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Home My WebLink AboutEHPR-06-2016-24031 (2).TIF P' THIS IS NOT A PERMIT Case # EHPR-06-2016-24031 Q CATAWBA COUNTY HEALTH DEPARTMENT p :ta 0 j?'�� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Environmental Health Plan Review - OSWP of `D o Pi 1 ti{ t REPLACE WELL • ,4 cr.ors Owner JERRY STONE, 8316 NOLLEY LN, SHERRILLS FORD NC 28673 C:8284782793 NAME TO APPEAR ON PERMIT Jerry Stone SITE ADDRESS: 8316 NOLLEY LN, SHERRILLS FORD NC 28673 PIN # 461601279569 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot# 73 Section/Block PROPERTY SIZE: Square Feet 55,321.20 Acres 1.27 DIRECTIONS: East on Hwy 150, Right on Slanting Bridge Rd, Left on Drena Dr, Right on Giles Ave, Left onto Nolley Lane, 5th house on Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Replacement Well -*No Water-Well is dry- Pumping Sand 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Mobile Home, Detached Garage, Storage Bldg EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: Mobile Home 24x60, Garage 24x32, Storage Bldg 8x16 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION 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: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES 09-ehapplication 06/06/2016 14:15 Page 1 of �,pA \ CATARBA COUNTY Case# EHPR-06-20 1 6-2403 1 /Q' ( n Public Health Department Subdivision CRESCENT LAND AND TIMBE < ;�( Environmental Health Division • PIN# 461601279569 �/842 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (JERRY STONE), 8316 NOLLEY LN, SHERRILLS FORD NC 28673 ( Jerry Stone) Site Address: 8316 NOLLEY LN, SHERRILLS FORD NC 28673 Property Size: Square Feet 55,321.20 Acres 1.27 Directions: East on Hwy 150, Right on Slanting Bridge Rd, Left on Drena Dr, Right on Giles Ave, Left onto Nolley Lane, 5th house 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 an, •rre•. Authorized county and sta - officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws .nd rule . I understand that I am s. - responsible for the proper identificatio •a •Jabe g of a l l property lines and corners and making the site acces ible so-t at a com e e site eva --•r• -,-• •- •erformed. Date: / (# 0 Signature of Applicant or Agent �,v ;2,-- A e An Environmental Health Specialist will contact you wit 5 worki ,_ days of application date. If you need further information or assistance please call 828-466-7291 AREA1 taF,�.IEEnktr IIIlEm 1j tfC( mk 1 lj4r 1 1` t. E'r iIjt 111111X11//I ��f I �I DATE.. . i I I'.kFEEpAMOUNT:�� EENAMEII�y ,t ph dJa„iaki ,,: taiA Ili Eli!! , I i Well Permit& Inspection Fee 06/06/2016 $300.00 1)TI�� II”1iil .il�w c!r4I ls11111H� 1, .� 1 lIM111111111111111�8111111111111uIII1illh111111111111 `I�IIh�l�l�� Ili( ooboo, 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 06/06/2016 14:15 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT coos - CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well O Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) /3/6 d)) 0 Application is for New Construction ❑ Existing Facility l Property Address /V Ut t l , y�/ Subdivision .5/1('R/2/L j 5 02.D /VC .X6,73 Lot# 73 Acres / • 3 Section/Block/Phase 3 2 Driving Directions to Property FAST ON /4W 1 /570 TO44r 0A1 .52 4H✓Tzc/6 e4J f)G'e te.h. ro IFFY (IN 2X2&6/,' 2c ro k'/G//r Oaf= ro Le% 0.-v //0ez ztt' 5m !leasj Oh i_ecr �( NAME TO APPEAR ON PERMIT? u Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name C1 7z27 D S7 p�/C Address 93,, rl,vvuey ZN $Nege//// �'2b1/e �-Cc 77 Phone s'a s'_ y7 _� 79 3 Cell Phone Owner Contact Information Name C Address ) Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? [✓'Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site MO; • HO E — RA a'e •77W — 'TdnetbG 3t-Ae' #of Bedrooms *j' 3 Structure Dimensions #of Occupants oZ Basement ❑ Yes [✓]' No Basement Fixtures ® Yes ICTIVo 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. gp s o Does the site contain any jurisdictional wetlands? QA es Does the site contain any existing wastewater systems? d Yes [ 4110 Is any wastewater going to be generated on the site other than domestic sewage? ® Yes D4 o Is the site subject to approval by any other public agency? CI Yes no Are there any easements or right of ways on this property? Describe Existing water supply in use [J 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): (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 ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes ® No LJ 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 if 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.) Li Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts f Other Facility Type Specify If Church#of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type VIndividual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ 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. 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 roper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluatio• can',- performed. Signature of Owner or Agent ass Q Date 6 /, G Printed Name of Owner or Agent JkR a.x7 brA0./ J roivr CATAWBA Geospatial Real Estate Search '- oe Information Services 0 D 0 70 • Q 4J 0 0 joir 74 � EX/fiiM!� 71 a Stoms`.. 0 8300 3 7 162 0834 b, O W �� WELL 1 61 Q 956 ?- L�� L o azas ti°... o to 5's o 8309 6349 8314 5 r .ti f"f� 1 in=100ft WtE 5 Parcel: 461601279569, 8316 NOLLEY LN SHERRILLS FORD, 28673 Owners: STONE JERRY DEAN. STONE PATSY Owner Address: 8316 NOLLEY LN Values - Building(s): $129,300, Land: $233,700, Total: $363,000 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 06/06/2016 Catawba County Environmental Health lu-Amullu III 1'I 1 it Bill I I I I llivii. I ',pia Ir I �I re ra llfil 1 xt ._ 1, I I Ill I q � , ]4u�{I, M r , 111 °il k�r I Ai ills {�°' ,ll ii��l1� (I .�I i ! p:;:.{� � 1 M. �% t 4 III nj18 tl 114I �I +I � : 'l∎, r a. ti `l &, i j 4', I 111111 Iii It t f 1" III I f ' �% Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461601279569 Owner: STONE JERRY DEAN Parcel Address: 8316 NOLLEY LN Owner2: STONE PATSY City: SHERRILLS FORD, 28673 Address: 8316 NOLLEY LN LRK(REID): 18845 Address2: null Deed Book/Page: 3205/1072 City: SHERRILLS FORD Subdivision: CRESCENT LAND AND TIMBER State/Zip: NC 28673-9389 CORP Lots/Block: 73/null School Information: School District: COUNTY Last Sale: Elementary School: SHERRILLS FORD Plat Book/Page: 15/183 Legal: LOT 73 PLAT 15-183 Middle School: MILL CREEK Calculated Acreage: 1.270 High School: BANDYS Tax Map: 018 X 32073 School Map Township: MOUNTAIN CREEK State Road #: 1934 Tax/Value 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: $129,300 Zoning2: null Land Value: $233,700 Zoning3: null Assessed Total Value: $363,000 Zoning Overlay: CRC-O,WP-O,FPM-0 Year Built/Remodeled: 1990/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 #: 3710461600L Building Details 2010 Census Block: 5029 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 Agricultural District: Proximity 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=461601279569&typ=P 6/6/2016 Kr- CATAWBA COUNTY E f 100A SOUTHWEST BLVD Qt' '17,79i.1111 NEWTON,NORTH CAROLINA 28658 RECEIPT 0 `i,t v , '•C PHONE: 828.465.8399 Monday, June 6, 2016 /$42 sM www.catawbacountync.gov PAYOR: Stone,Jerry PAYMENTS TRANSACTION NUMBER: TRC-686798-06-06-2016 PAYMENT DATE: 06/06/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329084 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS : $300.00 EHPR-06-20 1 6-2403 1 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8316 NOLLEY LN, SFIERRILLS FORD NC 28673 Owner JERRY STONE, 8316 NOLLEY LN, SHERRILLS FORD NC 28673 C:8284782793 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 06/06/2016 14:15 Page 1 of 1