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HomeMy WebLinkAboutEHPR-03-2016-23481.TIF /Y A . �� THIS IS NOT A PERMIT Case # EHPR-03-2016-23481 A CATAWBA COUNTY HEALTH DEPARTMENT Cl P r f Cl \� j¢="° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES , '�'�r ti \842 sM Environmental Health Plan Review - OSWP • 13• p o% r IMPROVEMENT • . leT - o 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 Billy Ray White Heirs SITE ADDRESS: 4355 MT PLEASANT RD, SHERRILLS FORD NC 28673 PIN # 369718406646 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 189.703.80 Acres_ 4.355 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-ehapplicalion 03/28/2016 11:06 Page 1 of 4 et• • CATAWBA COUNTY Case# EHPR-03-2016-23481 iiitti ,t Public Health Department Subdivision d •-•-':,- , Environmental Health Division PIN# 369718406646 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 t8.2 sm NAME ON PERMIT: ( BILLY RAY WHITE HEIRS),4445 GRASSY CREEK RD, DENVER NC 28037 ( Billy Ray White Heirs) Site Address: 4355 MT PLEASANT RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 189,703.80 Acres 4.355 Directions: From Hwy 150, Left Mt Pleasant Rd, Left 1/4 mile past Sherrills Ford Fire& 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 and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: .3-03 - /1/ Signature of Applicant or Agent v50n(na LL kL2f 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 i .hr t^'Y'*b*t9 . r; t i Fit 9, �h-Y T' Et RtR I!. 1 "v `gyp aaa N hIH P liFEENAME.' P ,t4r"P4t*,- Lrr� . . t`. ' }h"iDATEr .'. a FEE&AMOUNT? Improvement Permit Fee 03/28/2016 $150.00 a .*,. TOTALFEES git 1 "g sS W1 x$150 N_ a if 1!: ,.r.1_'nLdr i£, r .:uzls...,m :.._.__. sr°ta"au.5= -"',6-mied,,rvi`1....t-: ra,,, `',;m 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 03/28/2016 11:06 Page 2 of 4 ' I THIS IS NOT A PERMIT 4 NT, • CATAWBA COUNTY HEALTH DEPARTMENT ;r„ti Application for Environmental Services Page 1 Improvement Permit,[L Authorization to Construct❑ Septic Repair Li Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well i Well Abandonment❑ Well Repair in Existing System Inspection (Pre-Approval Required) ❑ App / i Application is for New Construction ❑ Existing Facility // ❑ Property Address `/355 l+. Phi /on Subdivision Lot# Acres Secti• Block/Phase Driving Directions to Property ■/ it \. 5 *t ,L alraitair S1,eyrlll j-drvk ■trt_ on) )Zecc(,(e, clock Ion on IVff rit\11- NsOt NAME TO APPEAR ON PERMIT? ❑ Owner V„.Apphcant fI Contractor Applicant Contact Information Address tannvignimpriwall r me Phone ell Phone VV _ � - Owner Contact Information Name 9-)A jhkK �Ae1xi� Address ) INa - go0 _ ptoQg Phone Ron --((�-`'"L�l\Q - (]lQ(✓1� Cell Phone lS1� l�I YY)YYl Contractor Contact Information J Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site OtYt.+ #of Bedrooms *t Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures a Yes 0 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. If the answer to any question is "yes", applicant must attach supporting documentation. Yes *No Does the site contain any jurisdictional wetlands? ® Yes RNo Does the site contain any existing wastewater systems? [l7 Yes No Is any wastewater going to be generated on the site other than domestic sewage? Ei Yes No Is the site subject to approval by any other public agency? Yes o Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well Semi-Public Well n County/City/Township Water Line Is a public water supply available? **V Yes n 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 `i( Any r-ri 1 } THIS IS NOT A PERMIT Ci}t til i C CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 • Proposed Facility Type ❑ Primary Residence New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description -' C Structure Dimensions #of Occupants Basement ❑ Yes No Basement Fixtures Yes `iNo ❑ Accessory Structure(s) Describe 3() X- #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes n No Plumbing n Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t Total Al Bedrooms *t Structure Dimensions - ------------------- ❑ Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift g 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 ❑ Semi-Public Well El Community Well Abandonment Type ❑ Drilled n Bored E. 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 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 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 comers and making the site accessible so that a complete site evaluation can be performed. / Signature of Owner or Agent C ft ) n T( e Date .3 (93 I Printed Name of Owner or Agent of .:sz!‘),,:," '4:f-a ° :!I-1 - s -1i: o }a tt € a , o � ']H[ o g s ✓z v € v/ 1 s 13 t .s i _ 6. 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' 1 1 / 1 1 1 1 1 1 1 1 d?°,nT.7-z''s= 11 1y 1 1 1 1 1 1 1 1 I. .°.oa - 1 11 11 1 1 I 1 1 1 1 1 ::.---1---r--1: • i' 1 1 1 H 1 , 1 1 I I `��1— i--1 1 _J--,p 1 J/ _ _-.gr o _ _ / - 3 // m =w - / 0 c u T ' -_ ,- O m N 1:11 al 1 F Z m o 2-A13211 15 . Catawba County Environmental Health s' \jed 114 4.3.,,,,.... \N„......7./e/ . ..„- 4-.". .*AV:ta'114:f .IC' ,,;r" tti.... . 1101V if 1, ,,...... : 0//iii /Ar' . oily,(1A/e/C .4,,,,,, As is es At tit -4 a: Ar ,_ A .* , \ - ilik 141*-1,:t.. .‘ . .. li,.7 . . ., n. . n . 44�F� Lr te t• 10,:b dIPPcs , 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 School Information: Last Sale: 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 Zoningl: 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 from this mapfreport product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. q355 nrn-,PkrAsail 2011 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=369718406646&typ=P 3/28/2016 4'A CATAWBA COUNTY t 0� IOOASOUTHWESTBLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 0191): ,t Monday, March 28, 2016 1842 sm www.catawbacountync.gov PAYOR: White, Sandra PAYMENTS TRANSACTION NUMBER: TRC-645260-28-03-2016 PAYMENT DATE : 03/28/2016 PAYMENT TYPE: Check 1673 INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326524 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-03-2016-23481 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4355 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 11:05 Page 1 of 1