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HomeMy WebLinkAboutRBPR-09-2016-24669.TIF • 41Atitathft THIS IS NOT A PERMIT Case # RBPR-09-2016-24669 CATAWBA COUNTY HEALTH DEPARTMENT ❑• '. ria arg D f© PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Ni841, 9., Residential Building Plan Review - Building New fir• ro o IMPROVEMENTfli 1'o - 'a Pitt RQ i SA d baht en Owner JIMMY SHERRILL, 2713 S NC 16 HWY, NEWTON NC 28658 H:828-464-2097 HOME:828-464-2097 NAME TO APPEAR ON PERMIT Jimmy Sherrill SITE ADDRESS: 2713 S NC 16 HWY,NEWTON NC 28658 PIN # 365915637391 NAME of SUBDIVISION: Lot# 2 3 7 Section/Block PROPERTY SIZE: Square Feet Acres 10.72 DIRECTIONS: 16 S/5 miles out of Newton PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: 1 Accessory story dwelling (no basement, no garage) 2 bedroom 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: ACCESSORY DWELLING FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF SW mobile home EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 12 x 7 1 NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM 24 x 36 #OF NEW BEDROOMS:a BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: 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 l 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 09/06/2016 12:09 Page 1 of 4 K•\144- •G , THIS IS NOT A PERMIT Case # RBPR-09-2016-24669 EST CATAWBA COUNTY HEALTH DEPARTMENT EP -v. h�o 11 Al y. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \8 2 sM Residential Building Plan Review - Building New D. if o IMPROVEMENTwricAs Owner JIMMY SHERRILL, 2713 S NC 16 HWY, NEWTON NC 28658 11:828-464-2097 HOME:828-464-2097 NAME TO APPEAR ON PERMIT Jimmy Sherrill SITE ADDRESS: 2713 S NC 16 HWY,NEWTON NC 28658 PIN # 365915637391 NAME of SUBDIVISION: Lot# 2 3 7 Section/Block PROPERTY SIZE: Square Feet Acres 10.72 DIRECTIONS: 16 S/5 miles out of Newton PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: 1 Accessory story dwelling (no basement, no garage) 2 bedroom 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: ACCESSORY DWELLING FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF SW mobile home EXISTING STRUCTURES . ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 2 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 12 x 70 #OF NEW BEDROOMS:: 1 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: 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 comple a site evaluation can be performed. Date: 9 —a - - (L Signature of Applicant or Agent �q r--,,1. r ,-.42e 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 09/06/2016 10:23 Page 1 of 4 .18• CATAWBA COUNTY Case# RBPR-09-2016-24669 cy( ��. Public Health Department Subdivision c"'^a� k y Environmental Health Division PIN# 365915637391 y\� 4� PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 #842 s. NAME ON PERMIT: (JIMMY SHERRILL),2713 SNC 16 HWY,NEWTON NC 28658 ( Jimmy Sherrill) Site Address: 2713 S NC 16 HWY,NEWTON NC 28658 Property Size: Square Feet Acres 10.72 Directions: 16 S/5 miles out of Newton FEENAME . . DATE_ , FEE AMOUNT Improvement Permit Fee 09/06/2016 $150.00 - TOTAL FEES $150.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 09/06/2016 10:23 Page 2 of 4 CATAWBA 712A THIS IS NOT A PERMIT ,z,,,ii:Lr L�VV 1J CATAWBA COUNTY HEALTH DEPARTMENT sr N,,,„c,,.o a Application for Environmental Services Page 1 Improvement Permi Authorization to Construct.E Septic Repair D Septic Malfunction 111Septic Expansion New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ y Application is for New Construction Existing Facility ❑ Property Address I inyyle l ull c..*r�[ Subdivision 4 .,2 f/3 i✓ter gusiNPSs Pfter .7 ,(/P i 1t Lot# Acres l� a56$ Section/Block/Phase 4' Driving Directions to Property e_,0 it-1,4.,d7 Se)(zit(& en5 , cs cT1r eidmto NAME TO APPEAR ON PERMIT? ® Owner Applicant ❑ Contractor Applicant Contact Information� Name Dt I r n:i 11r10., het ') Address -7 IS ) \( hl - I J Phone 51,...26.–$j 4{_., J (' 77 I Cell Phone Owner Contact Information Name 34 rye E Address Phone Cell Phone Contractor Contact Information Name 4A n'1 e Address Phone Cell Phone WHO WILL BE THEPRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site Jn tg,Xe L(n/I f # of Bedrooms *'r a Structure Dimensions !24 r/O #of Occupants / Basement E Yes IM No Basement Fixtures a Yes ® No — The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the grope ty in question. If the answer to any question is "yes", applicant must attach supporting documentation. ® YesNo Does the site contain any jurisdictional wetlands? *Yes ® No Does the site contain any existing wastewater systems? 0 Yes XNo Is any wastewater going to be generated on the site other than domestic sewage? lit Yes ❑No Is the site subject to approval by any other public agency? ® Yes 'ONo Are there any easements or right of ways on this property? Describe Existing water supply in use A Individual Well LJ Community Well H 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) 0 Accepted 0 Alternative ❑ Conventional 0 Innovative 0 Other 5/Any C ArrA`C'tj 7^Q A-1 THIS IS NOT A PERMIT • COUNT" CATAWBA COUNTY HEALTH DEPARTMENT N‘zzazi �a.a Application for Environmental Services Page 2 Proposed Facility Type • ❑ Primary Residence . New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description a Tied_ Gelid Ph_ F{-cj(AS e Structure Dimensions Z 4'X 3 6 #of Occupants Basement ❑ Yes ® No Basement Fixtures ® Yes ® No 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 *j Structure Dimensions ❑ Food Service Specify Type At 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 ❑ 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 ❑ Community Well Abandonment Type ❑ Drilled n Bored ❑ Dug n Unknown Well Repair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial f 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. !� / 4 -4Signature of Owner or Agent 7 / �(��n////� � Date±f J�/ Printed Name of Owner or Agent �r w ;r //c/e f (vet? �h� Catawba County Environmental Health es.,....„ _ c • J r. of — _ _ , i � ..a.y 111 1 C2 x i -yFr Pi -- ,,_1 l ` —• . . i • . Cr 4411 Qa H ip *% Psis lit N‘)"61 C3 4' I11 ,1' � NP / , % /...... / Parcel: 365915637391 , 2713 S NC 16 HWY 1in=200ft NEWTON, 28658 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 09/02/2016 Parcel Report • Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 365915637391 Owner: SHERRILL JIMMY PARLIER Parcel Address: 2713 S NC 16 HWY Owner2: SHERRILL SHIRLEY SHOOK City: NEWTON, 28658 Address: 2713 S NC 16 HWY LRK(REID): 506 Address2: Deed Book/Page: 0551/0324 City: NEWTON Subdivision: State/Zip: NC 28658-8207 Lots/Block: 2 3 7/ School Information: Last Sale: Plat Book/Page: 6/134 School District: COUNTY Legal: LOT 2 3 7 2713 S NC 16 HWY PL 6-134 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 10.720 Tax Map: 001 K 02003 High School: BANDYS Township: CALDWELL School Map State Road #: 16 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: NEWTON RURAL Zoningl: R-40 Building(s) Value: $133,600 Zoning2: Land Value: $82,200 Zoning3: Assessed Total Value: $215,800 Zoning Overlay: RP-O Year Built/Remodeled: 1965/1985 Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel 4t: 3710365900J Building Details 2010 Census Block: 1000 WaterShed: 2010 Census Tract: 011601 Voter Precinct: P20 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,toss 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. \SO 2 k1W to 200 5c4 I /e/uh http://gis.catawbacountync.gov/nomap/parcel_report.php?key=365915637391&typ=P 9/6/2016 '06 CATAWBA COUNTY HEALTH DEPARTMENT N° 5976 //� Telephone: (828)465-8270 TDD: (828)465-8200 V�,1 lnip. Prmt. Au h. to Const. pr. Prmt. Opr. Print. Sys. Type Well Prmt. Well Rpr. Print. V Owner/Agent l//li Phone 322,526 Address + S /� Subdivision 74_,• .�-}., Sc ion/Block/Phase ----tam-- Lot Size Directions: 144 - id f o. 0 (kV- try!.( -vt Facility: House Mobile Home Bus' ess Multi-family . Other: Tax Map or Pin Number Other . Zoning Approval# if Bedrooms N Seats if Empl ees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well k Public Semi-Public ********************************************************************************************** *************************** Type of System: Trench Bed Pimp Pump/Panel Panel LPP Other Septic Tank Size Pump Tank Nitrif' tion Field: Total Squar Feet Depth of Stone Bed Size Trench Width Total Le gth of All Trenches Number of Trenches Trench Length / / /_/_/_Feet on Center Maximum Trench epth Distance of Nearest Well *DO NOT INSTALL SEP'T'IC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************** Topo % Slope Texture Structure Clay Min._ Soil Wetpess " Soil D-t / (_' Restric Hoz. It " / c...) Avail.•le sp. a yes/no So.t(1 �t Over: CI.•. S PS U S� 9/-N\ \,/ r , Com ents: _J tb 1 ©t' r4 lip SO d 1-1 ...... ..._.-v-:(?0// fro.,!.< il 1s4. 1 did PI n 6(dItieilic . CL) r__."7:N.\\\ JZ 10 /tit **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possib a ources of contamination. No volume of water is guaranteed atap� he Health Dep artment. �j Permit Date J EHS if ki—__ A Owner/Agent Z.L.....-.."--c---) Septic T Installed / -/ Date EHS Well Installed By ,- I,•r e i' .9. ' / Well Gr•u Approval Date$ZL'- gej Well Head Approva Date 6'l7 ,1 Date Sample Collected i tU� Date of Results Voi Results EHS jr j--(ZA White-Office Blue- uildi/n�Inspection Operation Permit Yellow-OwneriA ent Green-Bud i Ins! lion, t or . on to Construct