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Home My WebLink AboutRBPR-07-2014-19582.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2014-19582 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Swimming Pool e,0'-k�c 601(etkd Owner IMPROVEMENT - AUTH CONST - REPAIR THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8286393899 0 �1p Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 NAME TO APPEAR ON PERMIT Thomas Cheatham SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 PIN # 373308993698 NAME of SUBDIVISION: GUNPOWDER RIDGE Lot # 9 Section/Block PROPERTY SIZE: Square Feet 29185.20 Acres 0.67 DIRECTIONS: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: 4/29/16 revise to 16 x 32 with 10' decking on 3 sides and 3' decking on property line side. inground swimming pool 20 x 20 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: STRUCTURE TYPE: New Structure ACCESSORY STRUCTURE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF single family dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 67 x 34 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 16 x 32 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: drain field removal E9-ehapplicatim 05/18/2016 09:28 Pagel of4 sYA CATANVBA COUNTY Case # RBPR-07-2014-19582 Q Public Health Department Subdivision GUNPOWDER RIDGE .o Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 PIN# 373308993698 !g % S. NAME ON PERMIT: ( THOMAS CHEATHAM), 4690 POWDER HORNE LN, CONOVER NC 28613 ( Thomas Cheatham) Site Address: 4690 POWDER HORNE LN, CONOVER NC 28613 Property Size: Square Feet 29,185.20 Acres 0.67 Directions: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the 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 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. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 ************************************************************************************************************ FEENAME i. DATE ,_. FEE kMOUNT� Improvement Permit Fee 07/23/2014 $150.00 Authorization to Construct (Repair) Fee 08/18/2014 $150.00 Improvement Permit Fee 04/29/2016 $150.00 Authorization to Construct (Repair) Fee 05/12/2016 $150.00 TOTAL FEES $600.00. 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) I.9 - ehapplication 05/18/2016 09:28 Page 2 of 4 PAYOR Cheatham, Michelle PAYMENTS TRANSACTION NUMBER: PAYMENT DATE: PAYMENT TYPE: 164051564 INVOICE NUMBER 05-16-328472 CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 www.catawbacountync.gov TRC -674716-18-05-2016 05/18/2016 Credit Card TOTAL PAYMENTS: RBPR-07-2014-19582 RECEIPT Wednesday, May 18, 2016 FEE NAME FEE AMOUNT Authorization to Construct (Repair) $150.00 Fee 5150.00 CASE TYPE: Residential Building Plan Review WORK CLASS: Swimming Pool SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 Owner THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8286393899 Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05/18/2016 09:24 Page I of 1 THIS IS NOT A PERMIT Case # RBPR-07-2014-19582 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Swimming Pool RUTH CONST -REPAIR 01 pia I s`►�e� ln��c rIV, � — Owner THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8286393899 10 fa 0 Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 NAME TO APPEAR ON PERMIT Thomas Cheatham SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 PIN # 373308993698 NAME of SUBDIVISION: GUNPOWDER RIDGE Lot # 9 Section/Block PROPERTY SIZE: Square Feet 29,185.20 Acres 0.67 DIRECTIONS: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY;Z 360 WATER SUPPLY : Public Water„ DESCRIBE WORD/29/16 revise to 16 x 32 with 10' decking on 3 sides an ng on property line side ingroun6 swimming poui 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: ACCESSORY STRUCTURE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF single family dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 67 x 34 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: r16 x 32 Desired system types (Imp ent Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: drain field removal E9 - ehapplication 04/29/2016 14:30 Page 1 of 4 CATAWBA COUNTYCase# RBPR-07-2014-19582 Subdivision GUNPOWDER RIDGE Pohl ic I lealth Department I":nVironnicrital 11callh Division PIN# 373308993698 110 Box 389, 100-A Southwest BMI, Newton. NC 28658 NAME ON PERMIT: (THOMAS CHENI'HAM),4690 POWDER HORNE I.N, CONOVER NC 28613 (Thomas Cheatham) Site Address: 4690 POWDER HORNE LN, CONOVER NC 28613 Property Size: Sqmjre beet 29,185.20 Aires 0.67 Directions: §p�nqs Rd_Lo Rifle Range Rd/ go 1 112 miles to Powder Horne Ln on the 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) rive years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be (evoked 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 idenItfication and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed, Signature ol*App) icant or Agent Aj.''�< A 1 '11. -b a 1�1_ _y F , I -_ — An EnN,ironrnerital Health Specialist will cujituct you within 5 working days oll'application date. Ifyou need further information or assistance please call 828-466-7291 AREA2 ,.FEEN, E AM, 'VE E' 11'NIOUNT Improvement Permit Fee 07/23i2014 $150.00 Authorization to Construct (Repair) Fee 08/18!2014 $150,00 Improvement Permit Fee 04/29/2016 $150.00 'EES, �450&0 'TotXL,F FEES ARE NON-REFUNDAB]"L 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) ;1 04/2912010 1430 Paste 2 ol"I to feAl 1 .1 fie loses� f Ppro- iMAi �' of }40.44e k'vftkl fCoI *--A4 iter, ,.4 S', -k- P'A0 re,ce,jea qpSltu rd� s i' maAMi o C, PAYOR: Cheatham, Michelle PAYMENTS TRANSACTION NUMBER: PAYMENT DATE: PAYMENT TYPE: 162841697 INVOICE NUMBER 04-16-327809 CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 www.catawbacountync.gov TRC -664020-29-04-2016 04/29/2016 Credit Card TOTAL PAYMENTS: RBPR-07-2014-19582 FEE NAME Improvement Permit Fee RECEIPT Friday, April 29, 2016 FEE AMOUNT $150.00 $150.00 CASE TYPE: Residential Building Plan Review WORK CLASS: Swimming Pool SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 Owner THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:828-514-2285 Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/29/2016 14:24 Page 1 of 1 Owner THIS IS NOT A PERMIT Case # RBPR-07-2014-19582 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Resident'iew -Swimming Pool AUTH CONST - REPA/R:�) THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:828-514-2285 Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 NAME TO APPEAR ON PERMIT Thomas Cheatham SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 PIN # 373308993698 NAME of SUBDIVISION: GUNPOWDER RIDGE Lot # 9 Section/Block PROPERTY SIZE: Square Feet 29,185.20 Acres 0.67 DIRECTIONS: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: inground swimming pool 20 x 20 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: ACCESSORY STRUCTURE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF single family dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 67 x 34 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 20 x 20 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: drain field removal 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 identificati nIand ljbeling of all property lines and corners and making the site ac es=1esotom I to site evaluation can be performed. Date: / 1l l q 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 EI - ehappl,cation 08/18/2014 12:47 Page I of 4 SpA CATAWBA COUNTY Case # F Public Health Department Subdivision Environmental Health Division PIN# PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 :u NAME ON PERMIT: ( THOMAS CHEATHAM), 4690 POWDER HORNE LN, CONOVER NC 28613 ( Thomas Cheatham) Site Address: 4690 POWDER HORNE LN, CONOVER NC 28613 Property Size: Square Feet 29,185.20 Acres 0.67 Directions: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the right MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 10 RBPR-07-2014-19582 GUNPOWDER RIDGE 373308993698 MAX HEIGHT: FEENAMEDATE �` FEE AMOUNT Improvement Permit Fee 07/23/2014 $150.00 Authorization to Construct (Repair) Fee 08/18/2014 $150.00 TOTALFEES $300.00 FEES ARE 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) ESI - ehapplication 08/18/2014 12:47 Page 2 of 4 PAYOR Cheatham, Thomas PAYMENTS TRANSACTION NUMBER: PAYMENT DATE: PAYMENT TYPE: 121921466 INVOICE NUMBER 08-14-309726 CATAWBA COUNTY IOOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 www.catawbacountync.gov TRC -365957-18-08-2014 08/18/2014 Credit Card TOTAL PAYMENTS: RBPR-07-2014-19582 RECEIPT Monday, August 18, 2014 FEE NAME FEE AMOUNT Authorization to Construct (Repair) $150.00 Fee $150.00 CASE TYPE: Residential Building Plan Review WORK CLASS: Swimming Pool SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 Owner THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:828-514-2285 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 E9 - receipt 08/18/2014 12:46 Page 1 of 1 Owner THIS IS NOT A PERMIT Case # RBPR-07-2014-19582 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Swimming Pool IMPROVEMENT THOMAS CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:828-514-2285 0 fp 0 Paid By MICHELLE CHEATHAM, 4690 POWDER HORNE LN, CONOVER NC 28613 C:8285143457 NAME TO APPEAR ON PERMIT Thomas Cheatham SITE ADDRESS: 4690 POWDER HORNE LN, CONOVER NC 28613 PIN # 373308993698 NAME of SUBDIVISION: GUNPOWDER RIDGE Lot # 9 Section/Block PROPERTY SIZE: Square Feet 29,185.20 Acres 0.67 DIRECTIONS: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY : Public Water DESCRIBE WORK: inground swimming pool 20 x 20 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: ACCESSORY STRUCTURE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF single family dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 67 x 34 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 20 x 20 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: YES INNOVATIVE: ANY: Other described: drain field removal 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. 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 ********************************************************************************************************************** E9 - chapplication 07/23/2014 16:52 Page I of 4 IgA CATAWBA COUNTY Case # Public Health Department Subdivision d� l� Environmental Health Division pIN# PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 1842 W NAME ON PERMIT: ( THOMAS CHEATHAM), 4690 POWDER HORNE LN, CONOVER NC 28613 ( Thomas Cheatham) Site Address: 4690 POWDER HORNE LN, CONOVER NC 28613 Property Size: Square Feet 29,185.20 Acres 0.67 Directions: Springs Rd to Rifle Range Rd/ go 1 1/2 miles to Powder Horne Ln on the right MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 10 RBPR-07-2014-19582 GUNPOWDER RIDGE 373308993698 MAX HEIGHT: FEENAME DATE FEE AMOUNT, Improvement Permit Fee 07/23/2014 $150.00 TOTAL FEES Q:Y&,: $150.00 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 - ehapplication 07/23/2014 16:52 Page 2 of 4 CA T A�J THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Envirdmuental Services Page I Improvement Permit 2) Authorization to Construct ❑ Septic Repair F1 Septic Malfunction ❑ Septic:Expansion El New Well Permit El Replacement Well ❑ Well Abandonnie 'it El Well Repair [I Existing System Inspection (Pre -Approval Required) Application is for New Construction 0 Existing Facility 0 Property Address WO Powdfr NOtnO LC70U Subdivision GUJJ PnV1l der Ridge) Corm-er NC, 38(0/3 Lot # 4 Acres I Sectio.n/B.IockIPhase Driving Directions to Property S,0r1'r)q5 Poad �0 etrle) Pan9ej Pd. C70 1 '12- - M('16S -tn A)wder 140((Ie-1 panel On fihcj riojh4. We-, arej -thu Q-0 houfw 6h 4kej NAME TOAPPEARONPERMIT? ElOwner ZApplicant ElContractor Applicant. Contact, Information J.Nqme 'Th -6.- M, CIS j�heQ4haM [Address " (le, -r 0i1,e).00n0Ve11VC1 U013 _W I CellPhone ('Ph6fie! P218 "8 55 __ 0 2 .Owncj�Cbiffff6t Ihf6rmation:----- -Name' .' 0 Address Phone Contractor Con6dt Information Name Address Phone .......... WHO, .Wff:LBE.TEM,P,RMARYICONTACT? MOAmer Applicant E3',Contractor 1.:'' Descri 'jiciii'bf Ekisfihg Structures 'on:Site - Y)ce 4 of Bedrooms *t. Structure.Dimensions # of Occ Basement Fixtures. No fl.Yes No Basement yes . ..... apply to.-: The s ��cationlif 13A'11,'n&*4he 16cal'health'd6prtmeht upon subffii.fW,'of thi �E*i6fth6fbfl' theproperty in question. Ifthe answerto any question is "yes)', applicant must:attac.h.supppr4ngg,ldocum"6niaL ion. a Yes #No Does the site contain any jurisdictional wetlands? 13 Yes 0, No Does the site contain any existing wastewater systems? dyes C�No Is any wastewater going to be generated on the site other,than domestic sewage? 1p"YesO.No anIs the site to approval by y othqr publjcqgency? El Yes:, ..ONo �e'thereapy easeme*sor right of ways.on,this.r- ' erty?. Describe u y� Individual Well Corriffinnity WellS6iiii-Pub4 W611ppl in County/City/To,�,nship Water Line Is a public wa,tersupply'available?'" EIJ4 tio, t e ca f6D'e inj e p d-� (systems can be.ranked'in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative aotherl.,D:min L;r)e) R ll C1) ATHIS IS NOT A PERMITAa COIJNETY-,, CATAWBA COUNTY HEALTH DEPARTMENT Application far Environmental Services Page 2 Proposed, Facility'Type Primary Residence E3 New Residence n Addition to Residence # of New Bedrooms 3 Project Descriptio'n 5wim'InI'm Poo/ eorliswu(,4100-movlr, StructureeDimenisions 2_0:XZ.0 # of Occupants Basement 0 Yes 91 No Basement Fixture's EJ Yes 0 No -Accessory. Strbeture(s) Describe #'of New Bedrooms *t ifapplicable, Structure Dimensions #of Occupants _ Accessory Dwelling F1 Yes E] No Plumbing [I Yes C3 No Describe Plumbing Needed -Ruld-farilily Residence # Units #Redrooms per UnivIt Total #-Bedrooms *t Structure Dimensions Food`.SerVi6e Spe-cify,Type, #Seats: Floor Spate -Entire Food Service'Facility,(Sq Ft) #,,EM0?y1e0Sver;S_h_iA #. of Shifts DiningArea , ek BURP & Specific es Retail Fl6o'or'SpAce' #'Of'Employees per Shift # of Shifts F1 Oth&.FacWty Type -Specify If Church # of Seats, Kitchen- El Yes n No If Daycare Specify Occupancy Xppl-ici#on;fcir,WiU-C-6usirliction/Ab'and6nin6at/Repair Proposed- Well Type E3 Individual" ell' 0 Semi -Public Well 0-Pommunity Well, Abandonment Type Drilled ❑ Bored 0 Dug own Well Repair Requested 0 Yes 0 No Describe Calculated Design Flow, Commercial t Additionafirtformation maybe design flow'from certaln,facilitles. This value will be determined during consultatiowwith .,611,si tesstait 7 *Any room Ahatwill.be intended for slee b6dr -ping at the time of construcdon for future consideratiop,'shpulil-,�e,ii,oted,ai;i, d or. oom'ao counteddd'all applications. The numberof bedrooms wi1be,confirm c4 by.roo.ms idcntifl6d on house,p as bedroom l at the'tini& 9P issuance. J�hls may,preven't the -need, -for septic system. gize4n I crease in the future'_. qfbuildio'.: 'nif;- t -, if structure is plumbed but no bedrooms, calculated desi flo required. , I I P _ , design w is requir IfNo, a well permit must be issued with the Authorization to Construct. SY,STIBM'REDESIG,N AND/OR RETRIP WILL INCURANADDITIONAL CHARGE (SEE ,FEE-8_CHED ULE) Improvement Permits issued as a result of this information are valid for 5 -years or maybe non-expqing:und 4 e , rciriilnspecified conditions An Authbfim'dozi to Construct issued by this department isyalldfor ,(5) five years fr om. the 'hate 4isucd'and,isnot' transferable, Imprqv�:mentperuiitsand ,-.Wcll'P6rmitsare 'tramferrable. Permits maybe revoi4if`tfie`iiiti fbrma -on,on'ihis,application, site plans or inte-rdeduse chang es for the Proposed facility. l ', I have read this application and certify that the information Provided herein is true, complete and correct.- Authorized county and -state ofEcia�'arp.iii6t&i'.ii,ghtbtentry,tocondur,tnecessa,ry.inspdctionstodetermin compliance, -laws;and. l ' rules I cc( np a;ncq with applicable e undcritand4fidt I am'sole] jjLf6r'jbe.proper iden"c'ation *and labeling of �11.prop6rty� lines andi- ' y.resp6iisib 'Comers and'i4*in$,-'t4c site accessible 1hata-coniplete site evaluation can be- performed. accessl so� Signature of Owner or Agent --i 12,v� WV -,-J Printed Name of Owner or Agent ThOmqi ChecytAqYY) Date T>',-, t3 ` c3 . LJ �t r7, / %`{,L: rt �i E' � I +cj ✓`p. 1 r I Cdr j t Poo Atu s o- 4699 �nJ X J� �0 4690 A, 4680 X, r\ 0 4745 6/ /2014 THIS IS NOT A LEGAL DOCUMENT Date J ' Saved: it - . _ .j e: Y.1.20 PM ^ .._ Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System N 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, toss 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: 3733-08-99-3698 1 inch = 50 feet Prepared for: e 4699 �nJ X J� �0 4690 A, 4680 X, r\ 0 4745 6/ /2014 THIS IS NOT A LEGAL DOCUMENT Date J ' Saved: it - . _ .j e: Y.1.20 PM ^ .._ CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3733-08-99-3698 Name: CHEATHAM THOMAS E Name2: CHEATHAM MICHELLE D Address: 4690 POWDER HORNE LN Address2: City: CONOVER State: NC Zip: 28613-8579 Account: Calc Acreage: 0.67 Tax Map: LRK: 402126 Deed Book: 2915 Deed Page: 1268 Subdivision Name: GUNPOWDER RIDGE Subdivision Block: Lots: 9 Plat Book: 45 Plat Page: 199 Building Number: 4690 Street Name: POWDER HORNE LN Site Zip: 28613 Township: CLINES Fire Dist: ST STEPHENS City/Tax: State Road: Total Bldgs Value: $111,700 Land Value: $10,600 Total Value: $122,300 Year Built: 2003 Year Remodeled: Last Sale Date: 5/30/2008 Last Sale Amount: $125,000 Neighborhood: 67 Watershed: Watershed Split: NO Voter Precinct: P33 E911 District: COUNTY Zoning: R-20 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: LYLE CREEK Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010202 Census Block 2010: 1010 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Wednesday, July 23, 2014 01:45 PM CATAWBA COUNTY HEALTH DEPARTMENT Paw ' Teleph 0 TDD : (828) 465-827/: (828) 465-8200 WLS # 05 60 6 f -/IP AC Rpr. Prmt. Opr. S�^ T�ype„ Well Prmt. Replacement Well Well Rpr. Prmt. Owner/Agent t�`�� 5 rar-1 C4� Phone t Address Subdivision &&h P004, Sec ' _i� BlocPr�-�CA`6lfY �%�ze 41u1Lo Directions f'Z� Property Address 4-6 T12 Facility: House Mobile Home Business Multi -family . Other: Pin Number 3 7-3 Other . Zoning Approval # # Bedrooms —5 # Seats # Employees . Application Rate 0. 3S GPD Flow 36 0 Hot Tub or Spa yes/no Special Fixtures Basement yeso . 100% Repair Areaes o Basement Plumbing yes/no Water Supply: Private Well Public Semi -Public *************************************************************************************************************************** Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size ICM Pump Tank Size Nitrification Field: Total Square Feet /6"9 Depth of Stone 6?/14'4 Bed Size Trench Width 3 4T' Total Length of All Trenches 3r -Z- Number of Trenches .6' ..y r Trench Length 1i/%/ 7�/ 4 0 s'7/ Feet on Center Maximum Trench Depth ZS� Distance of Nearest Well AJIA *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo % Slope Texture Structure ClayMin. Soil Wetness -t` Soil Depth 4-t Restric. Hoz. at — " Available space yp/no Overall Class S PS U Comments: k Filter Required Riser required when � �s- tank is more than 6 �r�° �%�` `' h ® V?,(� _ inches deep. L - **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *************************************************************************************************************************** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protec ' n fro kn possible urces of contamination. No volume of water is guaranteed at any site by the Health Department. Permit Date EHS 7 ®Owner/Agent _ Septic Tank Installe y,f" - Date EHS Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected Date of Results Results EHS White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct