Loading...
HomeMy WebLinkAboutEHPR-04-2016-23642.TIF THIS IS NOT A PERMIT Case # EHPR-04-20 1 6-2 3 642 , CATAWBA COUNTY HEALTH DEPARTMENT 0 `L �-o. '•t 0 !� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 5M Environmental Health Plan Review - OSWP �0L 10 IMPROVEMENT • . Applicant JOAN GARDNER, 8736 POPULAR LN, SHERRILLS FORD NC 28673 H:7046622045 HOME:7046622045 Owner RONALD SILVER, 150 KEYSTONE DR, ASHEVILLE NC 28606 NAME TO APPEAR ON PERMIT Joan Gardner SITE ADDRESS: 8646 DOG LEG RD, SHERRILLS FORD NC 28673 PIN # 461902652763 NAME of SUBDIVISION: SHERWOOD SHORES Lot# 17 Section/Block B PROPERTY SIZE: Square feel 20,473.20 Acres 0.47 DIRECTIONS: Hwy 150, West on Sherrills Ford, Right onto Mollys Backbone, Right onto Azalea, Left onto Dog Leg, Lot is on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase" existing well on property. 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot w/Well EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 45x40 #OF NEW BEDROOMS:: 3 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: E9-ehapplicauon 04/12/2016 16:41 Page 1 of 4 BA CATAWBA COUNTY Case# EHPR-04-2016-23642 Ci. {�� �L Public Health Department Subdivision SHERWOOD SHORES E Environmental Health Division �C-� PIN# 461902652763 "�• PO Box 389, 100-A Southwest Blvd, Newton. NC 28658 1842 :M NAME ON PERMIT: (JOAN GARDNER), 8736 POPULAR LN, SHERRILLS FORD NC 28673 ( Joan Gardner) Site Address: 8646 DOG LEG RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Hwy 150, West on Sherrills Ford, Right onto Mollys Backbone, Right onto Azalea, Left onto Dog Leg, Lot is on the Left. 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 identificatiop and labeli g of all property lines and corners and making the site accessible so th t a cymplete site evaluation.can be performed. Date: `.• ) a• I(' Signature of Applicant or Agent `94)0 O A\Atz-- 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 AREA1 e .'i it @ i I 3ptcp j a tt as {t 1"zvl§ is MS$ R P k ' t f 1..FEENAME,, _. tlm it x + .4 irttd t a + y,rll+lrE i�DATER�.0 V FEE-AMOUNT -'I Improvement Permit Fee 04/12/2016 5150.00 r t +Y i•".J$^.C.•A. t I i 41 I yK iNJ'P" ilifll ! 6a .p rTOTAL!FEESZ.t I :.eaM it pn a t liiil i.✓a xe e 1V1I4 Ir C4 $150007 i L;•ili{.t..6{'+ ,x__:_s 5.{12paI � _.,,1, m(.g`.wN"'. ,;.m +,ra vit.iN-=rc Lazait,s.6 i R_{I,,,§1k/ FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplicat ion 04/12/2016 16:41 Page 2 of 4 C TA\ B e THIS IS NOT A PERMIT CO NT\ w Y �. CATAWBA COUNTY HEALTH DEPARTMENT No„„ . Application for Environmental Services Page 1 Improvement Permit$ Authorization to Construct _ Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit IT Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application is for New Construction Existing Facility ❑ Property Address-5 Q4 ' ifC� & ' Subdivision c)\--t uc ooA 31n6YQ S Lot# I 9 Acres Section/Block/Phase 6 Driving Directions to Property 1-61., J (1- CO Shg.rhi pie Thri _ (-, n;17) /viol t(; i<E, o� � ; n LTA nG Lao, _ Lod- ow { . 1 NAME TO APPEAR ON PERMIT? U Owner Applicant El Contractor Applicant Contact Information Name JDIAN Address j(o prp-Kkizr Phone ,-)O� 1p to 1 - D-bys, Cell Phone ,s Owner Contact Information Name ( lak:\ � � Uei' Address 1 KwYS -fl.L cV tiycsk. ,1 Phone O Cell Phone D, /+ ) 3 L Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site \Luc� l ( #of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes El No Basement Fixtures El 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 ® 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? ❑ Yes 0 No Is the site subject to approval by any other public agency? ❑ Yes Q No Are there any easements or right of ways on this property? Describe Existing water supply in use 5 Individual Well ❑ Community Well ❑ Semi-Public Well El 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 „.;;„-- Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence [ ] New Residence ❑I Addition to Residence #of New Bedrooms *f 3 Project Description 5 017 �, 'Structure Dimensions '> 4 o' # of Occupants Basement ❑ Yes © No Basement Fixtures ❑ Yes n No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing Yes n No Describe Plumbing Needed E. Multi-Family Residence#Units #Bedrooms per Unit*j Total #Bedrooms *t Structure Dimensions n Food Service 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 n 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 Drilled [ Bored n 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. j If structure is plumbed but no bedrooms, calculated design (low 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. Pennits 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 J rcp K":32--❑- (.k/V-(Jv - Date ) 2" Printed Name of Owner or Agent D lam. E- 6--rNaD1'E Catawba County Environmental Health N C7 208.06 h v . P •8634 208.98 i .y_ lb f n yd` ' O CP -A o° ,5 \ 0 0866 g U' O T Nit -E- 2oao, al L' 8 r cl _ 1 Iri r) el, , S o • 2 r f: o N J 0 — Parcel: 461902652763, 8646 DOG LEG RD 1 in=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 04/12/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461902652763 Owner: SILVER RONALD H Parcel Address: 8646 DOG LEG RD Owner2: SILVER GRACIE E City: SHERRILLS FORD, 28673 Address: 150 KEYSTONE DR LRK(REID): 3999 Address2: null Deed Book/Page: 2071/0063 City: ASHEVILLE Subdivision: SHERWOOD SHORES State/Zip: NC 28806-9745 Lots/Block: 17/ B Last Sale: $7,000 on 1998-02-01 School Information: Plat Book/Page: 15/37 School District: COUNTY Legal: LOT 17 SHERWD S PL 15-37 Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: .470 Tax Map: 004AX 02017 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 2713 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: Land Value: $17,400 Zoning3: Assessed Total Value: $17,400 Zoning Overlay: CRC-O,WP-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: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710461900K Building Details 2010 Census Block: 2005 WaterShed: WS-IV Critical Area 2010 Census Tract: 011503 Voter Precinct: P31 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. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=461902652763&typ=P 4/12/2016 BA CATAWBA COUNTY Q� �� IOOASOUTHWES'1' BLVD l~ NEWTON,NORTH CAROLINA 28658 RECEIPT ®V a PHONE: 828.465.8399 U °a►�� Tuesday, April 12, 2016 1 * 2 5M www.catawbacountync.gov 84 PAYOR: Gardner,Joan PAYMENTS TRANSACTION NUMBER: TRC-654222-12-04-2016 PAYMENT DATE : 04/12/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327137 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-04-2016-23642 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8646 DOG LEG RD, SHERRILLS FORD NC 28673 Applicant JOAN GARDNER, 8736 POPULAR LN, SHERRILLS FORD NC 28673 H:7046622045 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner RONALD SILVER, 150 KEYSTONE DR, ASHEVILLE NC 28606 receipt 04/12/2016 16:40 Page 1 of 1