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HomeMy WebLinkAboutEHPR-06-2016-24158.TIF �h�A c G THIS IS NOT A PERMIT Case # EHPR-06-2016-24158 < CATAWBA COUNTY HEALTH DEPARTMENT 0 � , 0 „ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Environmental Health Plan Review - OSWP of n 'mac IMPROVEMENT 0 Kt� Applicant THE OAKS GROUP, PA (KATHLEEN SAUNDERS), 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I Owner CAROLINA CENTERS LLC,227 TRADE W ST 1000, CHARLOTTE NC 28202 NAME TO APPEAR ON PERMIT Carolina Centers LLC SITE ADDRESS: 3631 CI-IEVLOT HILLS RD, SHERRILLS FORD NC 28673 PIN # 460712765388 NAME of SUBDIVISION: Lot# 197 Section/Block PROPERTY SIZE: Square Feet 29,620.80 Acres 0.68 _ DIRECTIONS: Hwy 150, Left onto Cheviot Hills, Lot is on the Left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only' 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: 8 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60 #OF NEW BEDROOMS:: 4 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: 09-ehapplicalion 06/23/2016 09:12 Page I of4 A -110° CATAWBA COUNTY Case# EHPR-06-20 1 6-24 1 5 8 C P. i Public Health Department Subdivision Rs'® „"It, I3nviromnental Health Division PIN# 460712765388 ri` PO Box 389. 100-A Southwest Blvd,Newton. NC 28658 1842 .,w NAME ON PERMIT: CAROLINA CEN'T'ERS LLC ( ),227 TRADE W ST 1000, CHARLOTTE NC 28202 Carolina Centers LLC ( ) Site Address: 3631 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Property Size: Square Feel 29,620.80 Acres 0.68 Directions: Hwy 150, Left onto Cheviot Hills, Lot is on the Left 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.le • that a complete s�evaluatiop can be performed. Date: (of 3 /L Signature of Applicant or Agent n LA S 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 FEFNAMFI:'; ::',,: ::11j.'11;1'. AM"' 1y�11DATE I�FEE'AMOUNTI,'i Improvement Permit Fee 06/23/2016 $150.00 7,--roTAL;FEES x:;11„ ' ;;15150'00; , M tl 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) N9-ehapplicatinn 06/23/2016 09:12 Page 2 of CATAWBA THIS IS NOT A PERMIT FOUNTY A v� 1lyW CATAWBA COUNTY HEALTH DEPARTMENT " ,z:, .+.�-�°- „ „„ ` Application for Environmental Services Page 1 Improvement Permit kr Authorization to Construct ❑ Septic Repair Septic Malfunction ❑ Septic Expansion ❑ New Well Permit Replacement Well n Well Abandonment n Well Repair ❑ Existing System Inspection (Pre-Approval Required) 11 Application is for New Construction Existing Facility [ 1 Property Address 3(c3 j Chev\Q-t \--V\\\S"CE Subdivision Shevy.t lls FOrck t 241013 Lot# 1 C(1 Acres a(-,S Section/Block/Phase + O ?C3C1 sePtlQCc&a Driving Directions to Property hkkr 1 9Q ( T Oil 2.hev(et /1 1 k /Of (-)1/1 ben-- NAME TO APPEAR ON PERMIT? IR Owner 17 Applicant n Contractor Applicant Contact Information Name Qorok,v_)ct CZMrrs L_LC Address 227 west --ry,— c\c 9- ST E Joao Phone Cell Phone Owner Contact Information Name S(1,rn� its 0 pLdv1f Address Phone Cell Phone Contractor Contact Information Name I -I/ee-n Sounders' j The 00h Croup Address /2i Hen t i n flziOore vi( le Phone No(4) 67 a_ q9s) Cell Phone WHO WILL BE THE PRIMARY CONTACT? H Owner ❑ Applicant [Contractor Description of Existing Structures on Site #of Bedrooms *1' Structure Dimensions #of Occupants Basement Yes n No Basement Fixtures 0 Yes S' 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 Ai No Does the site contain any jurisdictional wetlands? C Yes a No Does the site contain any existing wastewater systems? • Yes )31.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 ;p-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? ** U 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 ❑ Any n•gTAFj]B A THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT = rwz t-- Application for Environmental Services- Page-2 Proposed Facility Type S ( VI Primary Residence New Residence n Addition to Residence # of New Bedrooms *t X New u Project Description ,>9 Structure Dimensions (60X ln' # of Occupants /77ax Basement *Yes E No Basement Fixtures Yes a No H Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes H No Plumbing n Yes [ No Describe Plumbing Needed I Multi-Family Residence if Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions n Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area (Sq. Ft.) n 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 cz, Individual Well n Semi-Public Well H Community Well Abandonment Type [ Drilled - Bored H Dug n Unknown Well Repair Requested ❑ Yes I 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 he 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 e?i.A.A-'uN, , � Date 0/21 // (o Printed Name of Owner or Agent /-01 nick HeHon t RJ N Lu RPM to �} w• n/ ;•�! P ESP a W a e n _ lel gepa:rf .e-,y 'a°,..•.-..,,• S • pOt `,PV P E•' VI pi, ,� it: amok m 4 �J OSt) ` 1 z ? caci 1C"£S) \ R9 - tic-) rat cniY I i , 1= J aQ , s( g,t LPPPS r i 41 Same F-cp Or 4 U W so 9t ` 11 / -.. t CA Ct7 Lt 'r au rZU.. E."' 5a ' r 9 . L pa �r U d 4O 5 '14 l l We . �'.+t,p. a tri O m 4'4m. ,: cp s t 2 /Vt 1 45.1%7; it G Z o O f----_____ T C7�r .. m ti 30 '~ 6) \ \ r ■ air / /'' ' -- - ----------- £g Cy. CO 3r �r k No lx 6r;U N CA 0 r r I t I % a `Q aCC. 1 = 0 cp o . W NZd . O ,' ID � rpa a w;: a U u DEPARTMENT OF HEALTH AND HUMAN SERVICES Street I of DIVISION OF PUBLIC HEALTH.ENVIRONMENTAL HEALTH SECTION PROPERTY ID#: II/IS 115 ON-SITE WATER PROTECTION BRANCH COUNTY: C04 h0. SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) OWNER: ( !l r()! ! ��t I':10; s- ,£_.0--C_ _ APPLICATION DATE ADDRESS: DATE EVALUATED: PROPOSED FACILITY: ,t- p_ PROPOSED DESIGN FLOW(.1949): 480 PROPERTY SIZE: LOCATION OF SITE: CAW v 1n4 'n>'x ,iph"r PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public Well 0 Spring 0 Other EVALUATION METHOD: 0 Auer Boring (1).Pit 0 Cut TYPE OF WASTEWATER: Sewage 0 Industrial Process 0 Mixed ` • • P R SOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS .1940 LANDSCAPE HORIZON POSITION/ DEI'TII PROFILE 194? k SLOPE% (IN.) .1941 - .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR 3 LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS 11ORIZ 0-5 fr1P i:2R 5L ER_ °-;r1 R ! 1 \4 4, q k rnO &EK Cc' 1 O. 3c ; C. ,ci5-iO 1 R i. Soo i°Ytu iK1 _ 13 No C-,k., F v. r- el rno v SIC"O3 m s, 7 cc-.r) • • • • DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): NJ/P- S SITE CLASSIFICATION(.1948): PS Available Space(.1945) S EVALUATED BY: kY',—) System Typxs) � OTHER(S)PRESENT: EL H Site LTAR 0.mil`; ! _ COMMENTS: Updated February 2014 Catawba County Environmental Health 1, ;t77 ,_ ,}iii , I,ljl 111,9 IIP ct ;: 1h' '',I"i /?1I 11�1i� =le ;l'; 11111 .4, ',II'i �I I r , ! �p, �,1inIIy . � 11„ fr t II1',.l.1n i;,, IIill1 r�l "t 1 11 fib ( i �a . i 1 ,t �. f ° if�fl1�' li ?j" � ' �il( !II I rl� f Ilit}i�uil�Il �j � • l i 11,01111'4; 1 ,l , iii I f 11 4.1 , i 11 I d � ,, r,+ (, t ' 1"� �Il I .i Ilflit��l �� 311a�, 1 , �'Iir 1 . IL:501111111r 19 r ',t , iI:I I i . 11 It , + 1, 11,..„..,31 ii . It 99 p�( ,, 11' r �,4� f • 144,, ,`7i 1',1 � I�"Ili ■ 13 53 I �'� 1 328 tip"---� � n 41 q t74Ir '1i Fk, t I il,i,1 d1 '( h 11114;411" 4l h" � �1+1r'1,11�1I1111111 •15, 711, ii1 ;� ?0 111"' 1"I, 1:110.1411 1 `Irl 1414.8E i 8 a�', !dill 1 4.0141 t� ill ., It ; Parcel Report Page 1 of 1 Parcel Report - Catawba County NC • Parcel Information: Owner Information: Parcel ID: 460712765388 Owner: CAROLINA CENTERS LLC Parcel Address: 3631 CHEVLOT HILLS RD Owner2: null City: SHERRILLS FORD, 28673 Address: 227 WEST TRADE ST STE 1000 LRK(REID): 12753 Address2: null Deed Book/Page: 1898/0427 City: CHARLOTTE Subdivision: null State/Zip: NC 28202 Lots/Block: 197/ null School Information: Last Sale: School District: COUNTY Plat Book/Page: 64/148 Legal: LOT 197 PL 64-148 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .680 Tax Map: 012 X 02075 High School: BANDYS School Map Township: MOUNTAIN CREEK State Road #: 1986 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: $6,100 Zoning2: null Land Value: $128,500 Zoning3: null Assessed Total Value: $134,600 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 #: 3710460700J Building Details 2010 Census Block: 3010 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 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 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=460712765388&typ=P 6/23/2016 1,A C CATAWBA COUNTY 'la r IOOA SOUTHWEST BLVD � " ' NEWTON, NORTH CAROLINA 28658 RECEIPT ) v�sv PHONE: 828.465.8399 Thursday, June 23, 2016 � v" Imo.. 1$42 SM www.catawbacountyncgov PAYOR: The Oaks Group, PA The Oaks Group, PA(Saunders, Kathleen) _ PAYMENTS TRANSACTION NUMBER: TRC-700238-23-06-2016 PAYMENT DATE : 06/23/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329776 Improvement Permit Fee S 150.00 TOTAL PAYMENTS : S150.00 El-iPR-06-2016-241 5 8 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3631 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Applicant THE OAKS GROUP, PA, 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner CAROLINA CENTERS TLC,227 TRADE W ST 1000, CHARLOTTE NC 28202 receipt 06/23/2016 09:11 Page 1 of 1