after public sewer
becomes available and Grantor's request, then and in any such event, this easement shall terminate and be
null and void. On the occurrence of an event resulting in the termination of this easement, Grantee shall
have no obligation to remove the sewer lines and septic drainage system from Grantor's Property, or
otherwise restore Grantor's Property to any condition existing prior to the construction of the sewer lines and
septic drainage system.
5. Grantor and Grantee shall promptly comply with all laws, statutes, ordinances, rules and
regulations of federal, state or municipal governments or authorities applicable to the use and occupancy of
their respective properties, including the obligation of Grantee to maintain the above described septic
drainage line, at their sole cost and expense.
6. Grantor covenants with Grantee that Grantor is seized of Grantor's Property in fee simple and
that Grantor has the right to convey such rights L caaciiient, that such property is free and clear of all
KA,
encumbrances, and that Grantor will forever wa Vii° nd the title to the same against lawful claims of
persons whomsoever.
f
0_H,&-KE=A�D=lO HOLD the easem( re v_ reated unto the Grantee, their heirs, successors
and ass: gns, as -an- aseme:dt appurtenant to the G }, _ perty, but subject to the termination conditions
stated a�)ove. _ .,4r4::
vA•_ -•. c'3 .levy-:3'tt:nez'.i
}.
IN VVI�� SS WHEREOF, the undersigned �``' v ereunto set their hands and seals as of the day
and yea: first aUvZiritte
GRANTOR: g, G' _` EE:
% (SEAL)_<' ��� (SEAL)
Hu
NOample, J y ea B. Sample
(SEAL) (SEAL)
Carolyn'R. Sample
NORTH CAROLINA
LINCOLN COUNTY
I, the undersigned Notary Public, do hereby certify that Hugh D. Sample, Jr. and wife, Carolyn R. Sample
and Shea B. Sample each personally appeared before me this day and acknowledged the execution of the
foregoing instrument.
WITNESS my hand and official seal, this Vti day of August, 2014. ,,\\``` AREN'p'�,,,
lvot,
Notary Public = y c°��in 001, biiC
My Commission Expires:
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DB — Deed Book Sl'
pg - Page
PP - Power Pole
MN - Mag Nall
MH. - Man Hole
EIP = Existing Iron Pipe
OR — Existing Iron Rod
NIR - New Iron Rod
Dwlg - Dwelling
Bldg - Building
C/L - Center Una
R/W - Right of Way
CM - Concrete Marker
CP - Computer Point
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Lot 10
Hugh D. Samp
Carolyn R. Sample B L O C K "B"
DB 3173 pg 1105
Lot 11
Hugh D. Sample, Jr
Caro/yn R. Sample
DB 3173 pg 1105
L David S. Clark. PLS certify that this plat 1
was drawn under my supervision from an actual survey made
under my super -Mian deed description, recorded In Book 3-�?
page aj51 that the bo ixiaries not surveyed are dearly Indicated
as drawn from Information found In Book —33L, pope 921
that the ratio of preclsbn as calculated Is tonal
that this plat was prepared In accordance with Stonards of Practices
i VISTxss my original signature, Licensed number and seal
this 13 day of �r4,
i
Surveyor
Hugh D. Sample, Jr
V
w
Carolyn R. Sample
Q Z
DB 3173 pg 1105
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\ Vicinity Map
Scale None
Survey Plot for
Sb ea B. Sample
and
Sharine M. Sample
1762 Sunfields Dr., Newton NC 28658
Newton Township, Cotowba County, North Corolinc
P/N 3648-16-73-8822 Drawn By DK6
DB J210 pg 355 DC 8 -1J -201 -
Date Aug 13th, 2014 Scale 1 "=40'
Sun Fields SID PB 3.3 pg 82
40 40 80 120
GRAPHIC SCALE -FEET
SWRVEYam
David S. Clark Surveyor
1920 32nd Street NE,, Hickory NC, 28601
828-256-6400 www.clark.gurveying.com