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HomeMy WebLinkAboutEHPR-07-2016-24249.TIF vIV'A �N THIS IS NOT A PERMIT Case # EFIPR-07-2016-24249 CATAWBA COUNTY HEALTH DEPARTMENT 0 ''i'�,,,,��� 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • ti /842 sm Environmental Health Plan Review - OSWP • NEW WELL Applicant ROBERT BOST JR, 305 IOTH AVE NE, CONOVER NC 28613 C:8287817116 Owner ROY TOWNSEND SR, 8300 NOLLEY LN, SI-IERRILLS FORD NC 28673-9389 C:7049292998 NAME TO APPEAR ON PERMIT Roy Townsend Sr SITE ADDRESS: 8300 NOLLEY LN, SHERRILLS FORD NC 28673 PIN # 461601277698 NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP Lot# 74 Section/131ock PROPERTY SIZE: Square Feet 3Q927.60 Acres 0.71 DIRECTIONS: Hwy 150 West to Slanting Bridge Rd, Left onto Drena Rd, Right onto Giles Ave, Left onot Nolley Ln, 4th house on Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: New Well Permit "Currently tied into neighbors well. Needing to get well on their own 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? 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF House, Boat House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 53x38, Boat House 20x24 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 1 PROPOSED CONSTRUCTION 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: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO 09-ehappl lcat ion 07/11/2016 09:55 Page 1 of 4 tt',A r CATAWBA COUNTY Case I/ EHPR-07-2016-24249 L Public Health Department Subdivision CRESCENT LAND AND TIMBE 4 ;1 ,�; Environmental Health Division PINK 461601277698 Igo PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 /8,2 ,M NAME ON PERMIT: (ROY TOWNSEND SR), 8300 NOLLEY LN, SHERRILLS FORD NC 28673-9389 ( Roy Townsend Sr) Site Address: 8300 NOLLEY LN, SI-IERRILLS FORD NC 28673 Property Size: Square Feet 30,927.60 Acres 0.71 Directions: Hwy 150 West to Slanting Bridge Rd, Left onto Drena Rd, Right onto Giles Ave, Left onot Nolley Ln, 4th house on 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 acce le so that a complete site evaluation can be performed. Date: 7—(/^/ Signature of Applicant or Agent / An Environmental Health Specialist will contact you within 5 working days application date. If you need further information or assistance please call 828-466-7291 AREA1 hli !,l,, e ri1 7� f I .,j t ..l ..N 4t j r r r w p . 1! FEENAME u tF ,r1- FFF'AMOUNT Well Permit & Inspection Fee 07/11/2016 $300.00 Syr 1Y1�im Sj 1111 4bu TOTA LFEFS 1h1 I1t`1 1 ' 1 , 11,i , 4'1'15300:00 ' S11IJh '. r..... 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-eha plicati,n 07/I1/2016 09:55 Page 2 of4 CATAto THIS IS NOT A PERMIT COUNTY ,�.w� � CATAWBA COUNTY HEALTH DEPARTMENT `-- „o„„ Application for Environmental Services Page 1 Improvement Permit ^ Authorization to Construct n Septic Repair❑ Septic Malfunction❑ Septic Expansion I New Well PermitXReplacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) Application is for New Construction ❑ Existing Facility' Property Address 6 J[l l 1 1� Subdivision Lot# Acres t1`gl"fi Section/Block/Phase Driving Directions to Property ( (W N ISO w +0 5-1-/A.4 ` �'` 45.9 gQ' t C )1 1 V 2 N t o t )n Q i i-eS • . 1- 0 /1/4, N ri ( (P . ±-1-- 4 (cu.C.,2 a Ni Ce '�f' NAME TO APPEAR ON PERMIT? Owner n Applicant n Contractor Applicant Contact Information Name \RU L. .) w 1. S e Address g2 00 �1Jt(,Q7 1 +o-e-- Phone ?D t j— 9 zei - 7-Ut 9f ce-e/ well Phone Owner Contact Information Name rRtLcfrt 'g1ct; U52- Address -30 G¢ C pi= • CoNav-�v� NCt (ok t�"e Nom' Phone Cell Phone 9-7 E-- 7 CH—7 1 1 4 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? I Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site #of Bedrooms *f Structure Dimensions # of Occupants Basement gl Yes n o Basement Fixtures 12 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. O Yes . No Does the site contain any jurisdictional wetlands? 0 Yes Oi 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 6" No Is the site subject to approval by any other public agency? 0 Yes IV No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well E Community Well I I Semi-Public Well County/City/Township Water Line Is a public water supply available? ** E Yes )-(1 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 CATAWBA THIS IS NOT A PERMIT coONtt — CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence _ Addition to Residence # of New Bedrooms *I. Project Description Structure Dimensions # of Occupants Basement I I Yes ❑ No Basement Fixtures 0 Yes DI No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions ft of Occupants Accessory Dwelling n Yes n No Plumbing n Yes I I No Describe Plumbing Needed I Multi-Family Residence#Units #Bedrooms per Unit*j' Total# Bedrooms *j Structure Dimensions • F• ood Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift It of Shifts Dining Area (Sq. Ft.) n B• usiness Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts n Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type Individual Well n Semi-Public Well C. Community Well Abandonment Type Drilled n Bored ❑ Dug n Unknown Well Repair Requested ❑ Yes n No Describe Calculated Design Flow, Commercial 1. 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. j 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 depat tment is valid for(5)five years from the date issued and is not transferable;Improvement Permits and Well Permits are transferable. 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. 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Parcel: 461601277698, 8300 NOLLEY LN 1 in=50ft SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County, NC Geospafial Information Services. Catawba County has made substantial eftods 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 07/11/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461601277698 Owner: TOWNSEND ROY LEONARD SR Parcel Address: 8300 NOLLEY LN Owner2: null City: SHERRILLS FORD, 28673 Address: 8300 NOLLEY LN LRK(REID): 18846 Address2: null Deed Book/Page: 1087/0697 City: SHERRILLS FORD Subdivision: CRESCENT LAND AND TIMBER State/Zip: NC 28673-9389 CORP Lots/Block: 74/ null School Information: School District: COUNTY Last Sale: Plat Book/Page: 15/183 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Legal: LOT 74 PL 15-183 Calculated Acreage: .710 High School: BANDYS Tax Map: 018 X 32074 School Map Township: MOUNTAIN CREEK State Road #: 1934 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: $200,400 Zoning2: null Land Value: $249,200 Zoning3: null Assessed Total Value: $449,600 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1975/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 #: 3710461600L Building Details 2010 Census Block: 5029 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 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=461601277698&typ=P 7/11/2016 �y,A CO CATAWBA COUNTY 100A SOUTHWEST BLVD I�� r'' ti: �� �; NEWTON,NORTH CAROLINA 28658 RECEIPT d+ '?„,,, ' PHONE: 828.465.8399 t,. a► Monday, July 11, 2016 U � ' vC 1842 sM www.catawbacountync.gov PAYOR: Townsend Sr, Roy PAYMENTS TRANSACTION NUMBER: TRC-728089-11-07-2016 PAYMENT DATE : 07/11/2016 PAYMENT TYPE: Check 526 Neighbor, Robert Bost brought by app/pmt INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330272 Well Permit & Inspection Fee $300.00 TOTAL PAYMENTS : $300.00 EHPR-07-2016-24249 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8300 NOLLEY LN, SHERRILLS FORD NC 28673 Applicant ROBERT BOCT JR, 305 I OTH AVE NE, CONOVER NC 28613 C:8287817116 Owner ROY TOWNSEND SR, 8300 NOLLEY LN, SHERRILLS FORD NC 28673-9389 C:7049292998 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/11/2016 0954 Page I of