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HomeMy WebLinkAboutEHPR-03-2016-23480.TIF $ THIS IS NOT A PERMIT Case # EHPR-03-2016-23480 $�. v CATAWBA COUNTY HEALTH DEPARTMENT r f PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Eli". o• {. 0 � a� 1842 sM Environmental Health Plan Review - OSWP op o o IMPROVEMENT 0` ii _ S Applicant SANDRA WHITE, 4445 GRASSY CREEK RD, DENVER NC 28037 C:8282444203 Owner BILLY RAY WHITE HEIRS, 4445 GRASSY CREEK RD, DENVER NC 28037 C:8282444203 NAME TO APPEAR ON PERMIT Bill Ra White Heirs SITE ADDRESS: 4343 MT PLEASANT RD, SHERRILLS FORD NC 28673 PIN # 369718406646 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 188,789.04 Acres 4.334 DIRECTIONS: From Hwy 150, Left Mt Pleasant Rd, Left 1/4 mile past Sherrills Ford Fire & Rescue on Left Beside them. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Public Water DESCRIBE WORK: IP for Subdividing 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 Vacant Land EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30x40 #OF NEW BEDROOMS:: 2 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-ehapplication 03/28/2016 11:14 Page 1 of4 ag CATAWBACOUNTY Case it EHPR-03-2016-23480 F p y Public Health Department Subdivision 4Environmental Health Division p)Ng' `c 369718406646 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 1842 sM NAME ON PERMIT: ( BILLY RAY WHITE HEIRS),4445 GRASSY CREEK RD, DENVER NC 28037 ( Billy Ray White Heirs) Site Address: 4343 MT PLEASANT RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 188,789.04 Acres 4.334 Directions: From Hwy 150, Left Mt Pleasant Rd, Left 1/4 mile past Sherrills Ford Fire 8 Rescue on Left Beside them. 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 a d labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: ,)- - /(p Signature of Applicant or Agent n�'^l flail(1 (Akct/ 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 P...... . t . YI.s..p t -„ -+-17-proaras4 m' yi.gtiri j t. s t5 i g+. i i g 'EENAME it s illi 1 .a s,. - Xffiy ,° „u DATE 'S .r s`;ttFEEAMOUNThl Improvement Permit Fee 03/28/2016 $150.00 pwa.Fa.a.w a r ¢gi h f . v P y'3 { #t"� 'i t w sE�,P�y °h,��` -TOTALEEES $1`,yt+ ss ' sv r � 'e, � 'r � �q a � 0�� ': 515000E aw,�......t�P..l`t '4 x.,l.ryu."mh"u..:u .ros. . . "-i...YlialI: Y,i 't-',l,rrail.,t.,a.li +c.. aa..edtc's FEES ARE NON-REFUNDABLE ONCE A SITE VISIT 1S MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 03/28/2016 11:14 Page 2 of 4 THIS IS NOT A PER V IT ai i cuuN, , CATAWBA COUNTY HEALTH DEPARTMENT f r Application for Environmental Services Page 1 Improvement Permit Authorization to Construct r Septic Repair n Septic Malfunction❑ Septic Expansion ❑ New Well Permit 7 Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Properly Address `/ _ �. P1eo.n r ki Subdivision Lot# I Acres Section/Block/Phase Driving Directions to Property From 1-I-;U U 16 U fVC Ve ntf PI.P((c{b1 f lad o n (.eft Ai 11 A.' I/ �S r rre ,lL - - I _ li . I 'ff s . . be „ F re— NAME TO APPEAR ON PERMIT? wner Applicant ❑ Contractor Applicant Contact Information Name s rA— hard °fil Address 44-145 Grn,'S��� C v-et'� o eir Phone 628 -24Q-t Cell Phone Ili _4.;b3 Owner Contact Information Name l3i►Uy Rai) Whi \t hdY Address Phone 3or- o1/43/4 -lt(Ap- o U Cell Phone ,301J -,mml , 104 4C0- Contractor Contact Information J1 Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant n Contractor Description of Existing Structures on Site V4 iicil 1— (A t- #of Bedrooms *j' Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes Al No 4'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. ® Yes a,�,�N(�o Does the site contain any jurisdictional wetlands? n Yes 621lo Does the site contain any existing wastewater systems? JO Yes 62' to Is any wastewater going to be generated on the site other than domestic sewage? li Yes 1'SNo Is the site subject to approval by any other public agency? f7 Yes We/No Are 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 lId'Any ri,p,T "['jt [.`�i� THIS IS NOT A PERMIT _ �.} yTS_ VV & CATAWBA COUNTY HEALTH DEPARTMENT �, ,,,,,off Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence K. New Residence ❑ Addition to Residence #of New Bedrooms *j' Z Project Description 4-}vu',e Structure Dimensions #of Occupants 2. Basement ❑ Yes © No Basement Fixtures 0 Yes lej-No ❑ Accessory Structure(s) Describe 36 /D #of New Bedrooms *j if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes _ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unittt Total#Bedrooms '11 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 Retail.Floor Space #of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church#of Seats_ Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested U 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 dr intended use changes for the'proposed facility. I have read this application and certify that die 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 ain solely responsible for the proper identification and labeling of all property•liries and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent 6I, a"... 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J L --�v. --- i - /' Ei 4 i rz m = w m h = -- V m ,- Z w 1 $ x F u ri • Catawba County Environmental Health of , w� lif . _ 4,,....u.silisy IA I . i. . ;0;v . ICil . - /.. '- ?..'' . li. (4/ thimii\ ..1. :ai q \dr . T 4 i. , ' s . . .igq�� I jor 4 • Parcel: 369718406646, SHERRILLS FORD, 1in=200ft 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 03/28/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 369718406646 Owner: WHITE BILLY RAY HEIRS Parcel Address: Owner2: null City: SHERRILLS FORD, 28673 Address: 4445 GRASSY CREEK RD LRK(REID): 11540 Address2: null Deed Book/Page: 2009E/0230 City: DENVER Subdivision: null State/Zip: NC 28037-6760 Lots/Block: null/ null Last Sale: School Information: Plat Book/Page: 22/224 School District: COUNTY Legal: PL 22-224 PL 22-224 Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: 12.950 Tax Map: 011 X 05006A High School: BANDYS Township: MOUNTAIN CREEK State Road #: 1849 TaxNalue 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: $0 Zoning2: null Land Value: $73,100 Zoning3: null Assessed Total Value: $73,100 Zoning Overlay: CRC-O,WP-O,FPM-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 It: 3710369700J Building Details 2010 Census Block: 3024 WaterShed: WS-IV Critical Area 2010 Census Tract: 011501 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 tram this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. 343 nn . 2 t * )2c http://gis.catawbacountync.gov/nomap/parcel_report.php?key=3 697 1 8406646&typ=P 3/28/2016 4'A • CATAWBA COUNTY ptil��' '•�� IOOASOUTHWESTBLVD NEWTON, NORTH CAROLINA 28658 RECEIPT q tr P a? PHONE: 828.465.8399 U 1 s�!' Monday, March 28, 2016 \842 sm www.catawbacountync.gov PAYOR: White, Sandra PAYMENTS TRANSACTION NUMBER: TRC-645259-28-03-2016 PAYMENT DATE : 03/28/2016 PAYMENT TYPE: Check 1673 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326523 Improvement Permit Fee $150.00 TOTAL PAYMENTS : 5150.00 EHPR-03-2016-23480 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4343 MT PLEASANT RD, SHERRILLS FORD NC 28673 Applicant SANDRA WHITE, 4445 GRASSY CREEK RD, DENVER NC 28037 C:8282444203 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner BILLY RAY WHITE HEIRS, 4445 GRASSY CREEK RD, DENVER NC 28037 C:8282444203 receipt 03/28/2016 11:04 Page 1 of 1