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HomeMy WebLinkAboutEHPR-02-2016-23256 (2).TIF BA �G THIS IS NOT A PERMIT Case # EI-IPR-02-2 0 1 6-23 2 5 6 Q n a CATAWBA COUNTY HEALTH DEPARTMENT 13 9i •xD CI ' � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES h 't 47 \842 sM Environmental Health Plan Review - OSWP 'o. . o S ktod. ilit I : REPLACE WELL . u . o I Applicant AARON DYKE, 7780 SKYLINE DR, SHERRILLS FORD NC 28673 C:9802008228 Owner SUE DAVIS, 501 HOURSESHOE DR, MOUNT HOLLY NC 28120-9779 H:7048222471 HOME:704822247I NAME TO APPEAR ON PERMIT Aaron Dyke SITE ADDRESS: 7780 SKYLINE DR, SHERRILLS FORD NC 28673 PIN # 460604735886 NAME of SUBDIVISION: Mobile Home Estates Lot 48 Section/Block PROPERTY SIZE: Square Feet 20,47320 Acres .470 DIRECTIONS: NC Hwy 150, right Slanting Bridge, 1.5 miles right on Wildlife, left on Skyline Dr, 3rd house on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New Well Problem with existing well. NO CURRENT WATER SUPPLY 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF reidence and 2 out buildings EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 36 x58 residence, 13 x 22 and 16 x22 outbuildings NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES E9-ehapplicition 02/22/2016 12:39 Page I o14 $w CATAWBA COUNTY Case# EHPR-02-2016-23256 .0 A G-! Public Health Department Subdivision Mobile Home Estates Q mat-. Health Division PIN# 460604735886 �^°f4 PO Box 389, 100-A Southwest BIvd,Newton, NC 28658 1;4 n NAME ON PERMIT: (AARON DYKE), 7780 SKYLINE DR, SHERRILLS FORD NC 28673 ( Aaron Dyke) Site Address: 7780 SKYLINE DR, SHERRILLS FORD NC 28673 Property Size: Square Feet 20,473.20 Acres .470 Directions: NC Hwy 150, right Slanting Bridge, 1.5 miles right on Wildlife, left on Skyline Dr, 3rd house 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 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 so that a omplete site evaluation can be performed. Date: a a-?- / (a Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 workin, s of application date. If you need further information or assistance please call 828-466-7291 AREA1 .4" ;i l #t . v_. u5 ' �. — . s :: 4 x 7#; 77 t FEENAME= .4,f 1 411; s?DATEt ~ vldFEE'AMOUNT 1 Well Permit& Inspection Fee 02/22/2016 $300.00 -TOTAL FEES '" r.m r ` dl h..v v4— •'. t to "'€N 8300 00 {' ro.W4Mfr.i?.w.hcz ,�:uy. -., 11,2[1274:71Q:- ._.._f 111i ,: hy.- aII I. i ir: ,,. .. .ieli i 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-eha)plicalion 02/22/2016 12:39 Page 2 of 4 CATA\ B e THIS IS NOT A PERMIT COUNTY a�' �.-....-LL 1 CATAWBA COUNTY HEALTH DEPARTMENT - — ' ...7 Application for Environmental Services Page 1 Improvement Permit ❑ Authorization to Const uct ❑ Septic Rep it ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ?'Replacement Well Well Abandonment❑ Well Repair ❑ Existing Syst•m Inspection (Pre-Approval Required) ❑ t I,J A plllication is fort New Construction ❑ Existing Facility n Property Address l9 O \.. \\ne Subdivision a• 111S let ► -3 Lot# Acres riving Directions to 1 \\A Property a )n (•' �tiq{�1 1 tease �`fC� • a z fl rn V ,,;.k - 6n -- f-w • ttco Ar\ve, ; - cy \\eS \n\ _ _ -�_- • \ nd -Is' \ itOChi\it 1 ,. ya&\ e . r'i� NA E • 'PEAR N 'ERMI Owner % Applicai r contractor JJJ Applicant Contact Information Name , '% , 1„,„..._ _ Address S(> $k\0'ne C PeYr1 _ C �y ���Y� Phone Cell Phone .� "I �() l Owner 1 tact Information---tion� �- �:brn r Address r 0 k ( n irt re Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor n Description of Existing Structures on Site H()USO p1 (,l I ((f I1nC5 Stu 1cIir ¶ xaS gU\ I 16 # of Bedrooms *t \.3 Structure Dimensions aD y 5e) '#of Occupants Basement JX1Yes ❑ 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 question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Y s No Does the site contain any jurisdictional wetlands? Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes ,. No Is any wastewater going to be generated on the site other than domestic sewage? "fates ❑ N Is the site subject to approval by any other public agency? ❑ Yes / "o Are there any}asements 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other ❑ Any CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT „o„„a,,, Application for Environmental Services Page 2 Proposed Facility Type _ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement n Yes ❑ No Basement Fixtures n Yes ❑ No n Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing n Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units _ #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft.) F1 Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts n Other Facility Type Specify If Church # of Seats Kitchen n Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n Unknown Well Repair Requested n Yes n 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 Ae✓ Date — I Cc? Printed Name of Owner or Agent Mr- Catawba County Environmental Health C. x ". rtt� ` � _ ' 62°52 F '. x Ad z ill� � , w x, AI-r , -6, 109'35 41 p8 i. k y t CCS i.'4'y ' '4 W� 4• o Ct f 8 i ,. NQ 8.39 ot. to to m cv to, 160p El 5 Q Q 1 .5 tS 135.15 s �p1E0R 118.74 P; , l 132.19 W C Parcel: 460604735886, 7780 SKYLINE DR tin=50ft SHERRILLS FORD, 28673 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 2014 Catawba County NC Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460604735886 Owner: DAVIS SUE ARNETT Parcel Address: 7780 SKYLINE DR Owner2: City: SHERRILLS FORD, 28673 Address: 501 HORSESHOE DR LRK(REID): 18158 Address2: Deed Book/Page: 2010E/0891 City: MOUNT HOLLY Subdivision: MOBILE HOME ESTATE State/Zip: NC 28120-9779 Lots/Block: 48/ Last Sale: School Information: Plat Book/Page: 12/39 School District: COUNTY Legal: LOT 48 MOBILE HOME ES PL 12-39 Elementary School: SHERRILLS FORD Calculated Acreage: .470 Middle School: MILL CREEK Tax Map: 017AX 02021 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1936 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: $184,100 Zoning2: Land Value: $43,400 Zoning3: Assessed Total Value: $227,500 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1990/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460600J Building Details 2010 Census Block: 4022 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 Agricultural District: 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 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. ©2016, Catawba County Government, North Carolina. 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Monday, February 22, 2016 \842 sM www.catawbacountync.gov PAYOR: Dyke, Aaron PAYMENTS TRANSACTION NUMBER: TRC-625 3 1 6-22-02-201 6 PAYMENT DATE : 02/22/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325495 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS : S300.00 EHPR-02-2016-23256 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7780 SKYLINE DR. SHERRILLS FORD NC 28673 Applicant AARON DYKE, 7780 SKYLINE DR, SI-IERRILLS FORD NC 28673 C:9802008228 ** NO PEOPLESOFTACCOUNTASSIGNED ** Owner SUE DAVIS, 501 HOURSESHOE DR, MOUNT HOLLY NC 28120-9779 H:704822247I receipt 02/22/2016 12:39 Page 1 of 1