Loading...
HomeMy WebLinkAboutEHPR-08-2016-24415.TIF �qA - � THIS IS NOTA PERMIT Case # EHPR-08-2016-24415 L CATAWBA COUNTY HEALTH DEPARTMENT �� V, .. o . CJ 170.P. `C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES � • 1842 cm Environmental Health Plan Review - OSWP o . + !+o rtl T • • IMPROVEMENT �, : - 'o Applicant CAROLINA PREMIER HOMES, INC. (GREG DUNCAN), 5176 GLENWOOD ST, DENVER NC 280 C:7043617717 Owner LOUISE MARLEY, 5176 GLENWOOD ST, SHERRILLS FORD NC 28673 NAME TO APPEAR ON PERMIT Carolina Premier Homes, Inc. (Greg Duncan) SITE ADDRESS: 7848 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 PIN # 460604814855 NAME of SUBDIVISION: H C BARKLEY PROP Lot 4 1 Section/Block A PROPERTY SIZE: Square Feet 29,18520 Acres 0.67 DIRECTIONS: Hwy 150 toward Lincolnton, Left onto Slanting Bridge Rd, Left onto Keistler Store Rd, 1st lot past Barkley Dr. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* All structures on this property will be removed.' 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 Abandoned House, Bldg (to be removed) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x65 #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: I J-ehapplication 08/01/2016 16:52 Page 1 of � \ CATAWBA COUNTY Calc it EHPR-08-2016-24415 ,�� � ,L Public Health Department Subdivision H C BARKLEY PROP 5 Wei ,r Environmental Health Division I'IN# 460604814855 14' PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 x„442 a NAME ON PERMIT: CAROLINA PREMIER HOMES, INC. (GREG DUNCAN), 5176 GLENWOOD ST, DENVER NC 28037 Carolina Premier Homes, Inc. ( Greg Duncan) Site Address: 7848 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 29,185.20 Acres 0.67 Directions: Hwy 150 toward Lincolnton, Left onto Slanting Bridge Rd, Left onto Keistler Store Rd, 1st lot past Barkley Dr. 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 omplete site evaluation can be performed. Date: k—/— 46. Signature of Applicant or Agent .60" i_ sip Environmental Health Specialist will contact you withi• working da sof application date. If you need further information or assistance please call 828-466-7291 AREA1 —Tighoul 'limbort,, 0171'14i • Imp IIoni ,jii i1 „ i leFFENAMEIIIS ;111:11110t:Li iiCtc i , 'IIDATEilliLliiliEEAMOUNT,u Improvement Permit Fee 08/01/2016 $150.00 t1, .n T Ah ilii l 11111' IP I l , I�IjI(,, )I l),i I R iI ( l 1'I 1 '' I11� TOTALFEES FItif, ,,Ilii1I'I II41Ii,,H0,fd6. .Chl, I ''iin I,�j. „+1.15000ip, ELL r' 'bLffIill i L ••".. .. ,..�..I Ih.ul lili8l•- •111,11!3L.=:11111...._alltl"? ld11I u 11; 1 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) 1)-ehapplication 08/01/2016 16:52 Page 2 of 4 tsCATAWBA THIS IS NOT A PERMIT 2�� T11�V ViJ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion E New Well Permit n Replacement Well ❑ Well Abandonment D Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Aoolication is for New Construction ❑ Existing Facility ❑ 1i I • , * Property Address_ G_ Ap '; 111112%, III Subdivision Lot# Acres Section/Block/Phase �`/y.. Driving Directions to Property J.Je-,y. /So !oe,o�d L�,".,fel Hal Jur., 4e cf • CA ^' SASAni/ y CZ-14o Ed /�-=-= /��'ii/rr,.f'S- • NAME TO APPEAR ON PERMIT? ❑ Owner 7 Applicant ❑ Contractor Applicant ContactInformation Name 6-rPce 0P LiCga / Celt-017)9 /-r PPM Pr" Ale,m Pp rr,6 Address 3,S_.36 Lrskv Cho—e led Sz, u/4r ,Oanvor- /1/C 2e-o37 Phone Cell Phone 70 et,. 3C / — 77/ 7 Owner Contact Information Name L• r a Address 6 ._ , �/ �n, Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant [ Contractor Description of Existing Structures on Site O/cf IJo uses Abead M / wP tv//l O -'o 14,44. J/ # of Bedrooms *j' 3 Structure Dimensions s�`tr/(ry S # of Occupants 0 �l Basement ❑ Yes to No Basement Fixtures a 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 a No Does the site contain any jurisdictional wetlands? ® Yes ® No Does the site contain any existing wastewater systems? 0 Yes El No Is any wastewater going to be generated on the site other than domestic sewage? K2 Yes ® No Is the site subject to approval by any other public agency? El Yes ®No Are there any easements or right of ways on this property? Describe Existing water supply in use ig Individual Well El Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** n 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 prefere e) �� Accepted 0 Alternative Ea ntional 0 Innovative 0 Other W Any C A STA Tb A THIS IS NOT A PERMIT COY CATAWBA COUNTY HEALTH DEPARTMENT �' " , Application for Environmental Services Page 2 Proposed Facility Type Primary Residence KI New Residence ❑ Addition to Residence # of New Bedrooms *1. y Project Description 4.-1// /9on%<P /recJ tf dedfx., 3$ /14;14 46e,S 9k Structure Dimensions 6D,X ft of Occupants Basement ❑ Yes ® No Basement Fixtures ® Yes fl No • ❑ Accessory Structure(s) Describe - # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes H No Plumbing H Yes ❑ No Describe Plumbing Needed Multi-Family Residence# 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 ❑ 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 ❑ Unknown Well Repair Requested ❑ 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 Agent — Date k/— /C Printed Name of Owner or Agent .1 C . I)t neo'1 Catawba County Environmental Health LA°61 00 O 15(3'�-4 R ASP��V Ilk '00 rno 1gt. C)) . • 0 0 Z .----- lQh \ )1DQ 0 1511110. C6� •7848 tis oD f, .A, 162'2,0 til �� — O 255 ,88 (l"PO ri) itt Uy / ii< 7859-1 tis •7854 O O •2 Parcel: 460604814855, 7848 KEISTLERS 1in=50ft STORE RD 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 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 08/01/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460604814855 Owner: MARLEY LOUISE SANDERS Parcel Address: 7848 KEISTLERS STORE RD Owner2: City: SHERRILLS FORD, 28673 Address: 5176 GLENWOOD ST LRK(REID): 19262 Address2: Deed Book/Page: 1027/0094 City: SHERRILLS FORD Subdivision: H C BARKLEY PROP State/Zip: NC 28673-9216 Lots/Block: 1/A Last Sale: School Information: Plat Book/Page: 15/29 School District: COUNTY Legal: LOT 1 1A PL 15 29 ASBURY PL 15-29 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .670 Tax Map: 018BX 05001 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1899 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: $2,000 Zoning2: Land Value: $31,000 Zoning3: Assessed Total Value: $33,000 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: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460600J Building Details 2010 Census Block: 4033 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 hold liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise tram this map/report product or the use ' thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. uplagE1, 1ccotorivvki http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460604814855&typ=P 8/1/2016 p,A CATAWBA COUNTY 15121 5 .. t I00A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT nVVa�' PHONE: 828.465.8399 C. I , owp Monday, August 1, 2016 j84Z sM www.catawbacountync.gov PAYOR: Carolina Premier Homes, Inc. Carolina Premier Homes, Inc. (Duncan, Greg) PAYMENTS TRANSACTION NUMBER: TRC-762009-01-08-2016 PAYMENT DATE : 08/01/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331116 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24415 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7848 KEISTLERS STORE RD, SHERRILLS FORD NC 28673 Applicant CAROLINA PREMIER HOMES, INC., 5176 GLENWOOD ST, DENVER NC 28037 C:7043617717 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner LOUISE MARLEY, 5176 GLENWOOD ST, SHERRILLS FORD NC 28673 receipt 08/01/2016 16:52 Page 1 of 1