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HomeMy WebLinkAboutEHPR-04-2016-23743.TIF ��3A THIS IS NOT A PERMIT Case # EHPR-04-2016-23743 CATAWBA COUNTY HEALTH DEPARTMENT ro a t 0 \,,i1'!'° PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1 rrilleet 842 SM Environmental Health Plan Review - OSWP n r n c t � IMPROVEMENT o o Applicant CHRISTINE CURCIO, 1833 JAYA DR, SHERRILLS FORD NC 28673-7290 C:8284550626 Contractor CHARLES E BEATTY (CHARLES E BEATTY), 3530 DOCKSIDE LN, SHERRILLS FORD NC 2867 B:828-320-0744 Owner CAROL HILL, 8917 STEINBECK CT, CHARLOTTE NC 28216 Paid By OZZIE PROPERTIES INC, 3561 PLATEAU RD, NEWTON NC 28658 NAME TO APPEAR ON PERMIT CHRISTINE CURCIO SITE ADDRESS: 2676 MT. PLEASANT RD, SHERRILLS FORD NC 28673 PIN # 460801256925 NAME of SUBDIVISION: Loth 1 Section/Block PROPERTY SIZE: Square Feet 60,112.80 Acres_ 1.38 DIRECTIONS: Hwy 16 S, to Hwy 150, Go East on Hwy 150, Left onto Mt. Pleasant Rd, Property is on the Right. PRIMARY CONTACT: Contractor 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 Vacant Lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 90x75 #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: 09-chapplicatioo 04/26/2016 16:43 Page 1 of 4 4‘", • CATAWBA COUNTY Case# EHPR-04-2016-23743 iC' ti�y Public Health Department Subdivision < �c1 „t; Environmental Health Division PIN# 460801256925 PO Box 389, 100-A Southwest Blvd, Newton,NC 28658 1g42 :. NAME ON PERMIT: (CHRISTINE CURCIO), 1833 JAYA DR, SHERRILLS FORD NC 28673-7290 ( CHRISTINE CURCIO) Site Address: 2676 MT. PLEASANT RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 60,112.80 Acres 1.38 Directions: Hwy 16 S, to Hwy 150, Go East on Hwy 150, Left onto Mt. Pleasant Rd, 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 . rules. I understand that I am solely responsible for the proper identification labeli of all property lines and corners and making the site ace- sa.o-th: : .•r rfe evaluation can be performed. Date; /7q Signature of Applicant or Agen a- A Environmental health Specialist will contact you w' in 5 working day o app ication .. If you need further information or assistance please call 828-466-7291 AREA1 ip'rn Stsl4lln'p; n+�i ITII��P�1 11.1 i1 ! I i��EI�1��Il�flI1]1�II(i iI'�ll�ilil�li II'i�"p . "lI9 ii„ I'7D"f"'S71I IIII IT"hlilPilllft;. LEE ENAMEllJ*il • lljWI IIIIIII1}J,�aIll. t ,!ihe 'lti�LIV.11II��DATE'ij {IFEEA'MOUNTf, Improvement Permit Fee 04/26/2016 $150.00 ij , I�Iif I' PI 11 °I fir "n x�I r t 11 1"- 1)IIt 1"„ ;;� �; , �7��TO,TAL FEES�Il1�1�1��Hhi�Pf�',I��I`I;1 dui, t!'"��dit!1Wllilll!llii�lly 14fllil� ,IIII11��� ��i��tso ooh, 313 14143 RlhtlfO :4 43111!U+nNIIUJ21IlUt1i Lou UI11WIL8tdti°'I' u".IV"ilftIII1110Umtt %Ilnluuj .p.IJit[I Lllltlt;; ' I' 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-ciapplication 04/26/2016 16:43 Page 2 of4 CATAWBA THIS IS NOT A PERMIT `co CATAWBA COUNTY HEALTH DEPARTMENT ,,,,0h�„;� Application for Environmental Services Page 1 Improvement Permit Authorization to Construct Li Septic Repair ❑ Septic Malfunction n Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) n Application is for New[Construction [ Existing pFacility ❑ tProperty Address 7(2 /%t f 41_ci l a l Subdivision %� y k7 k I lierrri ll c r--Ord rJG�2gi73 Lot# / Acres /,.3d / Sest'onBlock/Phase Driving Directions to Property // .1 j'i S 19 I/�y I S gas A coy y /Cc2 Tin, (_eft o14 /41-,P1ea.)0.4f kof , fropere-I 0 0 k 134 NAME TO APPEAR ON PERMIT? n Owner <Applicant n Contract or Applicant Contact Information \\ Name etz .v,,ro G / Address 1133 (.r4/,4 VrrSwerruI/krova A)6,(7742- , J3 Phone Cell Phone s---dg--- qS-c- -0 G 2 G Owner Contact Information - Name ri p( 747/ q �j Address 7 s*P.Ii”✓cJe „Lb ef„ri r! e pc ,)- 0. /4 Phone Cell Phone Contractor Contact Information Name ofin&I es bra i%L/ License # Address Phone / Cell Phone�Y4> 3Z0 -D1Yy WHO WILL BE THE PRIMARY CONTACT? ❑ Owner [r .pplicant - Contractor Description of Existing StrIJtures on Site x/�/tio'n- ( ‘D-i- # _ of Bedrooms *j' J Structure Dimensions 7S X %S # of Occupants Basement T Yes E 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 ,lk No Does the site contain any jurisdictional wetlands? ❑ Yes ''No Does the site contain any existing wastewater systems? ❑ 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 XTO Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well I I Community Well n Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes XNo 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) V I ❑ Accepted ❑ Alternative LI Conventional ❑ Innovative ❑ Other _X Any cArrA BA THIS IS NOT A PERMIT COUNTY VL? CATAWBA COUNTY HEALTH DEPARTMENT No,t„ = Application for Environmental Services Page 2 Proposed Facility Type [ ] Primary Residence New Residence Addition to Residence # of New Bedrooms *t Project Description FO k 7 S Structure Dimensions # of Occupants Basement U Yes 0. No Basement Fixtures Yes n No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes ❑ No Plumbing n Yes ❑ No Describe Plumbing Needed n Multi-Family Residence Al 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. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen n 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 n Drilled n Bored n Dug n Unknown Well Repair Requested n 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 A_ � �� Date Y(20? l b Printed Name of Owner or Agen r WIrts7i`4 / aro_o Catawba County Environmental Health \--1/4„.. _ n) J 7a 7 ti O QP Io J-\ • t° - �_. 885 .40/,--- ! 880-, `b I cr. 7 / .. 8.7. ,� s 1 Parcel: 460801256925, SHERRILLS FORD, 1in=60ft 28673 ago M ,1k 2°' 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 04/26/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460801256925 Owner: GIVENS CAROLE GABRIEL Parcel Address: Owner2: HILL LORI GABRIEL City: SHERRILLS FORD, 28673 Address: 8917 STEINBECK CT LRK(REID): 6113 Address2: null Deed Book/Page: 2011 E/0311 City: CHARLOTTE Subdivision: null State/Zip: NC 28216-1652 Lots/Block: 1/null School Information: Last Sale: School District: COUNTY Plat Book/Page: 19/87 Elementary School: SHERRILLS FORD Legal: LOT 1 R GABRIEL PL 19-87 Calculated Acreage: 1.380 Middle School: MILL CREEK Tax Map: 006 X 02001D High School: BANDYS Township: MOUNTAIN CREEK State Road #: 1849 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $13,200 Zoning3: null Assessed Total Value: $13,200 Zoning Overlay: 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: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460800J Building Details 2010 Census Block: 3000 WaterShed: WS-IV Protected Area 2010 Census Tract: 011504 Voter Precinct: P31 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 from 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=460801256925&typ=P 4/26/2016 s183A C CATAWBA COUNTY % 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 U w° Tuesday,April 26, 2016 \842 SM www.catawbacountync.gov PAYOR: Ozzie Properties Inc Ozzie Properties Inc PAYMENTS TRANSACTION NUMBER: TRC-662443-26-04-2016 PAYMENT DATE : 04/26/2016 PAYMENT TYPE: Check 1090 INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327654 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-04-2016-23743 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 2676 MT. PLEASANT RD, SHERRILLS FORD NC 28673 Applicant CHRISTINE CURCIO, 1833 JAYA DR, SHERRILLS FORD NC 28673-7290 C:8284550626 Owner CAROL HILL, 8917 STEINBECK CT, CHARLOTTE NC 28216 Paid By OZZIE PROPERTIES INC, 3561 PLATEAU RD, NEWTON NC 28658 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor CHARLES E BEATTY, 3530 DOCKSIDE LN, SHERRILLS FORD NC 28673 B:828-320-0744 receipt 04/26/2016 16'.43 Page 1 of I