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HomeMy WebLinkAboutEHPR-07-2016-24380.TIF ySY A � THIS IS NOTA PERMIT Case # EHPR-07-2016-24380 r\r ' i CATAWBA COUNTY HEALTH DEPARTMENT ❑� c rarr E' rTr \ !' / PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES P \/842/5. Environmental Health Plan Review - OSWP : 12 o , p c';; r • IMPROVEMENT �;' n e Contractor BEASON GENERAL CONTRACTORS (BRENT WILSON), PO BOX 636, SHERRILLS FORD NC 21 8:7042301016 C:7047756525 BRENT@BEASONNC.COM Land Owner LOIS TROUTMAN, 1913 SHELTON AV, STATESVILLE NC 28677 NAME TO APPEAR ON PERMIT Beason General Contractors (Brent Wilson) SITE ADDRESS: 8339 CHAPIN LN, SHERRILLS FORD NC 28673 PIN # 461601284872 NAME of SUBDIVISION: RALPH M SIGMON Lot 4 4 Section/Block PROPERTY SIZE: Square Feet 22,215.60 Acres 0.51 DIRECTIONS: Hwy 16 South about 12 miles to Hwy 150 East, Go about 4.5 miles, Right onto Slanting Bridge Rd about .4 miles, Left onto Drena Dr about 3/4 miles, Left onto Chapin Ln, Property is 100 yards on Right. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 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:: 60x60 #OF NEW BEDROOMS:: 4 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-ehappl'cation 07/27/2016 15:36 Page I of Ll v,A CATAAVBA COUNTY Case# EHPR-07-2016-24380 .e`' F.Y.I� Public Health Department Subdivision RALPH M SIGMON <,,,,,,,® y) Environmental Health Division PIN# 461601284872 '+ PO Box 389,100-A Southwest Blvd,Newton. NC 28658 lg.2 ni NAME ON PERMIT: BEASON GENERAL CONTRACTORS ( BRENT WILSON), PO BOX 636, SHERRILLS FORD NC 28673 Beason General Contractors ( Brent Wilson) Site Address: 8339 CHAPIN LN, SHERRILLS FORD NC 28673 Property Size: Square Feet 22,215.60 Acres 0.51 Directions: Hwy 16 South about 12 miles to Hwy 150 East, Go about 4.5 miles, Right onto Slanting Bridge Rd about .4 miles, Left onto Drena Dr about 3/4 miles, Left onto Chapin Ln, Property is 100 yards on 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 identifica. and labeling of all property lines and corners and making the site acct able so that a complete site/evaluation can be performed. Date: ?QJ( Q Signature of Applicant or Agent n; c �� y� ' % An Environmental Health Specialist will contact you within 5 working days ofs application . If you need further information or assistance please call 828-466-7291 AREA1 *******+Mt*WM#*h#kiYV**********######*****Wk#F#####M k*YY*Y **********k*P*######R******k*****#kk#####*****#♦ I! N !? i r ' 'ai`' �IiUr?EEAME ?NgIiiiG '.i,E iLialijoikili i� DATE :aittFEEAMOUNTy Improvement Permit Fee 07/27/2016 $150.00 `Till Illtiltiiil n 1 c 11 pi i n np�ti1 I ;1$ 4 i ,!li l i l lop ilitttimhi �il, {;,TOTAEIF. lit,w,kl„IyluhdllH/44 ,Nel .1! llf ��4f11141�Iso; ,til II t 1�I.id'Jr�,0 u.ifilth, .x51113 dlWllealJat1114111,311Ii1/2 11'.-° i PihmaL 6111111110: :11e11111111111116151101514— FEES a1,tlLIIIU1116110151 4..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-ehappl ication 07/27/2016 15:36 Page 2 of 4 CATAWBA THIS IS NOTA PERMIT cou�rl CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit❑0 Authorization to Construct❑ Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit❑ Replacement Well 0 Well Abandonment 0 Well Repair 0 Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 8339 CHAPIN LANE Subdivision RALPH M SIGMON SHERRILLS FORD,NC 28673 Lot# 4 Acres .51 SectionBlock/Phase 12/16 Driving Directions to Property TAKE HWY 16 SOUTH ABOUT 12 MILES TO HWY 150 EAST. GO ABOUT 4.5 MILES ON 150 EAST&TURN RIGHT ONTO SLANTING BRIDGE ROAD. GO ABOUT.4 MILES AND TURN LEFT ONTO DRENA DRIVE.GO ABOUT 3/4 MILE AND TURN LEFT ONTO CHAPIN LANE. PROPERTY IS 100 YARDS ON RIGHT. NAME TO APPEAR ON PERMIT? 0 Owner ❑ Applicant ❑■ Contractor Applicant Contact Information Name BEASON GENERAL CONTRACTORS Address po BOX 636,SHERRILLS FORD,NC 28673 Phone 704230.1016 Cell Phone 704.775.6525 Owner Contact Information Name RICK GASKINS Address 8344 CHAPIN LANE,SHERRILLS FORD,NC 28673 Phone 704.408.3487 Cell Phone SAME Contractor Contact Information Name SAME AS APPLICANT Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner 0 Applicant ❑t Contractor Description of Existing Structures on Site #of Bedrooms 4t 4 Structure Dimensions 6o'X 60' _ #of Occupants Basement ❑ Yes 0 No Basement Fixtures 0 Yes 9 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. C Yes E No Does the site contain any jurisdictional wetlands? C Yes K2 No Does the site contain any existing wastewater systems? O Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes ❑No Is the site subject to approval by any other public agency? C Yes JO No Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well U Community Well ❑ Semi-Public Well 0 County/City/Township Water Line Is a public water supply available? 4i 0 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) IN Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any S IS NOT A PERMIT CATAWBA C TAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type 0 Primary Residence 0 New Residence ❑ Addition to Residence #of New Bedrooms *t 4 Project Description CONSTRUCTION OF A 4 BEDROOM HOUSE Structure Dimensions 60'X 60' #of Occupants Basement ❑Yes ❑■ No Basement Fixtures ® Yes ,O No U Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑No Plumbing ❑ Yes ❑No Describe Plumbing Needed U Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *t Structure Dimensions U Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts U Other Facility Type Specify If Church#of Seats Kitchen 0 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 El Unknown Well Repair Requested 0 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 Signature of Owner or Agent 17171"2r4- Date 7/a 7//to Printed Name of Owner or Agent geihaa fri vtery 6u* c ,IIL Catawba County Environmental Health t a a $ co `° 765 tp ,.til ',�;il,;it {.r0,d A • 232.09 lea® .IPIIIIIIIIIIIIIIIIIIIIIIIIIII" PIPIPIPPIPrL 125.00 `rull f M 100.00 25/ S°o}� �hC 'so"/ (1-til lulu 1 •9x,Q9 1 Th p?so do�d q r. • ,3i I F 7 r i 15 1 125.r, I -- 1 M I - - r00.00 • \ , i 1 1 125.00 t 1 i N i 4.00% — a v\ 0R�N404, 40.0 • Parcel: 461601284872, 8339 CHAPIN LN 1In=50tt SHERRILLS FORD, 28673 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 dale 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 reap/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 07/26/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461601284872 Owner: TROUTMAN LOIS K Parcel Address: 8339 CHAPIN LN Owner2: City: SHERRILLS FORD, 28673 Address: 1913 SHELTON AVE LRK(REID): 14353 Address2: Deed Book/Page: 0888/0389 City: STATESVILLE Subdivision: RALPH M SIGMON State/Zip: NC 28677-7231 Lots/Block: 4/ B Last Sale: School Information: School District: COUNTY Plat Book/Page: 12/16 Elementary School: SHERRILLS FORD Legal: LOT 4 LOT 4 B PL 12-16 PL 12-16 Middle School: MILL CREEK Calculated Acreage: .510 Tax Map: 013BX 03004 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road it: 1905 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: $0 Zoning2: Land Value: $17,100 Zoning3: Assessed Total Value: $17,100 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel It: 3710461600L Building Details 2010 Census Block: 5035 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=461601284872&typ=P 7/27/2016 11?:...leA O CATAWBA COUNTY 100A SOUTFI W EST BLVD RECEIPT sir NEWTON, NORTH CAROLINA 28658 �_ V►e PHONE: 828.465.8399 U elf" vaw.P 't Wednesday, July 27, 2016 Stu€ I�u.� �8411 SM www.catawbacountync.gov PAYOR: Beason General Contractors Beason General Contractors(Wilson, Brent) PAYMENTS TRANSACTION NUMBER: TRC-754080-27-07-2016 PAYMENT DATE : 07/27/2016 PAYMENT TYPE: Credit Card payment by phone from Brent INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330945 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-07-2016-24380 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8339 CHAPIN LN, SHERRILLS FORD NC 28673 Land Owner LOIS TROUTMAN, 1913 SHELTON AV, STATESVILLE NC 28677 Contractor BEASON GENERAL CONTRACTORS, PO BOX 636, SHERRILLS FORD NC 28673 B:7042301016C:7047756525 BRENT@BEASONNC.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/27/2016 15.36 Page I of 1