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HomeMy WebLinkAboutEHPR-04-2016-23721.TIF stiY A •G THIS IS NOT A PERMIT Case# EHPR-04-2016-23721 2F NM 4',o " CATAWBA COUNTY HEALTH DEPARTMENT 0 • �o r S 0 7rezi 1.wG PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES t• 1842 sM Environmental Health Plan Review - OSWP 4r0 o•{ ey •t IMPROVEMENT Applicant NICKY WATTS, 117 RUTAN CT, MOORESVILLE NC 28117 C:7044531340 NWATTS@APPALACHIANTITLECO APPALACHIANTITLECO .COM Owner PENSCO TRUST COMPANY,426 31ST ST, SUNSET BEACH NC 28648 NAME TO APPEAR ON PERMIT Nicky Watts SITE ADDRESS: 4223 CASCADE ST, TERRELL NC 28682 PIN # 461703117638 NAME of SUBDIVISION: THAD AND HAROLD GABRIEL Lot# 20 Section/Block PROPERTY SIZE: Square Feet 20,908.80 Acres 0.48 DIRECTIONS: HWY 150, Right onto Sherrills Ford Rd, Right onto Hob Lane, Left onto Cascade St, Property is on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* Existing system on the property. Old trailer has been removed from property. Looking to use the existing system on the property for new home. 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? 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 Old trailer has been removed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 41x58 #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 119-caapplicatinn 04/25/2016 13:34 Page 1 of4 ,gA CATAWBA COUNTY Case# EHPR-04-2016-23721 1 r4.i Public Health Department Subdivision THAD AND HAROLD GABRIEL < *0( 4) Environmental Health Division PIN# 461703117638 is PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 tH.2 ,s NAME ON PERMIT: (NICKY WAT'T'S), 117 RUTAN CT, MOORESVILLE NC 28117 ( Nicky Watts) Site Address: 4223 CASCADE ST, TERRELL NC 28682 Property Size: Square Feet 20,908.80 Acres 0.48 Directions: HWY 150, Right onto Sherrills Ford Rd, Right onto Hob Lane, Left onto Cascade St, Property is 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 understand that I am solely responsible for the proper identificati and labeling of all property lines and corners and making the site ac�'�/ ible so that a complete site evaluation can be performed. Date: �� �io Signature of Applicant or Agent 1C � '� 1 f%nct ■ 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 FEENAM, Il1I[tIi'thl `I t 'tiL�i'i.u.�tali " lIIII�IM DATEII1.�`i: iFEEAMOUNT f 41 nn EEENAM E,.., ��c.li.� ita i rl .1r�?�ti I I I Italic" L., Improvement Permit Fee 04/25/2016 $150.00 i� )" I I II MI I I( �I i(I 81l It M i I ,Y�w r �lIVI I : I H€ ' � I� ,I�����'� TOTAL'IFEES� III�nl�lilil�Illlllill�l "'` �'?��ilhlRrfldNl� a�IIIIV'a 'I l,�a' sis000'�a�i� Iii n din ni“ligaWillruian mrtpLl: gitilWdWI ', WWW,1 A': "J1111ilCv,N;LWmr,. .t,pptl�ill', 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-chapplication 04/25/2016 13:34 Page 2 of 4 CATAWBA BA THIS IS NOT A PERMIT COUNTY mo,� CATAWBA COUNTY HEALTH DEPARTMENT „., ,a,. �;. 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 W on is for New Construction Existing Facility ❑ Property Address La?3_a,s Lee, 5T Subdivision 'T-'f. 0.,,A 'Solo Id 6- R i e- Tcree`l Lot# c20 Acres . 4firO Section/Blocic/Phas �` Driving Directions toProperty t-}W 1 /So �► 040 $ scrr"(ls Section/Block/Phase RP , o Om) 0-t\e- el ry b C. c- •e ?roper k-/ o n a� NAME TO APPEAR ON PERMIT? ❑ Owner L(V Applicant ❑Contractor Applicant Contact Information Name IJ tick)/ 1,0--Ak5 MEOW 02171x/.'11/NAM% , /7'MM Address 1 f SoA-o-r, CT m ooresd t\ C N C- ) / Phone jet- LA S'3 , 13yt] Cell Phone \i Owner Contact Information Name pen 5c,o no Jr Co Address W am 31'L' ST s..nsr✓1- Be Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone WIIO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site \j 1 t\� — 00 ' ',r �G( ii of Bedrooms *t Structure rmensions of ccupants Basement ❑Yes ❑ No Basement Fixtures ❑ 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 01To Does the site contain any jurisdictional wetlands? XYes No Does the site contain any existing wastewater systems? ❑ Yes Bl'o Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 0-No Is the site subject to approval by any other public agency? ❑ Yes 0-No Are there any casements or right of ways on this property? Describe Existing water supply in use E 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): I (systems can be ranked in order of yo;preference) ��.�❑ Accepted ❑Alternative , Conventional ❑ Innovative ❑ Other I ny 1_ CATAWBA x jj� ^ riIIS IS NOT A PERMIT COUNTY �.. VE -- CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Pro osed Facility Type ❑Primary Residence 'New Residence ❑ Addition to Repsidence #of New Bedrooms *t 3 Project Description Net 3 bedroom 5'k fc Structure Dimensions I-11 w )0110 leo r d«lc-#of Occupants Basement L✓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 ft Bedrooms j Structure Dimensions. El Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts During Area(Sq.Ft.) ❑ 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 pi No Describe (i3}`"{\ WeM 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 ou-site staff. *Any room that will be intended for sleeping at the time of construction or for Mute 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 Nn,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 comers and making the site accessible so that a complete site evaluation can be performed. � Signature of Owner or Agent 1/ �t WU� }nom Date H T)c2/10 Printed Name of Owner or Agent Apr-25-2010 10:12 AN LAW OFFICE OF NATALIE MILLER 704662.3576 5/5 • i ' 1406 . MAIN STREET ,re...., 7 j •t l \‘. moon aVILE, N.C. 2: 15 •., i l (704) 799— 12 G .. .,. /� I LOCATION MAP �9 G JJ k E ram NOT TO SCALE '� P '`�k f 1$ S / NON-PIN /pa S' j n MUD G'.s"''9G 9.1 ,0-- y f/7� (qq Pg�1 4.90 i"..---------5.,i*oN o �{ Sis V' l'0 k05� a(�, a I sY'• /l 0 I ■ 998,;6, / /r \ `y�go9y PIHpiEO t 1 PIPE FW4J \Z �\ II eff 8 t �( 0 Dr( 31\4 \ tr c I i. o tr YY y JJ 1 I • isI7DJ,tnaaa "- 20,922 SQ.. T. sa17DJ,tmz, } i 00?BY tYANlE Haan / ?,- )._\_ SECLPFREY S Y.00RE E 0B 116J PG JOJ ,/ 'f°- UAOOiE S NoaeE if( ' 00 2783 7G 76i II } 1 4J E � ;L.' s ;; so O Sc et 00 v/<' ' > 1- j / UI . - 7 1 14„0 i 1/ ` I R04-RW / QJ &g FOUND 1 • Er- . Na2'31'7a.fy oU 719.74' PitJGNET! z 15 REBM Fin FOUND I i FOUND I NOTES: i t eA ; new CA=700 CONTOUR 1, NO NCGS MONUMENT FOUND i t WITHIN 2000' t Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461703117638 Owner: PENSCO TRUST COMPANY Parcel Address: 4223 CASCADE ST Owner2: null City: TERRELL, 28682 Address: 426 31ST ST LRK(REID): 14177 Address2: null Deed Book/Page: 3028/1409 City: SUNSET BEACH Subdivision: THAD AND HAROLD GABRIEL State/Zip: NC 28468-4108 Lots/Block: 20/ School Information: Last Sale: School District: COUNTY Plat Book/Page: 12/21 Elementary School: SHERRILLS FORD Legal: LOT 20 PL 12-21 Middle School: MILL CREEK Calculated Acreage: .480 High School: BANDYS Tax Map: 013AX 01020 Township: MOUNTAIN CREEK School Map State Road #: 1917 Tax/Value Information: Tax Rates(pdt) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $2,000 Zoning2: Land Value: $165,200 Zoning3: Assessed Total Value: $167,200 Zoning Overlay: CRC-O,WP-O,FPM-O Year BuilVRemodeled: 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: 5030 Watershed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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 Geospatlal 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 verilicaton 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 Ilabte 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. ©2016, Catawba County Government,North Carolina. Ail rights reserved. ji:LhOt do in-}f, septiThunTh http://gis.catawbncountync.gov/nomap/parceli'eport.php?key=46 1 703 1 1 7638&typ=-P 4/22/2016 CATAWBA COUNTY 100A SOUTHWEST BLVD d �." NEWTON,NORTH CAROLINA 28658 RECEIPT aPe PHONE: 828.465.8399 V 119��1 oew. �C Monday, April 25, 2016 ve /842 sM www.calawbacountync.gov PAYOR: Watts,Nicky PAYMENTS TRANSACTION NUMBER: TRC-661612-25-04-2016 PAYMENT DATE : 04/25/2016 PAYMENT TYPE: Credit Card payment over phone INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327575 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-04-2016-23721 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4223 CASCADE ST, TERRELL NC 28682 Applicant NICKY WATTS, 117 RUTAN CT, MOORESVILLE NC 28117 C:7044531340 NWATTS@APPALACHIANTITLECO APPALACHIANTITLECO .COM **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner PENSCO TRUST COMPANY, 426 31 ST ST, SUNSET BEACH NC 28648 receipt 04/25/2016 13:33 Page I of 1 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461703117638 Owner: PENSCO TRUST COMPANY Parcel Address: 4223 CASCADE ST Owner2: null City: TERRELL, 28682 Address: 426 31ST ST LRK(REID): 14177 Address2: null Deed Book/Page: 3028/1409 City: SUNSET BEACH Subdivision: THAD AND HAROLD GABRIEL State/Zip: NC 28468-4108 Lots/Block: 20/ as Sale: School Information: School District: COUNTY Plat Book/Page: 12/21 Legal: LOT 20 PL 12-21 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .480 Tax Map: 013AX 01020 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1917 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: $2,000 Zoning2: Land Value: $165,200 Zoning3: Assessed Total Value: $167,200 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: 2008-03-18 Building Permits for this parcel. Firm Panel It: 3710461700K Building Details 2010 Census Block: 5030 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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,loss or liability,whether direct,indirect or consequential which arises or may arise horn this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. 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