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HomeMy WebLinkAboutRBPR-07-2014-19595.TIFSBA 1842 SM Applicant THIS IS NOT A PERMIT Case # RBPR-07-2014-19595 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTM CONST - NEW WELL ■; L&FRI R STROTHERS MASONRY (DAVID STROTHER), 7595 W NC 10 HWY, VALE NC 28168-9511 13:8282911321 Contractor CLAYTON HOMES #81 /CMH INC, 1230 CONOVER BLVD, CONOVER NC 28613 B:828-465-3450 C:828 -217-2104F:828-464-0261 R081@CLAYTON.NET Owner BART MATTHEWS, 4766 RIFLE RANGE RD, CONOVER NC 28613 NAME TO APPEAR ON PERMIT CLAYTON HOMES #81 /CMH INC SITE ADDRESS: 5505 SEPTEMBER LN, CONOVER NC 28613, PIN # 374408994183 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 1.6 DIRECTIONS: Hwy 16N/left on Swinging Bridge/left on August/left on September Ln PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 24 x 46 Doublewide 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: STRUCTURE TYPE: FACILITY TYPE: Mobile Home New Structure PRIMARY RESIDENCE OTHER DESCRIPTION: DESCRIPTION OF I none EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: doublewide 24 x 46 # OF NEW BEDROOMS:: Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E) - chapplication 08/21/2014 08:34 Page 1 of 4 CATAWBA COUNTY Case # RBPR-07-2014-19595 Public Health Department Subdivision Q Environmental Health Division PIN# � ^C 374408994183 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 SM NAME ON PERMIT: CLAYTON HOMES #81 /CMH INC (), 1230 CONOVER BLVD, CONOVER NC 28613 CLAYTON HOMES #81 /CMH INC ( ) Site Address: 5505 SEPTEMBER LN, CONOVER NC 28613 Property Size: Square Feet Acres 1.6 Directions: Hwy 16N/left on Swinging Bridge/left on August/left on September Ln 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 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/24/2014 $150.00 Fee Improvement Permit Fee 07/24/2014 $150.00 Well Permit & Inspection Fee 07/24/2014 $300.00 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) L`) - ehuphlicatmn 08/21/2014 08:34 Page 2 of 4 Applicant Contractor Owner THIS IS NOT A PERMIT Case # RBPR-07-2014-19595 CATAWBA COUNTY HEALTH DEPARTMENT IJEJ�� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT - AUTHI CONST - NEW WELL i0 10 STROTHERS MASONRY (DAVID STROTHER), 7595 W NC 10 HWY, VALE NC 28168-9511 13:8282911321 CLAYTON HOMES # 81 /CMH INC, 1230 CONOVER BLVD, CONOVER NC 28613 13:828-465-3450 C:828 -217-2104F:828-464-0261 R081@CLAYTON.NET BART MATTHEWS, 4766 RIFLE RANGE RD, CONOVER NC 28613 NAME TO APPEAR ON PERMIT CLAYTON HOMES #81 /CMH INC SITE ADDRESS: 5507 SEPTEMBER LN, CONOVER NC 28613 PIN # 374408994183 NAME of SUBDIVISION: Lot # 1 Section/Block PROPERTY SIZE: Square Feet Acres 1.6 DIRECTIONS: Hwy 16N/left on Swinging Bridge/left on August/left on September Ln PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 24 x 46 Doublewide 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: Mobile Home DESCRIPTION OF None EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 24 x 46 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: CONVENTIONAL: YES ANY: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9 - chapplication 07/24/2014 16:31 Page 1 of 4 $A CATAWBA COUNTY Case # RBPR-07-2014-19595 Public Health Department Subdivision 6 Environmental Health Division PIN# 374408994183 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 SM NAME ON PERMIT: CLAYTON HOMES #81 /CMH INC O, 1230 CONOVER BLVD, CONOVER NC 28613 CLAYTON HOMES #81 /CMH INC ( ) Site Address: 5507 SEPTEMBER LN, CONOVER NC 28613 Property Size: Square Feet Acres 1.6 Directions: Hwy 16N/left on Swinging Bridge/left on August/left on September Ln 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 th _a com to -site aluation can be performed. Date: 7 A_;Z / (-k Signature of Applicant or Agent 0 � _ lA 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 ************************************************************************************************************ MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/24/2014 $150.00 Fee Improvement Permit Fee 07/24/2014 $150.00 Well Permit & Inspection Fee 07/24/2014 $300.00 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) E9 - chapplication 07/24/2014 16:31 Page 2 of 4 CATARTBA nTHIS IS NOT A PERMIT COUNT' --- CATAWBA COUNTY HEALTH D EPARTMIENT North Carolina Application for Environmental Services Page 1 Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion © New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre -Approval Required) ❑ Application is for New Construction ❑ Existing ]Facility ❑ Property Address 5 S ©'� 5�,},� f Subdivision ( o K v v Lot # Acres / Driving Directions to Property r '^-�/ �L�1 �, Section/Block/Phase c� 5 �,, ; -. V 6, c i t, _ 9 .• NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant E C ntractor Api� a, t on actInformation - Name Address Phoned j -;�U So I Cell Phone Owner Contact Information Name {' `6,c, Ste; k Address Phone �� �, 4 %gVP-Cen4m.r.4s"Contact Information Name�- Cor Cell Phone Address ?. J' !1 C�w�/_ w (), Imo--- � S_/_�_ - Phone \�'2 � Q 9 ( (3 a - - - I Cell Phone - WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Contractor Description of Existing Structures on Site # of Bedrooms *t 3 Structure Dimensions �2 Lf k 0 b # of Occupants 2 -- Basement ❑ Yes 2 --No Basement Fixtures ❑ Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes 0"90 Does the site contain any jurisdictional wetlands? ❑ Yes El -N-(5---- Does the site contain any existing wastewater systems? ❑ Yes C-I'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? ❑ Yes Ehqo--- Are there any easements or right of ways on this property? Describe Existing water supply in use ❑" Individual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No 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) 13 Accepted 0 Alternative ErIconventional 0 Innovative 0 Other D.Any CATA�( BA THIS IS NOT A PERMIT �COUNT ��y�`/--_� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Proposed ]Facility Type ❑ Primary Residence E New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description Structure Dimensions # of Occupants 2 Basement ❑ Yes [ o Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units Total # Bedrooms *t ❑ ]Food Service Specify Type #Bedrooms per Unit*t Structure Dimensions # 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/Repair Proposed Well Type D Individual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Page 2 Calculated Design Flow, Commercial f 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 GN AND/OR RIETRIP 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 Date 7/' Printed Name of Owner or Agent 1) C-1 Lof : rk , �-(- /0 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s; Parcel ID: 3744-08-98-6915 Name:. MATTHEWS BART F Narne2: Address: 4766 RIFLE RANGE F Address2: City: CONOVER State: NC Zip: 28613-6716 Account: Calc Acreage: 12.45 Tax Map: 0900 00065 LRK: 42566 Deed Book: 1956 Deed Page: 0425 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 5507 Street Name: SEPTEMBER LN Site Zip: 28613 Township: CLINES Fire Dist: OXFORD City/Tax: State Road: 1515 Total Bldgs Value: Land Value: $71,200 Total Value: $71,200 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 67 Watershed: Watershed Split: NO Voter Precinct: P33 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-O,FPM-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010201 Census Block 2010: 2005 Small Area Plan: ST STEPHENS/OXFO! Agricultural District: Proximity Printed: Thursday, July 24, 2014 04:01 PI _TP Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. 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: 3744-08-99-4183 1 inch = 60 feet Prepared for: THIS IS NOT A LEGAL DOCUMENT 1.60A 4183 ?'45A 915 Time: 8:37 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3744-08-99-4183 Name: MATTHEWS BART F Name2: Address: 4760 RIFLE RANGE RD Address2: City: CONOVER State: NC Zip: 28613-6716 Account: Calc Acreage: 0 Tax Map: LRK: 404575 Deed Book: Deed Page: Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 5505 Street Name: SEPTEMBER LN Site Zip: 28613 Township: CLINES Fire Dist: OXFORD City/Tax: State Road: Total Bldgs Value: Land Value: Total Value: Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 67 Watershed: Watershed Split: Voter Precinct: P33 E911 District: COUNTY Zoning: Zoning2: Zoning3: Zoning Split: Zoning Overlay: Zoning District: Split Zoning Dist: Split Zoning Dist(1): Split Zoning Dist(2): School District: COUNTY Elementary School: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010201 Census Block 2010: 2005 Small Area Plan: ST STEP HENS/OXFORD Agricultural District: Printed: Thursday, August 21, 2014 08:37 AM