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HomeMy WebLinkAboutEHPR-04-2016-23698 (2).TIF sv A • THIS IS NOT A PERMIT Case # EHPR-04-2016-23698 itrin CATAWBA COUNTY HEALTH DEPARTMENT El — to . CI J 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES loAce.mr . 1842 sm Environmental Health Plan Review - OSWP T _° • ° + I&o IMPROVEMENT •-d - : } Contractor MICHAELATHANAS &ASSOCIATES (GARY MCNEELY), 561 ENNIS RD, WEDDINGTON NC C:7043101832 Owner LEAH DEVLIN, 2319 CHURCHILL RD, RALEIGH NC 27608 C:919-696-7095 NAME TO APPEAR ON PERMIT Leah Devlin SITE ADDRESS: 7940 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 PIN # 460604902708 NAME of SUBDIVISION: FRED MCCALL UNREC Lot# 29 Section/Block PROPERTY SIZE: Square Feet 39,639.60 Acres 0.91 DIRECTIONS: Hwy 150 East, Right Slanting Bridge Rd, Left Keistler Store Rd,At end of Rd on Left. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing* 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House to be Burned EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60 #OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: YES ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: F9 eliapplication 04/20/2016 15 25 Page 1 of4 ,„1-l",' ',„ CATAWBA COUNTY Case a EHPR-04-2016-23698 .f'tit / Public Health Department Subdivision FRED MCCALL UNREC 2 °^• . H Environmental Health Division PINE 460604902708 IA�t ,Y PO 13ox 389, 100-A Southwest Blvd.Newton,NC 28658 JH.2 is NAME ON PERMIT: ( LEAH DEVLIN), 2319 CHURCHILL RD, RALEIGH NC 27608 ( Leah Devlin) Site Address: 7940 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 39,639.60 Acres 0.91 Directions: Hwy 150 East, Right Slanting Bridge Rd, Left Keistler Store Rd,At end of Rd on 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 identificatip�-a d labeling of all property lines and corners and making the site accessibl: . at a a c�site evaluation can be performed. Date: Y�ZOAC6-741 Signature of Applicant or Agent �� An Environmental Health Specialist will contact you wi w.r ing days • .r.lication date. If you need further information or assistance please call 828-466-7291 AREA1 it,FEENAMEI �i1 I' r n1 t 11IYi�i'lri, ill 1i r Illnll i� .1 1 I ;�n I�F firTI AMOUNT, 1h - i. h IOII ICI I15111i 11,l I Ji ILillilk IIi�6hPAT Eaj,, I1.li .1 Improvement Permit Fee 04/20/2016 $150.00 k1 I (il+, IITOTAE'FEESu)NI(III"HIIIIIIDIlPr.t.10tI Ijil'l I! lI I i!I'� x�11 II!x y l! I„ stsoioo Gill HI I li1Lmmm, aaU aiutai Ptzul rb: X thomitMllb ,'UllIdliiii2101111Pi llillIaR01111kiili1, 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 04/20/2016 15:25 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT L' f — t rci -ugly �, CATAWBA COUNTY HEALTH DEPARTMENT ,„„„c,r 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 IEI Existing Facility ❑ Property Address7940 Keistler Store Rd Subdivision Fred McCall Sherrills Ford Lot# 2 q 9 Acres 0- l 1 A-c- Section/Block/Phase Driving Directions to Property Hwy 150 E,TR Slanting Bridge,TL Keistler Store,at end on left NAME TO APPEAR ON PERMIT? ❑ Owner 0 Applicant ❑ Contractor Applicant Contact Information Name Leah Devlin Address 2319 Churhill Rd, Raleigh, NC 27608 Phone Cell Phone Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Gary McNeely-Michael Athanas &Associates Address 561 Ennis Rd, Weddington, NC 28173 Phone 704-310-1832 Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant 0 Contractor Description of Existing Structures on Site' , ■• 10 . _ A& •A # of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q 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. O Yes o No Does the site contain any jurisdictional wetlands? O Yes ID No Does the site contain any existing wastewater systems? ❑ Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? O Yes C No Is the site subject to approval by any other public agency? ❑ Yes ❑ No Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well U Community Well U 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): (s stems can be ranked in order of your preference) Accepted ❑ Alternative ❑ Conventional enovative -Other 171 Any CATAWBA THIS IS NOT A PERT coup CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence RI New Residence ❑ Addition to Residence # of New Bedrooms *t 4 Project Description 4/�t4/ Structure Dimensions ( O r y 6' 0 # of Occupants Basement ❑ Yes ® No Basement Fixtures ® Yes ® No Li 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 #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions Li Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area (Sq. Ft.) U 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 ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial j' 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 S 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 Agen � a``' Date V/ /Zo jL Printed Name of Owner or Agen i ratigtCg MICHAEL ATHANAS &ASSOCIATES LICENSED SOIL SCIENTIST 561 Ennis Rd. Weddington,NC 28173 (704)576-3887 Reference: Data Sheet for Fred McCall Property Lot 29 House Footprint: 60' x 60' Building Setbacks: 30' front, 15' side Water Source: Private well Number of Bedrooms: 4/480 GPD Proposed LTAR: 0.25 GPD/FT2 (initial), 0.1 GPD/FT2 (repair) Proposed System Type: 25% Reduction Proposed Repair System Type: Drip irrigation Distribution: Pressure manifold Flow per Tap: 7.11 GPM Tap Size and Material: %" SCH 40 System Flow: 35.6 GPM Dosing Volume: 210 gallons Pump Run Time: 6 minutes Elevation Head: Friction Head: Pressure Head: 2' Total Dynamic Head: Supply Line Length: Septic/Pump Tank Size: 1000/1000 gallons Proposed Trench Bottom: 24" Line Design Length Actual Length Elevation Orange 1 96' 99' Blue 2 96' 110' Pink 3 96' 107' White 4 96' 107' Yellow 5 96' 107' Initial System: 480' Repair System: 4800 FT2 Pump Tank: House Corner: Benchmark: alt/ 300/41 1\ L_ m 3g2 FZ S •�' «F ZL ~ � _- ° --..._ Juba\ a �+vy� O 3. Li > �P 6q S wec `o • PEON FIELD t. (I R� a) EgSEME LOT 2 1 pORTION p SF /! i • Q � a� � 6,83 / i -�pp� ,1 y 39 / ! // I. U 1 I n y I / llefi0��'' Fs ?c' 1 1 R f''-' t 1 /1 /ma p en DP i::?r 1 1 W PI O O . .. 1 1 Ct + 1 I Ct Z a Ow ¢ 1 1 V O Q e U C 2rj``.. I I Lo •' e..:r:::. 1 1 Q _ 0�0 O lV 0 I W:ib(:. O a N '{' W;`'; I I J EN N. I I h v pQ -,' 144 CO F:..a•.� l 11 In a:, h 1 0 lid \ 4.N.1 ,- I 1 1 ‘..-.. t;Calf.-77. i ""••• Cpl 1 1 — ---- c KEISTLERS o STORE RD 6 ,i f%Stusimaii Ea? '-, L5 c/L L9 & L8 8 L7 r L6 b j Ea?E� o SR # 1899 60' PUBLIC R/W — R/W DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheer 1 o(_2_ DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID//:McCall lot 29_ ON-SITE WASTEWATER SECTION COUNTY:Catawba_ SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM OWNER:_Leah Devlin APPLICATION DATE ADDRESS: DATE EVALUATED: PROPOSED FACILITY: 4 bdrm PROPOSED DESIGN FLOW(1949): 480 GPD PROPERTY SIZE: 0.91 AC LOCATION OF SITE:_Kiestler Store Rd PROPERTY RECORDED: 2016 WATER SUPPLY: E Private U Public E Well U Spring U Other EVALUATION METHOD: E Auger Boring U Pit U Cut TYPE OF WASTEWATER: "Sewage U Industrial Process U Mixed IP p ► . - P R SOIL MORPHOLOGY OTHER 0 F (.1941) PROFILE FACTORS 1 .1940 L E HORIZON POSITION/. DEPTH 1942 PROFILE N SLOPE% (IN.) .1941 .1941 SOIL .1943 .1956 .1944 . CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ - SOIL SAPRO RESTR &LTAR TEXTURE MINERALOGY COLOR • DEPTH CLASS HORIZ LS 4% 0-15 Br SCL WSBK FR SS SP SEXP N/A 48" N/A N/A PS 0.3-0.25 1548 BrR C WSBK FR SS SP SEXP 1 LS 4% 0-26 Br CL WSBK FR SS SP SEXP N/A 48" N/A N/A PS 0.3 2618 RCSBK FR SS SP SEXY 2 LS 4% 0-4 Br SCL GR ER SS SP SEXP 40„ N/A N/A PS 0.25 440 RCSBK FRSSSPSEXP FCYB 3 CHR 2 440° • LS 4% 06 FILL 40" N/A N/A PS 0.25 6-40 RCSBK FR SS SP SEXP F-C YB 4 CHR2(ii/40" DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): SITE CLASSIFICATION(.1948): PS Available Space(.1945) 1440 FT2 4800 FT2 System Type(s) 25%Reduction DRIP EVALUATED BY: MA&A OTHER(S)PRESENT: Site LTAR 0.25 0.1 COMMENTS: SOIL/SITE EVALUATION Sheet_2 of_2 (Continuation Sheet) DEPARTMENT OF ENVIRONMENT PROPERTY ID#: MCCALL LOT 29 AND NATURAL RESOURCES DATE OF EVALUATION: DIVISION OF ENVIRONMENTAL HEALTH COUNTY: CATAWBA o SOIL MORPHOLOGY OTHER P (.1941) PROFILE FACTORS 1 :1940 - E LANDSCAPE HORIZ .1942 POSITION/ ON .1941 .1941 SOIL .1943 .1956 .1944 PROFIT E # .SLOPE-% DEPTH STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO ' RESTR CLASS (IN:). . TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ &LTAR LS 4% 0-5 Br CL WSBK FR SS SP SEXP 36" N/A N/A PS 0.25 F-C YB 5-36 R C SBK FR SS SP SEXP CHR 2@ 5 36 LS 4% 0-4 Br CL WSBK FR SS SP SEXP 43" N/A N/A PS 0.25 Y13 @ 32" 4-43 R C SBK FR SS SP SEXP — CHR2c@ 6 43" LS 4% 0-14 Br CL WSBK FR SS SP SEXP N/A 48" N/A PS 0.3 7 14-40 R C SBK FR SS SP SEXP / 40-48 R CL WSBK FR SS SP SEXP F-C SAP LS 4% 0-6 Br CL WSBK FR SS SP SEXY 48" N/A N/A PS 0.25 YB/Mn 0 6-48 R C WSBK FR SS SP SEXP _ COMMENTS: Catawba County Environmental Health 4 1!! , hIC`p' , i °rJ � 3 • ,r eN .€) i natal " 6 194 $ 1331 (AI! 7e lit .1 libi lit ill! 'IAN, 'NCI" i, ;0, 11 ;n 2o1 s5 fli' - *7940 $ --- ..... ,. ' (284) 1} a3 V• c°1 6(S Z m i) i i 1 Q - --- _ — — — — — �� (250) — — — — — O Parcel: 460604902708, 7940 KEISTLERS tin=50ft STORE RD 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 04/20/2016 T., I a>az� _ Ti- I T281T-$ g^ "_ 4 a o.qw� _o6m.aw:C w NE' "°Sty€I _Ea y s9R ,�s� ' 1 re 0R.R° zzzz z U ^ in gaol A. e� �° '. wag \ u8]{oo&&kEO TS' A 18,(12�n " -0/I' 0X13 \ n' \ � ll8u�^ 'Y WI i'0. 8 —..ter.. m i \ L77' m 6 o � oe.°° \ °m.oia "� L Mgi Fe yF '6,61617;p "t :s a� �d NO Ym -g,z� °i 12.1 \ k4zs \ ',";',J1 A iON`za D. o..7 rn°d`% 1 a§000b� p 2 ml' mS k?0 ] � � a 3Q Si 2 " Y° q/ d z v,®F9� AA/8 Jl7HI1d�09 6691# 8S o V3 u +V_ n R 97 o e e, 61 w u n e I/���G s e p gc /'� - o8 _38015 a S8JuSI3N _ yE�F rei F i s� n m A$ a N€Y' c0L"-- °O y 8 lu =- GNS t2w F ta;C, C„ Azsa O _.[z:,I mn :G�+A�a3ga^' i Say - }I n0 'gsm°w i D x °°~qL d$ G ^ P9a 2 ' 1 0 �� s F .•!,� a i n mAW m m $ -o °m A _I a'o ;, mm -fr go. 28 w pm a; n o CI A 1- E c c k Ai 0 355. --3 kus8 t5,� oln ° ^ G ^6 "9 a,1k O , i ''-2211 4:4 S 52 m \ I mom\. . £ �_ e zV 3 \ _� P_ 3 ul 62 a � '�` £ z �CiG- t "°.'a..-�`O= z X �s atR'uaad F," 9' oe :;t iM3 3s3 _ __ 7A A '-- J 3uo s _ _ p I" ,E . „ g a s� y Egg = ,� MiocE 444,g- "- °� ^:;g _ s� §o6 , A A F Ft n 6E_7 �i C49'04 --F.__ gag � ' 9 c� 60 049 g oat A \ ,p/4, �� 9-,s 711 I X26 ° ➢ gad - a :67. 6'3.6, 3m om RY °X Sn aF¢€� k ^C� a 5C= om cina^ lz-, 0 3= N� e Ok 4f'= ',gAg Awl obs ' P sa �s `"`�� . Aa `_ ''.13 -as Pya Ear _' 7 7 NR gg Pao y N11 0 a p S 1;1;1'R EXEMPT SU90 p:ory NW FOR 1 1 fP ' .' i5� s u HARRIS LAND SURVEYING, PLLC o gee s_a ^g is s LEAH M. DEVLIN Si FIRM LICENSE #zesso29.5 �, 'yx yy^ JANET P.MCCALL LIVING TRUST 4080 DAYS RD 'Pt' r:°' DEED 8004:Jul-126: 704-400-6800 DATE Pfl 15105 8, Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460604902708 - Owner: DEVLIN LEAH MCCALL Parcel Address: 7940 KEISTLERS STORE RD Owner2: MCCALL JANET P LIVING TRUST City: SHERRILLS FORD, 28673 Address: 2319 CHURCHILL RD LRK(REID): 19598 Address2: null Deed Book/Page: 3137/1261 City: RALEIGH Subdivision: FRED MCCALL UNREC State/Zip: NC 27608-2003 Lots/Block: 29-30/ null Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: LOT 29 & 30 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: 1.550 Tax Map: 018EX 01030 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1899 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: $52,100 Zoning2: null Land Value: $39,500 Zoning3: null Assessed Total Value: $91,600 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: 1890/1963 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: 4035 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. http://gis.catawbacountync.gov/notnap/parcel_report.php?key=460604902708&typ=P 4/20/2016 Y r � Case k o e CATAWBA COUNTY 0 I a WELL-02.2016-069463 ,,P r" T Public Health Department T� 10 Subdivision FRED MCCALL UNREC 12 w 4 Y Environmental Health!Division I' { + 7J - PIN;I 460604902708 �� PO Box 389. 100-A Southwest 13lvd,Newton, NC 28658 L O i- I O'1'N 29-30 2 r { o ter. NAME ON PERMIT: LEAH DEVLIN, 2319 CHURCHILL RD, RALEIGH NC 27608 Site Address: 7940 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 Property Size: Square Feet:67,518.00 Acres:1.55 Directions: Slanting Bridge Rd, Keistler Store Rd, on left at end of road WELL ABANDONMENT PERMIT Wells shall be abandoned in accordance with state regulations: Article 15A North Carolina Administrative Code Subsection 2C The Well Abandonment Report must be submitted to the Catawba County Environmental Health within 30 days upor completion of a well abandonment. Well contractor must schedule well abandonment inspection with Catawba County Environmental Health. WELL TYPE Bored Robbie Phelps 02123/2016 ISSUED BY PERMIT ISSUANCE DATE ehpermit 02/23/2016 13:21 Pays I of 2 p'A CATAWBA COUNTY 100A SOUTHWEST BLVD f' 4 NEWTON,NORTH CAROLINA 28658 RECEIPT sa► �, PHONE: 828.465.8399 �I17 ®ate Wednesday, April 20, 2016 It 1842 sm www.catawbacomtrync.gov PAYOR: Michael Athanas & Associates Michael Athanas&Associates(McNeely, Gary) PAYMENTS TRANSACTION NUMBER: TRC-658873-20-04-2016 PAYMENT DATE : 04/20/2016 PAYMENT TYPE: Check 1371 INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327433 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EI-IPR-04-2016-23698 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7940 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 Owner LEAH DEVLIN,2319 CHURCHILL RD, RALEIGH NC 27608 C:919-696-7095 Contractor MICHAEL ATHANAS &ASSOCIATES, 561 ENNIS RD, WEDDINGTON NC 28163 C:7043101832 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/20/2016 15• 5 Page 1 of I