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HomeMy WebLinkAboutEHPR-04-2016-23547.TIF BA � THIS IS NOT A PERMIT Case # EHPR-04-2016-23547 Ty fin H CATAWBA COUNTY HEALTH DEPARTMENT C d . .0 " IIr 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES a ri \1942 SM Environmental Health Plan Review - OSWP • - o SI r�ti� •r ~ • •y{ r IMPROVEMENT I Applicant ALLEN-HUGHES REALTY (JOHNNY ALLEN), PO BOX 547,TERRELL NC 28682 C:7045910I26 Owner KATHY SANDIFER, 114 W DEBBY RD, SHELBY NC 28152 H:704-476-5320 HOME:704-476-5320 NAME TO APPEAR ON PERMIT Kathy Sandifer SITE ADDRESS: 3963 FLAT ROCK RD, TERRELL NC 28682 PIN # 461714430376 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 31,798.80 Acres 0.73 DIRECTIONS: Hwy 150 E, right Sherrills Ford Rd, corner of Sherrills Ford Rd and Flat Rock Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase of property 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 EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 78 x 63 #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-eliappllcalion 04/01/2016 11:34 Page 1 of4 ` CATAWBACOUNTY Case# EHPR-04-2016-23547 Public Health Department Subdivision one „�; Environmental Health Division PIN# 461714430376 PO Box 389, 100-A Southwest Blvd, Newton.NC 28658 /842 ss NAME ON PERMIT: ( KATHY SANDIFER), 114 W DEBBY RD, SHELBY NC 28152 ( Kathy Sandifer) Site Address: 3963 FLAT ROCK RD, TERRELL NC 28682 Property Size: Square Feet 31,798.80 Acres 0.73 Directions: Hwy 150 E, right Sherrills Ford Rd, corner of Sherrills Ford Rd and Flat Rock Rd 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 accessi so hat a co plete site evaluation can be performed. ."Date: y-I-ll. 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 1FEENAME°' ('a'`.. } ..ittt(i,;HirDATE i FEEAMOUNT;,,' Improvement Permit Fee 04/01/2016 5150.00 zNMr c- TOTAL FEES' 4°la '/ .. t r 'v: Pi I4u�h a$. iti,k jF .4 5150 00 r r s r p� � 4 4 .+a an : -..- . +....... -..-...... ..-.> ................._..... Y�t'S:v.. ...- na......rld'v Il..e -12c1-9.t.L :.'F 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-chapplicaiion 04/01/2016 11:34 Page 2 of 4 CATAWBA TEAS IS NOT A PERMIT couTr CATAWBA COUNTY HEALTH DEPARTMENT �. . 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) ❑ Ilea FiatIcix.h ad Application is for New Construction ❑ Existing Facility ❑ PropWVAdd?ssherr Its goad i d - Terrell Subdivision PAacel Si) H6171HH3037(e Lot# Acres Section/Block/Phase Driving Directions to Property Igor, lOenve.z : I(w•1 150 EASt- - R:cjhf on Skcrr;its ti'td Rd Prvnc,- of Cog Nag of Sherri 115 Foa! Rd F F/,x+Ruck Rd. NAME TO APPEAR ON PERMIT? ® Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name 5 ictwor„;,z Sze lest Address 59 IRLHoollpi, Rd Howell N 1 07731 Phone Cell Phone 'a'-lg 525 0439 Owner Contact Information Name Kc.fL„I Se, Felt Address j I LI W- toe66 R d Phone Shelby NC 25152- Cell Phone 104 476 5320 Contractor Contact Information 11 Name SohN Al PtlIeN - A lICH- Jl,eS 4C- Address Pa So;x 547 Phone Te.rr�11 NC ZB&S1 Cell Phone '704 591- 012 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ® Contractor Description of Existing Structures on Site NONC #of Bedrooms *fi Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures Q Yes ® 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 10 No Does the site contain any jurisdictional wetlands? O Yes El No Does the site contain any existing wastewater systems? O Yes ®No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes ®No Is the site subject to approval by any other public agency? *Yes 6"No Are there any easements or right of ways on this property? Describe Road RC S14 of Won, Existing water supply in use ❑ Individual Well U Community Well U Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes 4 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 El Innovative ❑ Other X. Any CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT ��„ Application for Environmental Services Page 2 Proposed Facility Type ® Primary Residence ® New Residence -❑ Addition to Residence # of New Bedrooms *t 3 Project Description New 16 16ewj t�een I4ousc Structure Dimensions '75 x 43 # of Occupants 3 Basement M Yes ❑ No Basement Fixtures ® Yes I 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 *t _ Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area(Sq. FL) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift it 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 r... 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 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 }�I lC AcypM f Date ---/-/4 Printed Name of Owner or Agent ThNN.j 4164 AikkN. 4,91,e5 Rea /hi r Qq0) % cr, • J S T 181 — . Bedroom 3 Covered Porch :_ Patio r kt 11-6212-8 13-8x13-0 18.8x9.4 f(Clear) i` a— .9'Coaling L 9,0 Clg Hi 1 *COO r:. ._�. CIO4. N _7 Sitting 1 73 1r8ai:? �- Dining 9 ea q v Master _,� o { - •i' •:.u: n-s a t59 Bedroom Mstr Bath +o.eeai.w 73.8 x 76.8 _70-0 x 16.8 ire' 1� .,,. —.7; Great Room S/ Flex 8 , u 15-10 x 20.0 Space C _" ra.a.\ _ - 6-6x6.8 f •:.u:: i.Ux L .. S . ..3 1I G u�W 1 us . BatT ` Hall - tr •♦ O �2 1 +c.il Kitchen S[or. 1, ._ Q7 _, 112.10 x 131 - 1 6-8 a r. N Nalt \ Da.++io e..w.en: Foyer {f F p Laun. _ Belo \• ' \ (1 Bedroom2 c 8.6x5-0, "o i •"L –.IQ., tSO•w• 11-6 x 13.6\ u tvT-i•- I 8: ramp P. _j (�.., — Covered Porch 9 29-6 a 6-0 SD r. Two Car Garage 23-4 x 23-6 i 1 1 i t I t • . LP I-Q I-,2. ,r=L AT (ZOc- RD Catawba County Environmental Health I 1 II 0 N • CO 'sSot On t.tte) et I 1 44;11":0411111.,: ' ' 41) (6. V I g"'"`"•Cil.a.rri°).°777:I , 440.01# . 1 . 6' 4 dp (7) 49 4x 9J r✓4 • �O A. • lg. ,.o �• nr y 14 n *ICP m "5 . Parcel: 461714430376, SHERRILLS FORD RD tin=50ft TERRELL, 28682 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. Coovrioht 2014 Catawba County NC Parcel Report Page 1 of l Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461714430376 Owner: BELL BETTY L Parcel Address: SHERRILLS FORD RD Owner2: SANDIFER CATHY L City: TERRELL, 28682 Address: 114 W DEBBY RD LRK(REID): 13946 Address2: null Deed Book/Page: 1946/0563 City: SHELBY Subdivision: null State/Zip: NC 28152-6000 Lots/Block: null/null School Information: Last Sale: School District: COUNTY Plat Book/Page: Elementary School: SHERRILLS FORD Legal: null Middle School: MILL CREEK Calculated Acreage: .730 High School: BANDYS Tax Map: 013 X 02006H Township: MOUNTAIN CREEK State Road #: 1848 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: $0 Zoning2: null Land Value: $21,500 Zoning3: null Assessed Total Value: $21,500 Zoning Overlay: CRC-O,WP-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: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710461700K Building Details 2010 Census Block: 5031 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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 SeNines.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 tram this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=461714430376&typ=P 4/1/2016 j co CATAWBA COUNTY • IOOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT�' PHONE: 828.465.8399 \ sue ' Friday, April 1, 2016 ;48 4'L 58 www.catawbacountync.gov PAYOORR: Allen-Hughes Realty Allen-Hughes Realty(Allen, Johnny) PAYMENTS TRANSACTION NUMBER: TRC-647632-01-04-2016 PAYMENT DATE : 04/01/2016 PAYMENT TYPE. Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-326764 Improvement Permit Fee 5150.00 TOTAL PAYMENTS : $150.00 EHPR-04-2016-23547 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3963 FLAT ROCK RD, TERRELL NC 28682 Applicant ALLEN-HUGHES REALTY, PO BOX 547, TERRELL NC 28682 C:7045910126 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner KATHY SANDIFER, 114 W DEBBY RD, SHELBY NC 28152 H:704-476-5320 receipt 04!01!2016 11.33 Page I oil