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HomeMy WebLinkAboutEHPR-02-2016-23286.TIF �gA •G THIS IS NOT A PERMIT Case # EHPR-02-2016-23286 ti CATAWBA COUNTY HEALTH DEPARTMENT U TM:WI �' c i` 0, 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '�� 842?� Environmental Health Plan Review - OSWP r o •• • d IMPROVEMENT �' Applicant GIL SWAIM, 7483 LAKEWOOD DR, SHERRILLS FORD NC 28673 H:7044839587 C:7044721605 HOME:7044839587 Owner VERA WATERS, 916 MYRTLE AV, VENICE FL 342857833 NAME TO APPEAR ON PERMIT GIL SWAIM SITE ADDRESS: 3990 DUFFY DR, SI-1ERRILLS FORD NC 28673 PIN # 460703037402 NAME of SUBDIVISION: A L ROBINSON Lot# 4 Section/Block B PROPERTY SIZE: Square Feet 17,424.00 Acres 0.4 DIRECTIONS: Hwy 16 South, Left onto Buffalo Shoals, Right onto Little Mtn Rd, Right onto Rolling Hills Dr, At Stop Sign go Right& lot will be the 2nd on the Right, PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for purchase* 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? 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: — PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF metal carport(can be moved) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 20x20 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: House 30x40, Decks: front 6x5, back 6x10 #OF NEW BEDROOMS:: 3 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: E9-ehapplicauon 02/26/2016 10.28 Page 1 of 5 ,qA CATAWBA COUNTY Case/1 EI-IPR-02-20]6-23286 Cam' �4. Public Health Department Subdivision A L ROBINSON Q � " Environmental Health Division ;'�'O' Y PIN 460703037402 c-;., PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 /842 s. NAME ON PERMIT: (GIL SWAIM), 7483 LAKEWOOD DR, SHERRILLS FORD NC 28673 ( GIL SWAIM) Site Address: 3990 DUFFY DR, SHERRILLS FORD NC 28673 Property Size: Square Feet 17,424.00 Acres 0.4 Directions: Hwy 16 South, Left onto Buffalo Shoals, Right onto Little Mtn Rd, Right onto Rolling Hills Dr,At Stop Sign go Right&lot will be the 2nd on the Right. 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 u erstand that I am solely responsible for the proper identification nd la eling of all property lines and corners and making the site accessi .s ; at a m-et�aluation can be performed. Date: a 0�MY 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 9'` LIPI:C F S _ ll $ ,'c a Y s s s I Ii f111:1' F 5d3 N e IrFEENAME hft : :l °kt! ti .-11z . an`. DATE ° FEE AMOUNT i Improvement Permit Fee 02/26/2016 $150.00 '" vr_ r a5: ' err" " : u Vs ,Sg,.a �,' is< x TOTAL-FEES Ly. � �i r:._ , F s; ass r s S150 00i°r �.. gaill .k-.- gV ni!P.^.rl. ,_-i::_a31661.!:'*1 itria..ss.....i:,em km,r,.v ?t..,I ai-- fla' inurriii,ANI 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 02/26/2016 10:28 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT Lot r AJ CATAWBA COUNTY HEALTH DEPARTMENT m pit \ Application for Environmental Services Page I 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 ❑ Existing Facility f Property Address 3990 Duffy Drive Subdivision A. L. Robinson Sherrills Ford, NC 28673 Lot# 4 Acres .40 Section/Block/Phase_ Driving Directions to Property From Little Mt Rd-,turn onto Rolling Hills Drive. At stop sign turn right. Lot is 2nd lot on the right.. NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Gil Swaim Address 7483 Lakewood Drive Sherrills Ford, NC 28673 Phone704-483-9587 home Cell Phone 704-472-1605 Owner Contact Information Name 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 vacant land moat carponm # of Bedrooms *t Structure Dimensions 7(l'-7o #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes P 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. lithe answer to any question is "yes", applicant must attach supporting documentation. ® Yes e7 No Does the site contain any jurisdictional wetlands? Yes a No Does the site contain any existing wastewater systems? • Yes c No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes o No Is the site subject to approval by any other public agency? C Yes gS No -Arc there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ 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 CATA`� � A THIS IS NOT A PERMIT COUNTY L�VV1: CATAWBA COUNTY HEALTH DEPARTMENT -. _ No„Acn,&_ Application for Environmental Services Page 2 Proposed Facility Type . ❑ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t _ Project Description t douse @-,7c t10 c&rAc\bacC �X _ r cYC-L_ Structure Dimensions 30 x 40 h 00-9 e., # of Occupants 1 Basement ❑ Yes ❑ No Basement Fixtures ® Yes O) 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 if Units #Bedrooms per Unit*t Total #Bedrooms *t Structure Dimensions L Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) H Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Scats 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 ❑ 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 fixture. 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 c n be performed. / Pi r 24 . Signature of Owner or Agent G\ y� Date Printed Name of Owner or Agent ;' \ s i Y� l \ 6 Catawba County Environmental Health - \ l o \ Co 4 0 CV rY \ v, \ \ \ \€13 p0• (145) \ �, d� d �. . � C psi ± • 'p o . \0 i 38.9 / N \ 7 1 * I p °o o$ ,31, Nr0 c.,,,,, a N .s Parcel: 460703037402, 3990 DUFFY DR iin=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 02/26/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460703037402 Owner: WATERS VERA MAYLENA Parcel Address: 3990 DUFFY DR Owner2: City: SHERRILLS FORD, 28673 Address: 916 MYRTLE AVE LRK(REID): 12108 Address2: Deed Book/Page: 3284/0259 City: VENICE Subdivision: A L ROBINSON State/Zip: FL 34285-7833 Lots/Block: 4/ B Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: Elementary School: SHERRILLS FORD Calculated Acreage: .400 Middle School: MILL CREEK Tax Map: 011 DX 01023 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1941 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: $500 Zoning2: Land Value: $12,800 Zoning3: Assessed Total Value: $13,300 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460700J Building Details 2010 Census Block: 3039 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P31 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. ©2015, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460703037402&typ=P 2/26/2016 A Cp CATAWBA COUNTY 4$111 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT d �Pav ' PHONE: 828.465.8399 11 agar �C Friday, February 26, 2016 2 s 84M www.catawbacountync.gov PAYOR: SWAIM, GIL PAYMENTS TRANSACTION NUMBER: TRC-627474-26-02-2016 PAYMENT DATE : 02/26/2016 PAYMENT TYPE: Check 1245 INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325644 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-02-2016-23286 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3990 DUFFY DR, SHERRILLS FORD NC 28673 Applicant GIL SWAIM, 7483 LAKEWOOD DR, SHERRILLS FORD NC 28673 H:7044839587C:704472 I 605 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner VERA WATERS, 916 MYRTLE AV, VENICE FL 342857833 receipt 02/26/2016 10:27 Page I of 1