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HomeMy WebLinkAboutEHPR-08-2016-24441.TIF THIS IS NOT A PERMIT Case # EHPR-08-2016-24441 d i1 a CATAWBA COUNTY HEALTH DEPARTMENT ❑` ` Yo•3. .❑° 'r % PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ,•: ad /g42 5M Environmental Health Plan Review - Septic Malfunction so •• • el +7�o- AUTH_CONST- SEPTIC_MALFUNCTIONO ti o, ❑ er . Owner BRETT PRESTON, 26 NORWOOD RD, CHARLESTON WV 25314 C:304-550-0240 NAME TO APPEAR ON PERMIT Brett Preston SITE ADDRESS: 5054 MALLARD COVE, SHERRILLS FORD NC 28673 PIN # 461603036550 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 76,230.00 Acres 1.75 DIRECTIONS: Hwy 150 E, right Slanting Bridge, left Keistler Store Rd, left Barkley Rd, left Mallard Cove, straight ahead at end PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: septic slow to drain 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 single family residence EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 81 x 107 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 8 PROPOSED CONSTRUCTION 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: 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 identificatty a labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: r) Lip Signature of Applicant or Agent+hthpi 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 E9-ehappl kation 08/04/2016 11:32 Page 1 of 7 sq• • CATAWBA COUNTY Case# EHPR-08-2016-24441 : "titiCs Public Health Department Subdivision 4 , , Environmental Health Division PIN# 461603036550 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 18 4% sig NAME ON PERMIT: ( BRETT PRESTON), 26 NORWOOD RD, CHARLESTON WV 25314 ( Brett Preston) Site Address: 5054 MALLARD COVE, SHERRILLS FORD NC 28673 Property Size: Square Feet 76,230.00 Acres 1.75 Directions: Hwy 150 E, right Slanting Bridge, left Keistler Store Rd, left Barkley Rd, left Mallard Cove, straight ahead at end r scan n1ax*�1 i t EFFNAME 1 ;`° z.41.-a- r0 5g llDATE ; EE AMOUNT*, Authorization to Construct (Repair) Fee 08/04/2016 $450.00 r1101114114.a. «� TOAEFEES « _ c ,s? ",aa iro A3x $45000k y Tk. u . a4tigaa,na1Wo ::i°;-.sN.m.t_..di .N5z 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-ehapplicadon 08/04/2016 11:32 Page 2 of 7 • CAt , w Y A THIS IS NOT A PERMIT cuuyrt 1 CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services ,t) 11'1 Page 1 Improvement Permit ❑ Authorization to Construct❑ Septic Repair® Septic Malfunction ❑® Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑® 5054 Mallard Cove N/A Property Address _.. Subdivision Sherrills Cove, North Carolina 28208 Lot# N/A Aeres'1.75 Section/Block/Phase N/A Driving Directions to Property From 1-77 Exit 36(Mooresville);take Route 150 towards Denver;Left on Slanting Bridge Road;Left on Keisllees Store Road; Left on Barkley Road;Left on Mallard Cove. NAME TO APPEAR ON PERMIT? Q Owner 9 Applicant ❑ Contractor Applicant Contact Information Name Brett J.Preston Address26 Norwood Road,Charleston WV 25314 Phone(304)550 0240 Cell Phone(304)550 0240 Owner Contact Information Name same Address Phone Cell Phone Contractor Contact Information Name None _.. Address ...- ....... Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? 0',Owner Applicant 9 Contractor Description of Existing Structures on Site Single Family.Residence q # of Bedrooms *t 4 Structure Dimensions 1486 sq.ft. V / 0#of Occupants 8 Basement ❑ Yes ❑ No Basement Fixtures 9 Yes Q 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 ig No Does'the site contain any jurisdictional wetlands? . Yes 0 No Does the site contain any existing wastewater systems? • Sgpr ic'� �Ei?"ni N ❑ Yes el No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes '13 No Is the site subject to approval by any other public agency? ❑ Yes -a No Are there any easements or right of ways on this property? Describe Existing water supply in use [®];Individual Well "U'Corrimunity"Well "'"'LJ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ 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) O Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other _.. B Any CATAWBA THIS IS NOT A PERMIT couNrt CATAWBA COUNTY HEALTH DEPARTMENT &- — Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑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 Li Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) _# Employees per Shift #of Shifts Dining Area(Sq. Ft) Li Business Specific Type of Business Retail Floor Space #of Employees per Shift_ 4 of Shifts U 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 Bow 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. 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Av s 44. 4,..5. ,+.us 4p.-e }5�b recIyY }'.It li.�`'f 4k Y ® t ,' .4*,k (�.1'. .3•t•�t c.b ka k't"at • ,a/ T 3Y v r ,s `ka�, <1 C.Jt-L� ',...Et `"E"' . i, r,ti }a 1 4,rr.rsb It st, Tq� r � t ±t�,4 A y a �y i�,, °%`.�Y' Y AL 4�' , cos • t .,• ,5,.,-'. _.roach ., At.l • i ltt, ^1' a �y ^� x .@**. . - k'i .t ` °SNS' a ,,.,'" ' 4ru,.,4zr 'i '. Viz'nE zEby .i....i ,..y,„k•,,nkr, ;,Y F. „ n '&�'.— t 4 g ;J.,„,,,C.`a # r".1ti J?.1.r.!K)IxN ext,,y.1 r y y,4a.se r TF?.z`'..F•,1> ''0,' .... e sx'"r` p .; 4^'4tia .92 ks. '�* `.' atit4k tl`k' f `'w.er xx .l:;m, p- 117 .,. ) Parcel: 461603036550, 5054 MALLARD COVE 1 in=60ft SHERRILLS FORD, 28673 This.map/report product.was prepared from the Catawba-County.NC Geospatial Information Services. Catawba- County has_ made substantial ettods to ensure the accuracy of location and labeling information;.containedon 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 Ilability,whether direct;Indirect or consequential which apses or may arise from Ihis'map/report product..the use thereof by zany yright 014 Cat: ' �' Copyright 2014Catawba County NC 08/03/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461603036550 Owner: PRESTON BRETT J Parcel Address: 5054 MALLARD COVE Owner2: SALANGO C BENJAMIN City: SHERRILLS FORD, 28673 Address: 26 NORWOOD ST LRK(REID): 18766 Address2: null Deed Book/Page: 3130/1912 City: CHARLESTON Subdivision: null State/Zip: WV 25314-1327 Lots/Block: null/ null Last Sale: School Information: Plat Book/Page: School District: COUNTY Legal: LK NOR Elementary School: SHERRILLS FORD Calculated Acreage: 1.750 Middle School: MILL CREEK Tax Map: 018 X 02021 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road#: 1921 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: $193,200 Zoning2: null Land Value: $892,500 Zoning3: null Assessed Total Value: $1,085,700 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1963/2003 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: 4032 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/nornap/parcel_report.php?key=461603036550&typ=P 8/3/2016 . Q:: . N c) CI ^ 'y T-1 \ W •v dt F F, Z mVV a R co• '0ea ` \ W AI "J �t ac o is F12 ) osei ' \ W wr4 ai k .▪ ti .Q ; rACCATAWBA COUNTY ,, 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 �U Thursday, August 4, 2016 \ 184' SM www.catawbacountync.gov PAYOR Preston, Brett PAYMENTS TRANSACTION NUMBER: TRC-765745-04-08-2016 PAYMENT DATE : 08/04/2016 PAYMENT TYPE: Credit Card 169539206 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331256 Authorization to Construct (Repair) $450.00 Fee TOTAL PAYMENTS : $450.00 EHPR-08-2016-24441 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5054 MALLARD COVE, SHERRILLS FORD NC 28673 Owner BRETT PRESTON, 26 NORWOOD RD, CHARLESTON WV 25314 C:304-550-0240 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 0810412016 1129 Page 1 of 1