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HomeMy WebLinkAboutCBPR-07-2016-24358.TIF • MICHAEL ATHANAS&ASSOCIATES LICENSED SOIL SCIENTIST 561 Ennis Rd. Weddington, NC 28173 (704) 576-3887 Reference: Data Sheet for 3502 Mt. Pleasant Rd, PIN 460701281050 Building Footprint: See attached plan Building Setbacks: Water Source: Existing Well Number of Employees: 18/450 GPD Proposed LTAR: 0.5 GPD/FT2 (initial), 0.4 GPD/FT2 (repair) Proposed System Type: 25% Reduction Proposed Repair System Type: PPBPS Distribution: Gravity-Distribution Box Septic Tank Size: 1000 Gallons Proposed Trench Bottom: 36" Line Design Length Actual Length Blue 1 75' 90' Pink 2 75' 90' White 3 75' 90' White 4 33' Pink 5 65' Yellow 6 48' Blue 7 67' Initial System: 225' Repair System: 213' Comments: This commercial building can only be used for general business. The maximum occupancy is 18 full time employees. The system should be installed at 36" trench bottom. rn z J E at so 176 1- % § , . c ,00 • U ,2/ III. co W � gP/� g� /QC = l S o � v Al'g - a 4116). . .,1 },-7.,s � t. Li\, , 9646IA" c g a�I .66 DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet I of 2 DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#:460701281050_ ON-SITE WATER PROTECTION BRANCH COUNTY:Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) OWNER: Dockside Storage LLC APPLICATION DATE ADDRESS: DATE EVALUATED: PROPOSED FACILITY:_18 Employees PROPOSED DESIGN FLOW(.1949):_450 GPD PROPERTY SIZE: 1.19 AC LOCATION OF SITE: 3502 Mt Pleasant Rd, Sherrils Ford PROPERTY RECORDED: WATER SUPPLY: 2 Private U Public E Well ❑ Spring C Other EVALUATION METHOD: 2 Auv�er Boring 5 Pit U Cut TYPE OF WASTEWATER: S Sewage U Industrial Process U Mixed e P j 4R. -D- .' SOIL MORPHOLOGY ° . !OTHERa .I E r ' FS , I1( 1941) PROFILE FACTORS ' 'vl . L 1948 F 1 i,I%_ If i l { 111 E LANDSCAPE , ii HORIZON 1 • 1 .,.E �STRUCTURE/ �} CONSISTENCE/ .WETNESS/ SOIL` �S 1PRO 4 REST R E ' PROFILE LTAR POSITION/ION/ DEPTH E I E I`„ e SLOPE% ( N) • I ^r i . TENTURE •' ,`.. MINERALOGYD ,COLOR. EP,TH CLASS, 'I HORIZ ','.y LS 6% 0-12 FILL N/A 30" N/A PS 0.4-0.5 F-C SAP PIT 12-30 R CL WSBK FR SS SP SEXP PS 1 30-63 SL SAP M VFR SS SP SEXP LS 6% 0-15 FILL N/A 34„ N/A PS 0.4-0.5 F-C SAP PIT 15-34 R CL WSBK FR SS SP SEXP PS 2 34-61 SL SAP NI VFR SS SP SEXP LS 0-1% 0-67 SL SAP M VFR SS SP SEXP N/A PS N/A PS 0.5-0.6 PIT 3 LS 0-1% 0-16 FILL N/A PS N/A PS 0.5-0.6 PIT 16-65 SL SAP M VER SS SI'SEXI' 4 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): SITE CLASSIFICATION(.1948): PS Available Space(.1945) 675 FT2 426 FT2 System Type(s) 25%Reduction PPBPS EVALUATED BY: MA&A - _ OTHER(S) PRESENT: Site LTAR 0.5 0.4 COMMENTS: Updated February 2014 SOIL/SITE EVALUATION Sheet 2 of 2 (Continuation Sheet-Complete all field in fill) DEPARTMENT OF HEALTH AND HUMAN SERVICES PROPERTY ID#: 460701281050_ DIVISION OF PUBLIC HEALTH DATE OF EVALUATION: ENVIRONMENTAL HEALTH SECTION COUNTY:_CATAWBA ON-SITE WATER PROTECTION BRANCH • • • • Pr " , 7 I �. II I u ((,, SOILMORPHOLOGY ';`� OTHER �, ',, �,tr rr:opt F 1 ipi44r ,il i(1941) PROFILE FACTORS:: L 1940 .• N �� rd,'16 1 ,J r lij r(E .f: r s Ur4r • v,R r LANDSCAPE r ;;;;44,44,,:4;;;4,..10,014, V 1942 r pp E HORIL r 1� ilt, u m s ri POSI I ION/., ON 1 i I ' I �-�r 1941 i c- �r:1911 i 1 SOIL �i�i .1943 i 1195671! .1944 PROFILE q SCOPE /o '1 STRUCTURE./ CONSISTENCE/ N L FNESS( SOIL .iSAPRO RI STR L' CLASS ONTH TE\TURF. r '1DIIAERALOCS r.: COL014 ra DEPTH CLASS ' IIORIZ '. & I:EAR ", LS 5% 0-22 R CL WSBK FR SS SP SEXP N/A 34" Few SAP N/A PS 0.4 Corn AB 22-34 R SCL WSBK VFR SS SP SEXP SAP 1 34-60 SL SAP M VFR SS SP SEXP PS LS 5% 0-12 R CL WSBK FR SS SP SEXP N/A 12" F-C SAP N/A PS 0.4- 0.6 AB 12-48 SL SAP M VFR SS SP SEXP 2 48-60 LS SAP M VFR SS SP SEXP • COMMENTS: Updated February 2014 •\ THIS IS NOT A PERMIT Case # CBPR-07-2016-24358 mu A CATAWBA COUNTY HEALTH DEPARTMENT ❑' ; 43 +.f i❑' < 7706 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Commercial Building Plan Review - Building New o ; IMPROVEMENT - AUTH_CONST � } � Ii� os Contact Person - Erosion WILLIS SPIVEY, 7000 HYDE ST, SHERRIES FORD NC 28673 Control C:7043637288 Contractor *SPIVEY CONSTRUCTION (WILLIS SPIVEY), PO BOX 4268, MOORESVILLE NC 28117 B:7045634189 C:704-363-7288 WILLIS SPIVEYF:704-663-472 I WILLIS@SPIVEYINC.COM Financier WILLIS SPIVEY, 7000 HYDE ST, SHERRIES FORD NC 28673 C:7043637288 Owner WILLIS SPIVEY, P.O. BOX 4268, MOORESVILLE NC 28117 C:7043637288 WILLIS@SPIVEYINC.COM SPIVEYINC.COM NAME TO APPEAR ON PERMIT *SPIVEY CONSTRUCTION (Willis Spivey) SITE ADDRESS: 3502 MT PLEASANT RD, SHERRILLS FORD NC 28673 PIN # 460701281050 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 51,836.40 Acres 1.19 DIRECTIONS: Hwy 165 to Hwy 150E Left on Mt.Pleasant Rd. corner of Mt. Pleasant and dockside lane PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 450 WATER SUPPLY: Private Well DESCRIBE WORK: 110x66 Office/Warehouse space, 1/2 space used for construction office/storage with two employees, other(3) 66x20 Bays TBD but no retail. Sizing based on 25 GPD per employee w/ Max 18 employees - soil scientist proposal to follow- Owner wanted sizing to be based on max system that will fit on the lot w/ 100% repair. *will be using existing bored well on property Erosion Control for Dockside Flexspace 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? Yes 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: Business OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 110x66 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: 18 SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 7,260 RETAIL FLOOR SPACE (SQ FT): 0 DINING AREA FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: No 139-eltapplicatinn 07/28/2016 13:48 Page I of 4 .,4w _� CATAWBACOUNTY Case# CBPR-07-2016-24358 .e' Public Health Department Subdivision Ya "la Y Environmental Health Division PIN# 460701281050 'to PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 /842 :m NAME ON PERMIT: *SPIVEY CONSTRUCTION ( WILLIS SPIVEY), PO BOX 4268, MOORESVILLE NC 28117 *SPIVEY CONSTRUCTION ( Willis Spivey) Site Address: 3502 MT PLEASANT RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 51,836.40 Acres 1.19 Directions: Hwy 165 to Hwy 150E Left on Mt.Pleasant Rd. corner of Mt. Pleasant and dockside lane 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 �Ih FEEN'ME 4il'1II���III�� dita,, ilii j. --.a.I+llSllu!4S ATEA I%IIWk �rFEEi'AMOUNT4 inj Erosion Control Plan Review Fee 07/25/20]6 $350.00 Authorization to Construct Fee (New/Expansion) 07/28/2016 $300.00 Fee Improvement Permit Fee 07/28/2016 $150.00 l(IiI ;ill ,' lii�j, TomA lif Es+lUilllliiiipillivii.• �lll�dh�(��d�, n i 9 9! I�soo'oo N hl, Wfll'111 l 1 11,i iE.4U ��ijjtr .LwiNtnl IIWWwu4n..' .;2:I1tW alltl1ltlttlilMlil8SLibUlIIfalU riI:mimta i�x :i 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 07/28/2016 13:48 Page 2 of 4 SBA •� THIS IS NOTA PERMIT Case # CBPR-07-2016-24358 d :.,, ,«� Y CATAWBA COUNTY HEALTH DEPARTMENT 0+.A. , .. �0117.r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ?`'�'� ,,ti i Ig }2 s�, Commercial Building Plan Review - Building New ' lira { �' ? IMPROVEMENT - AUTH_CONST '-aN ' ;=R*f Contact Person - Erosion WILLIS SPIVEY, 7000 HYDE ST, SHERRILLS FORD NC 28673 Control C:7043637288 Contractor *SPIVEY CONSTRUCTION (WILLIS SPIVEY), PO BOX 4268, MOORESVILLE NC 28117 B:7046634189 C:704-363-7288 WILLIS SPIVEYF:704-663-4721 WILLIS@SPIVEYINC.COM Financier WILLIS SPIVEY, 7000 HYDE ST, SHERRILLS FORD NC 28673 C:7043637288 OwnerWILLIS SPIVEY, P.O. BOX 4268, MOORESVILLE NC 28117 NC:7043637288 WILLIS@SPIVEYINC.COM J t 0V� NAME TO APPEAR ON PERMIT ✓\\ *SPIVEY CONSTRUCTION (Willis Spivey) SITE ADDRESS: ' 3502 MT PLEASANT RD, SHERRILLS FORD NC 28673 PIN # 460701281050 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 51,836.40 Acres 1.19 DIRECTIONS: Hwy 165 to Hwy 150E Left on Mt.Pleasant Rd. corner of Mt. Pleasant and dockside lane PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 450 WATER SUPPLY: Private Well DESCRIBE WORK: 110x66 Office/Warehouse space, (3) 66x20 Bays, 1/2 space used for construction office with two employees, other space TBD but no retail. *25 GPD per employeed - soil scientist proposal to follow-will be using existing bored well on adjacent property** Erosion Control for Dockside Flexspace 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? Yes 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: Business OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 110x66 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: 18 SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 7,260 RETAIL FLOOR SPACE (SQ FT): 0 DINING AREA FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-chapplication • 0728/2016 11:28 Page I of 4 3A �. CATAWBACOUNTY Case# CBPR-07-2016-24358 /T :.n 2 Public Health Department Subdivision C 3#C®�IIH Environmental Health Division PIN# 460701281050 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 (842 w NAME ON PERMIT: *SPIVEY CONSTRUCTION (WILLIS SPIVEY), PO BOX 4268,MOORESVILLE NC 28117 *SPIVEY CONSTRUCTION ( Willis Spivey) Site Address: 3502 MT PLEASANT RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 51,836.40 Acres 1.19 Directions: Hwy 165 to Hwy 150E Left on Mt.Pleasant Rd. corner of Mt. Pleasant and dockside lane 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 AREAI FEENAME DATE FEE AMOUNT Erosion Control Plan Review Fee 07/25/2016 $350.00 Authorization to Construct Fee (New/Expansion) 07/28/2016 $300.00 Fee Improvement Permit Fee 07/28/2016 $150.00 TOTAL'FEES - 5800.00 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-chappl[cation 07/28/2016 11:28 Page 2 of 4 03 �r THIS IS NOT A PERMIT Case# CBPR-07-2016-24358 a CATAWBA COUNTY HEALTH DEPARTMENT 021A' g, bEl PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES `: ''. 44,1116i Sit 1842 s�+ Commercial Building Plan Review - Building New • •so. It • IMPROVEMENT- AUTH CONST � 10.112.9r4 ' Contact Person - Erosion WILLIS SPIVEY, 7000 HYDE ST, SHERRILLS FORD NC 28673 Control C:7043637288 Contractor *SPIVEY CONSTRUCTION (WILLIS SPIVEY), PO BOX 4268,MOORESVILLE NC 28117 B:7046634189 C:704-363-7288 WILLIS SPIVEYF:704-663-472 WILLIS@SPIVEYINC.COM Financier WILLIS SPIVEY, 7000 HYDE ST, SI-IERRILLS FORD NC 28673 C:7043637288 Owner `�N�ILLIS SPIVEY, P.O. BOX 4268, MOORESVILLE NC 28117 .Y,�1D C:7043637288 WILLIS@SPIVEYINC.COM � z J� e53 NAME TO APPEAR ON PERMIT Y� t"`°,O&, *SPIVEY CONSTRUCTION (Willis Spivey) SITE ADDRESS: SDE LN, SI-IERRILLS FORD NC 28673 PIN # 460701281050 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 51,836.40 Acres 1.19 DIRECTIONS: Hwy 165 to Hwy 150E Left on Mt.Pleasant Rd. corner of Mt. Pleasant and dockside lane PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 450 WATER SUPPLY: Private Well DESCRIBE WORK: 110x66 Office/Warehouse space, (3) 66x20 Bays, 1/2 space used for construction office with two employees, other space TBD but no retail. *25 GPD per employeed - soil scientist proposal to follow-will be using existing bored well on adjacent property** Erosion Control for Dockside Flexspace 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? Yes 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: Business OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 110x66 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: 18 SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): 7,260 RETAIL FLOOR SPACE (SQ FT): 0 DINING AREA FLOOR SPACE (SQ FT): DAYCARE OCCUPANCY: KITCHEN: No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES E9-chapplication 07/28/2016 10:24 Page 1 of 4 eA CATAWBA COUNTY Case# CBPR-07-2016-24358 rta Z Public Health Department Subdivision s rtA ®p Environmental Health Division PIN# 460701281050 sr PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 841 ,M NAME ON PERMIT: *SPIVEY CONSTRUCTION (WILLIS SPIVEY),PO BOX 4268, MOORESVILLE NC 28117 'SPIVEY CONSTRUCTION (Willis Spivey) Site Address: 3579 DOCKSIDE LN, SNERRILLS FORD NC 28673 Property Size: Square Feet 51,836.40 Acres 1.19 Directions: Hwy 165 to Hwy 150E Left on Mt.Pleasant Rd. corner of Mt. Pleasant and dockside lane 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 access1b1 so that a c p1 t site evaluation can be performed. Date: '1 - 1 % — LC)(o Signature of Applicant or Agent Z T An Environmental Health Specialist will contact you within 5 working days of app ication dat . If you need further information or assistance please call 828-466-7291 AREA1 FEENAME , DATE z FEE AMOUNT Erosion Control Plan Review Fee 07/25/2016 5350.00 Authorization to Construct Fee (New/Expansion) 07/28/2016 5300.00 Fee Improvement Permit Fee 07/28/2016 $150.00 . TOTAL.FEES ,>._ ,,. . ". $800.00 '! L. 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) 09-ehappl ic:uion 07/28/2016 10 24 Page 2 of 4 CATiV v aJ THIS IS NOT A PERMIT COUNTY EA CATAWBA COUNTY HEALTH DEPARTMENT , Application for Environmental Services Page 1 Improvement Permit Authorization to Construe 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 Constructionn( Existing Facility ❑ i Property Address 3 S U a On 1 P 2t Saw �C �t Subdivision SL c cr .(\\ s Fera /V L Lot# Acres 2 8 L') 3 Section/Block/Phase Driving Directions to Property 1-I- to ,1 I (e s -k--o t-k-w I 5 D1 r \ n M i . P t1z<s t ,c `k{- A- 0 ,A.. 1�k . \. t. ,-,n c. %A.- j PUPS t1-1-ors t tri:}h-cvs Pc U & T. t ' `, G NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant Contractor 1 Applicant Contact Information Name La ,\\\ s S p i 0 -t1 Address e 13ox 42, 6c' I JYlborz5o \\e- moi_ igeiti - . Phonea 1 3 103 - 2 2 `; e CC, 11 Cell Phone 1 Owner Contact Information ` Name '(J o �-� s T b---e.. To s c< L G-,1., Address 353 o m4. Q\«)SG- v`- N- g D, , S F 2 8 6) J PhoneCell Phone } 0 9 3 b3 - 2 2 3 9 Contractor Contact Information ll Name S - .� z� �. � ws� r � cT fo G . Swc Address P g 8 ,X i2 6 IS Phone Cell Phone; ?J o 1 3 L3 -9 2_ 2 8 WHO WILL BE THE PRIMARY CONTACT? [ Owner ❑ Applicant Contractor Description of Existing Structures on Site #of Bedrooms *1. Structure Dimensions #of Occupants p� Wet I Basement ❑ Yes El No Basement Fixtures 0 Yes ® No `vl l 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. In Yes ' No Does the site contain any jurisdictional wetlands? ® Yes Y..Nn Does the site contain any existing wastewater systems? Yes ( ________) Is any wastewater going to be generated on the site other than domestic sewage? Ye In No Is the site subject to approval by any other public agency? D Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well U Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes No \t , If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): V (systems can be ranked in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other &Any CATAw IJL 1 A THIS IS NOT A PERMIT �COUNT , CATAWBA COUNTY HEALTH DEPARTMENT „„n;e,;„;e 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 7 Yes ❑ No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe #of New Bedrooms *1. if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed n Multi-Family Residence# Units #Bedrooms per Unit*j' 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.) Business Specific Type of Business Dc Cee / 0.3 ct r-c IA o,._s c Retail Floor Space /go #of Employees per Shift 15 # of Shifts ❑ Other Facility Type Specify [f 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 ❑ Bored ] Dug n Unknown Well Repair Requested ❑ Yes n No Describe Calculated Design Flow, Commercial f Ca) Additional information may be required to determine design flow from certain facilities/This value will be determined during consultation with on-site staff. t t- i `. *Airy 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 £ Date 2 — 2-i ^ /44 Printed Name of Owner or Agent (� 1 1\ 5 k SHO i 0 -(-- - , Catawba County Environmental Health s,, S0e-X • • '$ 06,cc ( . inQ I 41: ` A. s"0F �ti J `^ /O� CI\ 6 O Co / ,AW*. / / / ,r 22.10\ / V / / O r /ur co o co• OA 7-6 Q. CO 4.711 CD 3 /Ale M \\IIII • �5 Parcel: 460701281050, 3502 MT PLEASANT 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 07/28/2016 Parcel Report Page 1 of 1 e3 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460701281050 Owner: DOCKSIDE STORAGE LLC Parcel Address: 3502 MT PLEASANT RD Owner2: 4 _ City: SHERRILLS FORD, 28673 Address: PO BOX 4358 LRK(REID): 70716 Address2: Deed Book/Page: 3007/1075 City: MOORESVILLE Subdivision: State/Zip: NC 28117-4358 Lots/Block: / 3 5 School Information: Last Sale: Plat Book/Page: School District: COUNTY Elementary School: SHERRILLS FORD Legal: Calculated Acreage: 1.190 Middle School: MILL CREEK High School: BANDYS 34 Tax Map: 011 X 03001K Township: MOUNTAIN CREEK School Map State Road #: 1849 I . d Tax/Value Information: Tax Rates(pdf) Zoning Information: N A City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: RC Building(s) Value: $3,200 Zoning2: ------ Land Value: $28,600 Zoning3: d--- Assessed Assessed Total Value: $31,800 Zoning Overlay: CRC-O,WP-O ••••••)4 Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / n Zoning Agency Phone Numbers c.. . A Z Miscellaneous: Firm Panel Date: 2607-09-05 I Building Permits for this parcel. Firm Panel #: 3710460700J �J( Building Details 2010 Census Block: 3019 X WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Q Voter Precinct: P31 Agricultural District: Proximity Parcel Report Data Descriptions N (re) i 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 horn this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. Clap me ► 8e nC -Rsikto a11 tt ca aw acoun ync.gov/nomap/pa eel_report.php?key=460701281050&typ=P 7/28/2016