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HomeMy WebLinkAboutRBPR-07-2016-24252.TIF Z3A O THIS IS NOT A PERMIT Case # RBPR-07-2016-24252 gift G2i O�•nvn•r ❑ G ''" 'I�o�li CATAWBA COUNTY HEALTH DEPARTMENT r �.� °!'L' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �r , {`ter+ Igo L s�� Residential Building Plan Review - Building New .-- o o if ailtjt .47 .07, IMPROVEMENT •O0; ROA-SO Rgfirb Owner SHARAN ST JOHN, 5022 GRACE CHAPPEL RD, NAME TO APPEAR ON PERMIT SHARAN ST JOHN SITE ADDRESS: 7011 WILSON RD, SHERRILLS FORD NC 28673 PIN # 460803011295 NAME of SUBDIVISION: RODNEY WHITE LAKE PROP Lot ft 2 Section/Block PROPERTY SIZE: Square Feet Acres 0.49 DIRECTIONS: hWY 16 LEFT ON HWY 150 TURN LEFT ON MT PLEASANT ROAD TURN LEFT ON LOCKE TO RIGHT ON WILSON PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 3 BdRm house 40'8" x 32'8". Proposing to use the Existing septic &well on property. Old 3 BdRm house burnt down years ago & there is currently a camper on the 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? 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: New Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF Camper, Storage Bldg, Pavilion EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: Pavilion 12x20 NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 40'8"x 32'8" #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 139-ehapplic itinn 07/11/2016 13:01 Page 1 of 4 ,p,,A , CATAWBACOUNTY Case4 RBPR-07-2016-24252 z `i Public Health Department Subdivision RODNEY WHITE LAKE PROP < cif>u<{ ,'R) Environmental Health Division PIN# 460803011295 -• PO Box 389; 100-A Southwest Blvd,Newton,NC 28658 /842 sw NAME ON PERMIT: ( SHARAN ST JOHN), 5022 GRACE CHAPPEL RD, ( SHARAN ST JOHN) Site Address: 7011 WILSON RD, SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 0.49 Directions: hWY 16 LEFT ON HWY 150 TURN LEFT ON MT PLEASANT ROAD TURN LEFT ON LOCKE TO RIGHT ON WILSON 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. Date: Signature of Applicant or Agent 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 ;Fr' . �_tlwi711 r iI I" Y I i _...._ 1tl 1lw.�J'ts�tt Irc{mt �.s- n t tni l_ 6f!IEEFNAME1lGU4�� Wl do .•s, Isu1l„k; uaDATEIL..- ;FEE AMOUNT Improvement Permit Fee 07/11/2016 $150.00 IGI( '"glilI�IN �u TOTAL'tF'EESI°ii, kId'lllllIfll1I•t .. • •n liiIIll{lih i llijl;1$15000• `I�iSthill�' .i a'- 1uj' I". a rk.rt.l..ulirt' aail6lsll, eilltlthlha. .wIIL 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) 1i9-ehappli caunn 07/11/2016 13:01 Page 2 of 4 BA • THIS IS NOT A PERMIT Case # RBPR-07-2016-24252 ti CATAWBA COUNTY HEALTH DEPARTMENT 0�. x Iv• PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES .•t• - /g 2 sM Residential Building Plan Review - Building New o. • 5: IMPROVEMENT IMPROVEMENT 0 :°, Owner SHARAN ST JOHN, 5022 GRACE CHAPPEL RD, NAME TO APPEAR ON PERMIT SHARAN ST JOHN SITE ADDRESS: 7011 WILSON RD, SHERRILLS FORD NC 28673 PIN # 460803011295 NAME of SUBDIVISION: RODNEY WHITE LAKE PROP Lot# 2 Section/Block PROPERTY SIZE: Square Feet Acres 0.49 DIRECTIONS: hWY 16 LEFT ON HWY 150 TURN LEFT ON MT PLEASANT ROAD TURN LEFT ON LOCKE TO RIGHT ON WILSON PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: ZONING AND EH 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: New Structure STRUCTURE TYPE: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION #OF NEW BEDROOMS::- 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 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. Date: Signature of Applicant or Agent 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 E9-ehapplication 07/I1/2016 11:00 Page 1 of SBA CATAWBA COUNTY case# RBPR-07-2016-24252 �� Public Health Department Subdivision RODNEY WHITE LAKE PROP t�1r <,`---> Environmental Health Division PIN# 3 460803011295 ?'. PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 /841,<1 NAME ON PERMIT: (SHARAN ST JOHN), 5022 GRACE CHAPPEL RD, ( SHARAN ST JOHN) Site Address: 7011 WILSON RD. SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 0.49 Directions: hWY 16 LEFT ON HWY 150 TURN LEFT ON MT PLEASANT ROAD TURN LEFT ON LOCKE TO RIGHT ON WILSON FEENAME • DATE '' FEE AMOUNT s-( Improvement Permit Fee 07/11/2016 S150.00 TOTAL`FEES .— ' 5150.00 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-chapplication 07/11/2016 11:00 Page 2 of 4 THIS IS NOT A PERMIT ����\\ }� CATAWBA COUNTY HEALTH DEPARTMENT S.011 .--„,„\I" -° - !e Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair I I Septic Malfunction❑ Septic Expansion I I New Well Permit C Replacement Well ❑ Well Abandonment❑ Well Repair I I Existing System Inspection (Pre-Approval Required) Application is for New Construction IX Existing Facility ❑ Property Address ---70 Q// (!t-% i (50 N ll Rd Subdivision 4t -,Sl iItwo/ Lc-4- ,C- Lot# Acres / c9.5'673 Section/Block/Phase Driving Directions to Property CL /, - L..€ F) a M1.) y I S o — fiZ . e_c i p0 1.4 ) 156 Ai NAME TO APPEAR ON PERMIT? t Owner U Applicant n Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name %. y(,tt� ST- .�0l-i'(J _ 6-9./0,3 -ri✓ cc s ti-c D-3-630 Address � � 'Z GA C��P`["C� �F'� Phone Z g- -7 ci/— 35 3 -5,,,,y(Cell Phone -5,,,,y( E- .1 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant {l Contractor rJ t f / .9`� Lr-tc� t ,31 C6 / CLpj l ( t d a.� Description of Existing Stmctures on Site Cam"` / # of Bedrooms *j' Structure Dimensions # of Occupants Basement 7--Wes ❑ No Basement Fixtures 0 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. 0 yes No Does the site contain any jurisdictional wetlands? Yes 119 Does the site contain any existing wastewater systems? 0 Yes Is any wastewater going to be generated on the site other than domestic sewage? ICI Yes --/ Is the site subject to approval by any other public agency? D4�o 0 Yes o Are there as easements or right of ways on this property? Describe Existing water supply in use PSI Individual Well ❑ Community Well ❑ Semi-Public Well n County/City/Towmship 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 kAny CATA\I BA THIS IS NOT A PERMIT , coup u „ —_ 3 CATAWBA COUNTY HEALTH DEPARTMENT =-T . „„ Application for Environmental Services Page 2 Pro osed Facility Type .--; Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t c3 [[�� Project Description, �/ it S Structure Dimet s ons7d ''`%'')i• a X 3L #of Occupants Basement ['Yes ❑ No Basement Fixtures ri Yes fl No ❑ Accessory Structure(s) Describe # of New Bedrooms *1. if applicable Structure Dimensions • # of Occupants Accessory Dwelling n Yes ❑No Plumbing n Yes n No Describe Plumbing Needed I Multi-Family Residence#Units #Bedrooms per Unit*t Total# Bedrooms *j• Structure Dimensions I I Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) I Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts U Other Facility Type Specify If Church# of Seats Kitchen n Yes ❑ No If Daycare Specify Occupancy , Application for Well Consty ction/Abandonment/Repair Proposed Well Type L r dividua ell n Semi-Public Well I1 Community Well Abandonment Type Ii , Drilled ❑ Bored ❑ Dug I-I 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 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 �� C/� ,� V� ( Date / Printed Name of Owner or Agent 5 1-hn 1J 5 T73.rI r.V • Catawba County Environmental Health 70000 `P74SO .rRO 80 00 00 tits —190/1 \ \ 7002 4 0� / ee ` ` . n40 liil I-gi fall I'1tar�,� j41'I I ,11!� �. ni� i �,,{{ y ��lr (� Ill 111 ;tyry t,ri p plot 01t. 111;g;i1) III'l ("- "IIII k, 'r 111 (, , ��. j �11��11i 1� 1�i�l��fl �I � t��l� r tl���: I 'CI� �I t p �nVV.ll�r ,N I �1 lNS' C'1 Oro , r Ill AAitil�, 1 1'4p}�� �fi p \ . �1 • ll� , I I Iil,t l li' t4�rllts49 t tjldL ri,i ? 1MII ill 11 N t , "441 c1 11 i 11 I, n ail VA;0 i� ,?L iti4 I it � :1,11'1,10 11,1 1111 �il'I N111� title P1j1.1 ft n1y •.0111 I 1 Ill 1 I I r 1 d l i y 4� ( ' �l Ti s ry ' mlf G 11111 I �.' :,It Oil I� 1 Opt t-c ).n I ill'l i?, a Q 9 t l 1 1 � 1 J � .Gl�a , 1 n,. s � � A III b �� , N � T111 a e� r i ,,jj I£ �1 )�t, 1 t� p •jt'f1�^ Ii,'11.11 �� 1.4-I�I� 031 Y t .° t 1771 1 1111 a t 1K '1fliji 1 �'�I 1�I I B ,'' J�Z� d fir,.Ii,;ii NI 1 In ■ !i l I MI 1 ,h 1'l h o`:41 1 1J-th, 1't r .Nul tfli' .1101 I I �11i 04 lib,i iii 1 1.111 li 11 ia4:1, 'y. Parcel: 460803011295, 7011 WILSON 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 07/11/2016 Parcel Report Page I of I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460803011295 Owner: ST JOHN SHARAN Parcel Address: 7011 WILSON RD Owner2: null City: SHERRILLS FORD, 28673 Address: 5022 GRACE CHAPEL RD LRK(REID): 6299 Address2: null Deed Book/Page: 2976/1452 City: GRANITE FALLS Subdivision: RODNEY WHITE LAKE PROP State/Zip: NC 28630-9509 Lots/Block: 2/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: 12/14 Legal: LOT 2 LOT 2 PL 12-14 PL 12-14 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .490 Tax Map: 006AX 01002 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1933 Tax/Value 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: $4,600 Zoning2: null Land Value: $103,600 Zoning3: null Assessed Total Value: $108,200 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: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460800J Building Details 2010 Census Block: 3004 WaterShed: WS-IV Critical Area 2010 Census Tract: 011501 Voter Precinct: P31 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. octistns \vet( /Sept (P lb-0 es 4n ormo- c)Frri 3CsO 911 /d6 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460803011295&typ=P 7/11/2016