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HomeMy WebLinkAboutEHPR-03-2016-23531 (2).TIF A, - i� THIS IS NOT A PERMIT Case # EHPR-03-2016-23531 a r ti CATAWBA COUNTY HEALTH DEPARTMENT E i xo . 0 K.u !� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES _ is sM Environmental Health Plan Review - OSWP 5 3• Q S Flo rr . - • Na IMPROVEMENT 1 o+µ10 i Applicant DONALD JORDAN,2504 NW CALGARY PL, CONCORD NC 28027 H:7048962721 C:7043106582 HOME:7048962721 Owner STEVE& CHERI MCCARTHY, I 1 110 BROKEN PEBBLE LN, CHARLOTTE NC 28227 H:704-241-4030 HOME:704-241-4030 NAME TO APPEAR ON PERMIT Donald Jordan SITE ADDRESS: 7766 SKYLINE DR, SHERRILLS FORD NC 28673 PIN # 460604734883 NAME of SUBDIVISION: MOBILE HOME ESTATE Lot# 47 Section/Block PROPERTY SIZE: Square Feet 21,780.00 Acres 0.5 DIRECTIONS: Hwy 16, Hwy 150, Right on Slanting Bridge Rd, Right on Skyline Dr, 4th house on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* Existing camper on site. Proposing a 4 BdRm Modular 28x76, Decks: Front & Back 10x10 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Camper 27x8 (to be removed) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Modular 28x76, Decks: Front& Back 10x10 #OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 19-ehappticmton 03/31/2016 13:09 Page 1 of4 03A CATAWBA COUNTY Case# RHPR-03-20 1 6-23 53 1 r �-. Public Health Department Subdivision MOBILE HOME ESTATE Environmental Health Division PIN# 460604734883 PO Box 389, 100-A Southwest Blvd. Newton.NC 28658 18.2 0 NAME ON PERMIT: ( DONALD JORDAN), 2504 NW CALGARY PL, CONCORD NC 28027 ( Donald Jordan) Site Address: 7766 SKYLINE DR, SHERRILLS FORD NC 28673 Property Size: Square Feet 21,780.00 Acres (15 Directions: Hwy 16, Hwy 150, Right on Slanting Bridge Rd, Right on Skyline Dr, 4th house 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 accasible so that a co •lete site evaluation can be performed. Date: 3 s/ fit- Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working da s if application date. If you need further information or assistance please call 828-'66-7291 AREA1 r r vcy,y-'^' FEENAME _ _..aTM„,,F DATE ,11 ',,FEE AMOUNT Vii;! Improvement Permit Fee 03/31/2016 $150.00 ) t Uf TOTFE ALES e ,? a ,1 � r',M, h 515000 r ...:, ..-41 3. ._x....:._ 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) ti9-ehappl ication 03/31/2016 13:09 Page 2 of 4 C ATAWBA THIS IS NOT A PERMIT couNTY �" CATAWBA COUNTY HEALTH DEPARTMENT '*u� `*."" North c,—;;;,..----': Application for Environmental Services Page 1 Improvement Permit 1SI Authorization to Construct n Septic Repair n Septic Malfunction (l Septic Expansion n New Well Permit n Replacement Well El Well Abandonment❑ Well Repair n Existing System Inspection (Pre-Approval Required) El Application is for New Construction QQ Existing Facility n Property Address 77( le 5K'/L 'NNL b,e_ Subdivision .5N`2AZ « s se c9 Lot# rf 7 Acres Pa Section/Block/Phase Driving Directions to Property ZT /43 to 1 x o R oN 5L0 47;<<re ,3e,or-F I?cq 7 0,4 SKyc ,aJ< Pi< NAME TO APPEAR ON PERMIT? I I Owner Applicant n Contractor Applicant Contact Information Name Dom/AL o 7%- Sato A Address z-co v C4cGA ? 1 ?4- ti' i.,i Co„(co2D Phone 76A/-77( L7e/ Cell Phone .2oV 3 ' o 65-i2_, Owner Contact Inform 'in a Name imam� irre- i UMW T�r►� j� Address i��1\' � s M Ra 111G�MAT Wi ta Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? _2, Owner Applicant El Contractor Description of Existing Structures on Site C/l m P C/a- Z-2 A--;-. # of Bedrooms *t Structure Dimensions ? 0 X b # of Occupants Basement n Yes ' ,No Basement Fixtures I Yes sKNo 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 Ei No Does the site contain any jurisdictional wetlands? S"Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes E No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes o Is the site subject to approval by any other public agency? ❑ Yes [hI No Are there any easements or right of ways on this property? Describe Existing water supply in use t❑` Individual Well n Community Well n Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** 7 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 11 Any cATA 7BA THIS IS NOT A PERMIT COUNTY ,� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 � Proposed Facility Type 10y�� ❑ Primary Residence New Residence n Addition to Residence # of New Bedrooms *t •Project Description Oct( (a ( t °' Structure Dimensions .:i? V I/ 2C, # of Occupants % Basement Li Yes 1 No Basement Fixtures ❑ Yes n No n Accessory Structure(s) Describe # of New Bedrooms *1. if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes ❑ No Plumbing ❑ Yes n No Describe Plumbing Needed n 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.) n Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi-Public Well n Community Well Abandonment Type n Drilled n Bored ❑ Dug n Unknown Well Repair Requested n Yes n No Describe 644< A WGc — 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. 1' 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 g. Date $ 3 (- /6 Printed Name of Owner or Agent T o,vAC0 R , Catawba County Environmental Health sytt 50`035 �� _ at120.90 27.70 ).,liarisi,��©D d 1 I fi v 8.39 44 eV I 111 0111: 1 411111k5 / a IS I 0 evini Illii:T- . tit1/4 , 0 35 l21Il 135.15 (� O Ktr, SKYLINE Oa 118.74 NI� mA �- 13 CP ` (01 (116) \\ Parcel: 460604734883, 7766 SKYLINE DR tin=50ft SHERRILLS FORD, 28673 A i' Teof p)r I ocv 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 03/31/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460604734883 Owner: MCCARTHY STEVE Parcel Address: 7766 SKYLINE DR Owner2: MCCARTHY CHERI City: SHERRILLS FORD, 28673 Address: 11110 BROKEN PEBBLE LN LRK(REID): 18157 Address2: null Deed Book/Page: 3156/0845 City: CHARLOTTE Subdivision: MOBILE HOME ESTATE State/Zip: NC 28227-7671 Lots/Block: 47/ null Last Sale: $71,000 on 2012-11-07 School Information: Plat Book/Page: 12/39 School District: COUNTY Legal: LOT 47 MOBILE HOME ES PL 12-39 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .500 Tax Map: 017AX 02020 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: $5,300 Zoning2: null Land Value: $56,300 Zoning3: null Assessed Total Value: $61,600 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: null/null Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: null/null 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. All rights reserved.Riporti.Crjwi \\ID )00 `(` o Se, c sept l5 http://gis.catawbacountync.gov/nornap/parcel_report.php?key=460604734883&typ=P 3/31/2016 ��A \�' CATAWBA COUNTY �� �� I OOA SOUTHWEST BLVD RECEIPT a NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 U Tit Thursday, March 31, 2016 1gt} sm www.catawbacountymc.gov PAYOR: Jordan, Donald PAYMENTS TRANSACTION NUMBER: TRC-647 1 56-3 1-03-201 6 PAYMENT DATE : 03/31/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326709 Improvement Permit Fee 5150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23531 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7766 SKYLINE DR, SHERRILLS FORD NC 28673 Applicant DONALD JORDAN,2504 NW CALGARY PL. CONCORD NC 28027 H:704896272IC:7043106582 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner STEVE& CHERI MCCARTHY, 11110 BROKEN PEBBLE LN, CHARLOTTE NC 28227 H:704-241-4030 receipt 03/31/2016 13:09 Page I of