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HomeMy WebLinkAboutEHPR-06-2016-24195.TIF vat �G THIS IS NOT A PERMIT Case # EI-IPR-06-2016-24195 A-gni 2 CATAWBA COUNTY HEALTH DEPARTMENT D ?a' iY o t PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES f • \ 1842 sm Environmental Health Plan Review - OSWP ti o IMPROVEMENT • ci Applicant CHARLES CUNNINGHAM, 178 WEEBO RD, RUTHERFORDTON NC 28139 H:8282470099 C:8282892585 HOME:8282470099 Land Owner CHARLES& LOUISE WALKER, 797 US HWY 22IA, FOREST CITY NC 28043 H:8282452888 C:7046008246 HOME:8282452888 NAME TO APPEAR ON PERMIT Charles Cunningham SITE ADDRESS: 5075 SALLYBROOK LN, DENVER NC 28037 PIN # 460603438191 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot k 154 Section/Block PROPERTY SIZE: Square Feet 35,719.20 Acres 0.82 DIRECTIONS: From Stacy's Restaurant in Denver, Take Campground Rd, Left onto Catawba Burris Rd, Right onto Bankhead Rd, right onto Sallybrook Cross Railroad tracks & property on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP to determine potential swapout of home. Proposing a DW 3 BdRm 28x52 wI decks: Front 10x20 & Back 4x4. New DW would sit on top of existing septic tank & part of drain lines. Preliminary to determine if new system & repair would fit on the lot. 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: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF SW (to be Removed) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 10x55 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: DW 28x52 w/Decks F 10x20, B 4x4 #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: F9-ehupplication 06/29/2016 10:56 Page 1 of4 0) CATAWBA COUNTY Case# EFIPR-06-20 1 6-24 1 9 5 .Q A . Public Health Department Subdivision CRESCENT LAND AND TIMBE 4 Jti,re ,�; Environmental Health Division PING 460603438191 s,.aH^' PO Box 389, I DO-A Southwest Blvd, Newton. NC 28658 /8.2 :» NAME ON PERMIT: (CHARLES CUNNINGHAM), 178 WEEBO RD, RUTFIERFORDTON NC 28139 ( Charles Cunningham) Site Address: 5075 SALLYBROOK LN, DENVER NC 28037 Property Size: Square Feet 35,719.20 Acres 0.82 Directions: From Stacy's Restaurant in Denver, Take Campground Rd, Left onto Catawba Burris Rd, Right onto Bankhead Rd, right onto Sallybrook Cross Railroad tracks& property 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 identification and labelin of all property lines and corners and making the site acc�ee s�ii�bb e so that�,comp`lete site evaluation can be performed. Date: F—2 �� Signature of Applicant or Agent acne 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 **************♦******** ** ************* ****M*Arts#**k**M***A************************************************ i'FEFNAME''I���� 7{i&jii°r 71'`'lliciD TElii:.; i+jLFEF,MOUNT Improvement Permit Fee 06/29/2016 $150.00 — r TOTALiFEES _ l'IIii ' .ililii i 1i� 1141�1 5150 00 lIt P 1.l:.L.-_ it l, ii - ! nw6. i �.. — ,_aiiiL ___LnhL:tiiiMc__.111111 _...__ lh: 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 (16/29/2016 I0S6 Page 2 of 4 ATM \ hA THIS IS NOT A PERMIT couNIv -� CATAWBA COUNTY HEALTH DEPARTMENT , i . Application for Environmental Services Page 1 Improvement PermitN Authorization to Construct _ Septic Repair❑ Septic Malfunction ❑ Septic Expansion n New Well Permit n Replacement Well ❑ Well Abandonment n Well Repair ❑ Existing System Inspection (Pre-Approval Required) 111 e'-' Application is for New Construction A Existing Facility n t S,L Property Address U ♦f__.:,,, e. �_ mist Subdivision .\ nringl ,O Lot# Acres 0 . 8-2O Section/Block/Phase rR,i : s•.0 ,,l Driving Directions to Prope �. ' ' __, � r,'-. ,. ',,•r'r •- - � '- u�d —. - - - foaa• 6�., !.l , S_ •% - ,f. �. 2� iL,I ,�-ak NAME TO APPEAR ON PERMIT? ■wner %Applicant n Contractor Applicant Contact Information Address I $ , [le .k t .4 k Ir.1F��?. r tl A) a z§ i 349 Phone $' f_ a.0._ Do I Cell Phone 48-2_8-_ 3-9 - At 3,.5--- Owner C intact Information ,w 1iffiiifi�'�o a�_l tigP 1.1�k a. Addressl ( t x �t� - ag,t I i .i Q Q._ a 7't 24-- Phone ,7,7i-,. ,,.zt4 _ a ; It Cel Phone t7 O y_ to 0,0 _ ?a 4 (j Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site ., , e t _ '_P r NIA '..t' .• # of Bedrooms *t 3 Structure 4'imensions /0 S( 5-1— #of Occupants Basement ❑ Yes X. No Basement Fixtures 0 Yes CI 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. 0 Yes O No Does the site contain any jurisdictional wetlands? El 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? El Yes ®No Is the site subject to approval by any other public agency? 0 Yes IS No Are there any easements or right of ways on this property? Describe Existing water supply in use ® Individual Well n Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes VNo 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 R Conventional ❑ Innovative ❑ Other Any i / CATAWBA THIS IS NOT A PERMIT k-5; . c UN ) T CATAWBA CATAWBA COUNTY HEALTH DEPARTMENT No„ a Application for Environmental Services Page 2 C oln Li)04 Proposed Facility Type ❑ Primary Residence New Residence Addition to Residence # of New Bedrooms *t 3 Project Description Neo.J Dot,',It wide- Structure Dimensions ag x c a. # of Occupants 3 Basement ❑ Yes [X1 No Basement Fixtures 10 Yes C2 No I-1 Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes U No Plumbing n Yes n No Describe Plumbing Needed I Multi-Family Residence#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 n Individual Well n Semi-Public Well n Community Well Abandonment Type ❑ Drilled n Bored [ Dug [ Unknown Well Repair Requested Yes n 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. -et) d Signature of Owner or Agent Date Printed Name of Owner or Agent a/LD'LU In Uaiawoa uounry pia real tswae maps CATAWBA Geospatial Real Estate Search i Information Seri rZoom In Zoom Out I Pan Identify ' Select by Prey • , L . 1 __Meng, I . Poem' ' I inon^. . Print_i I Measure by 1_ _ _-_- 020 � Print Scale: Search f� ‘St — — ?-` tin=100ft RO ■OK LN Last Search Parcel ID: 1 t1 867 4606034381911 LRK/REID: 1 Search i 1 17969 1 b / �OSSr 5075 I Parcel i to ,`'B Si SALLYBROOkI 'f .90 LN Ii ID: 111 �s ° ! \\ DENVER,28021 '1 1 i 6� ��. ml° �r WALKER ; i' 'y' s CHARLES 1 Find I �� :� HUBERT 12 ?7 ,..\ WALKER I digits no / /' LOUISE J I 0 Parcel - dashes. / + 0 °� i t\-6 '. Report I When 14 6S0 </y0 ,ems' �° eta List all• the i t S owners I •building 1 1! Deed History I ) it and parcel '• E d Report owners 46 Assessment Report l are 1 1 different ' I' 000gle binq ! there i • 94'05 are an ' lI' Map addition) ' 4� 4°e° Layers { 4 P 1 11 characters, 1 6> on the 1 -9j O Parcel Selected ID Parcels o u Address Parcel o Dimensions Owner D 4 Name Digit Pinc o Owner 0 Lot# Name O Misc. (any portion) Lines O O SubdivisioI Aerial 2014 . 1 ,-----1 r -81.000663,35.555923 4 L,-. L_ t ©2016, Catawba County Government, North Carolina. All rights reserved. Disclaimer • Privacy/Security Notice hHnd/ni a rmInwhnrnI inhnv nemdrorral/ 1 N Catawba County Environmental Health 102.50 ,✓ SA��.039- 1 / �,.�-�-" /-r1-5 f / ?es •s> x-11 by • II 1\ yr . \2 0- c0 -41.,c1 i'fifrlitii C5 i � /' � d1 Ili ;A i n• Ner `S' n'\ g 'If ilia' 4i Ili- a IrI " �Cp 1��= 1�Ih I ;1i:NI It o Ill I �, iltt ti, Id{ ' i v 41 �h,1 11, � �j, qtl;Illy '>G �6 'N 1 . I,µ r 1 l I�l� l :il N , �II , � 1 it 1I- I�I Pl ill'I ;,1 jl Ti..� � 'rl s, ,tl 1{1'4.11,11 + , Ili � � Try 94.0 NI �I p I 1 rMl h�i qn k �,Ill I1. I� ,( iIN W, �a y � 11 i l IL?oyll II I It, � h�� II , i 1 1( p 'ti �� i ,1 �C IN 1 ,11111 „ 1 lit "� II' }N, I 1 , a i ; Parcel: 460603438191 , 5075 SALLYBROOK LN 1 in=50ft DENVER, 28037 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 06/29/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460603438191 Owner: WALKER CHARLES HUBERT Parcel Address: 5075 SALLYBROOK LN Owner2: WALKER LOUISE J City: DENVER, 28037 Address: 797 US HIGHWAY 221A LRK(REID): 17969 Address2: null Deed Book/Page: 1101/0746 City: FOREST CITY Subdivision: CRESCENT LAND AND TIMBER State/Zip: NC 28043-5911 CORP Lots/Block: 154/ null School Information: School District: COUNTY Last Sale: Elementary School: SHERRILLS FORD Plat Book/Page: 16/22 Middle School: MILL CREEK Legal: LOT 154 SEC 34 LT154 PL16-22 PL 16- 22 High School: BANDYS School Map Calculated Acreage: .820 Tax Map: 017 X 34154 Township: MOUNTAIN CREEK State Road #: 2647 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: $5,000 Zoning2: null Land Value: $143,900 Zoning3: null Assessed Total Value: $148,900 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 #: 3710460600J Building Details 2010 Census Block: 4018 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 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=460603438191&typ=P 6/29/2016 I N• Lu \Ss . • N4 4. : 11: p N o CM a. W O S F-- • Z a � l _.. 4• m cx. I in 61 O °' T .... E Y U • Z 1 I to W 1.- 3 p~, I T W X I— IT(X a z a I o I C 7 ■4.O co I i — Z 73 co c•-il, I 00 0 o L vi O - o a 2 < }. 1 O O I t— Q .. f- a u &- ceirt C \A • ...k i 0 43\ QCD Y- in \-1 c>":7) o , � o LU 0. ZLLJ____, D � v 'u O O.. w U n W U Ca 0 I l (\� ZZ 0 us Z 6 e- w J -- 1• ° U F°'{ 2 I 2 '1J Q Q chi) 6 Q c~n gmw 0 I Z �n N m u w d "- w CS i`t L Z C8 • U m T O O vs Z S Z U 0 O d N K)s?A CATAWBA COUNTY �G IOOA SOUTH WEST BLVD t ri NEWTON, NORTH CAROLINA 28658 RECEIPT 4V hjvd�°vhf `G PHONE: 828.465.8399 Wednesday, June 29, 2016 $42 SM www.catawbacountync.gov PAYOR : Cunningham, Charles PAYMENTS TRANSACTION NUMBER: 1 RC-709775-29-06-2016 PAYMENT DATE: 06/29/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329950 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-06-2016-24195 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5075 SALLYBROOK LN, DENVER NC 28037 Applicant CHARLES CUNNINGHAM, 178 WEEBO RD, RUTHERFORDTON NC 28139 H:8282470099C:8282892585 ** NO PEOPLESOFTACCOUNTASSIGNED ** Land Owner CHARLES& LOUISE WALKER, 797 US HWY 22IA, FOREST CITY NC 28043 H:8282452888C:7046008246 receipt 06/29/2016 10:55 Page 1 of 1