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HomeMy WebLinkAboutEHPR-08-2016-24474.TIF �AA C THIS IS NOTA PERMIT Case # EI-IPR-08-2016-24474 fl G �i.nY . - :,�.,, a CATAWBA COUNTY HEALTH DEPARTMENT ❑° r.o ,14;1:1'!'•r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '}' r • ,T L84T s^� Environmental Health Plan Review - OSWI' CI r T. ABANDONMENT li' ' d f,.o Applicant PETER WEINRICH, 9260 JACOB FORK RIVER RD, VALE NC 28168 C:8282445133 Owner COOKSVILLE VOL FIRE DEPT INC, 6942 OLD SHELBY RD, VALE NC 28168 8:704-462-2127 NAME TO APPEAR ON PERMIT COOKSVILLE VOL FIRE DEPT INC SITE ADDRESS: 6942 OLD SHELBY RD, VALE NC 28168 PIN # 266701387436 NAME of SUBDIVISION: Lot k Section/Block PROPERTY SIZE: Square Peet 29,18520 Acres 0.67 DIRECTIONS: Hwy 10 W, right Old Shelby Rd, on right approx 1 miles PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Public Water DESCRIBE WORK: Well Abandonment 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: Other OTHER DESCRIPTION: Volunteer Fire Department DESCRIPTION OF volunteer fire department EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 36 x 86 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE (SQ FT): Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Bored f9-ehapplicaiinn 08/09/2016 09:46 Page 1 of 8 yypA • CATAWBA COUNTY Case fl EHPR-08-2016-24474 fT � Public Health Department Subdivision C; .�� s; Environmental Health Division PIN# 266701387436 :et. PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 1842 is NAME ON PERMIT: COOKSVILLE VOL FIRE DEPT INC ( 6942 OLD SHELBY RD,VALE NC 28168 COOKSVILLE VOL FIRE DEPT INC ( ) Site Address: 6942 OLD SHELBY RD, VALE NC 28168 Property Size: Square Feet 29,185.20 Acres 0.67 Directions: Hwy 10 W, right Old Shelby Rd, on right approx 1 miles 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 correctAut onzed 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 accessjble so that a complete site evaluation can be performed. Date: O S- Zof( Signature of Applicant or Agent 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 AREA2 3-'"- ,FEENAME ,1 -r- DATE FEE AMOUNT � E Well Abandonment Fee 08/09/2016 5100.00 1-71 11 '1A 'TOTALFEES i • '; $100 00-: FEES ARE NON-REFUNDABLE . ONCE A SITE VISIT 1S MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE ; (SEE FEE SCHEDULE) • 4 a , Puge � 09-ehapplication 08/09/2016 09:46 a • CATAWBA 1J A'( TL2A THIS IS NOT A PERMIT cou""TCATAWBA COUNTY HEALTH DEPARTMENT — Application for Environmental Services Page 1 NorM1 C/el Improvement Permit IT 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 Property Address (p 9'/ 2- OL) 5/iii..-/a i £t� Subdivision vita, pc- zi•/4 V Lot# Acres Section/Block/Phase Driving Directions to Property F/20 A,Scan> s- - kLJV /0 t.0 EST-- rf'1SNeC A- 2r6,sfrr ;v21•-) o,o oto 57-n.L4 Y 2-) - ode A/tv Y yo COS s qt,r /il �[o,�>.ursrvS D So 71:( oN oeb 6:/tic Y Pf NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name (-H/6/ - per-4.z L LJ2/N41 C/' 4 Address 924O 1.4r;o(3 , 1,,,2/c_ . icc-'t it ✓mc- 1cC- Phone Cell Phone 9ZS-- 2-V/9- O/ 33 Owner Contact Information Name (i' DOk51/I LLQ VOLuNretest fi 2c D �P % $ /•�L Address 6, ? q L CL..0 $l'/ccL+s Y (?_Ir] LM-1,4,- �3 - Zt/6 23- Phone 1A Cell Phone 2'Z&-2y'/—S/33 Contractor Contact Information Name 6,0a24r Z- coitL 7J2..1Lt/"4- -boo -PO"tic 0 Address W NG /D /&cit Hleko2Y ,-'C - 2100 2- Phone Phone 5 -Lz///-/YZO Cell Phone •joy _ y4 2 — /3 22 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner KApplicant ❑ Contractor Description of Existing Structures on Site F/e . Ho L/5 £ - gb at f0ar4€ * # of Bedrooms *j 0 Structure Dimensions 3‘ X ?Sri, # of Occupants Basement ❑ Yes g No Basement Fixtures a Yes fzi 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 jcNo Does the site contain any jurisdictional wetlands? 6 Yes ® No Does the site contain any existing wastewater systems? .5-Ern C-- i7 Yes pi No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes J(No Is the site subject to approval by any other public agency? C Yes OfNo Are there any easements or right of ways on this property? Describe Existing water supply in use IT Individual Well ❑ Community Well ❑ Semi-Public Well y:1 County/City/Township Water Line Is a public water supply available? ** X 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 ❑ Alternative 0 Conventional 0 Innovative 0 Other 0 Any c ArrAZY Tp A THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT N...""kiett9t r��,,� Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary,Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms 11. Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® Yes fl No L Accessory Structure(s) Describe #of New Bedrooms *j if applicable Structure Dimensions • # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed Multi-Family Residence#Units #Bedrooms per Unit*t Total # Bedrooms *j 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 E Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type E Individual Well [ Semi-Public Well ❑ Community Well A„` Abandonment Type E Drilled 5 Bored [1] Dug n Unknown Well Repair Requested ❑ Yes KNo De tribe A AA,7oo.✓m€,v j 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 wanted 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 /dDate. C$--o 8- zo/C Printed Name of Owner or Agent CH/EF- ?E-R-42- C Wg,,vfate(f C11'0 Catawba County Environmental Health • \\\I i�'a L itji \11111\1,0 C.LL co O n .--- --,, o Or N S rn ' ift m i9- ' K! 03 (21 ` O - ' 0 •• �2gol / I a F • A cnO O (58) .5037 • Parcel: 266701387436, 6942 OLD SHELBY RD 1 in=50ft VALE, 28168 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 08/09/2016 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 266701387436 Owner: COOKSVILLE VOL FIRE DEPT INC Parcel Address: 6942 OLD SHELBY RD Owner2: null City: VALE, 28168 Address: 6942 OLD SHELBY RD LRK(REID): 10975 Address2: null Deed Book/Page: 1193/0100 City: VALE Subdivision: null State/Zip: NC 28168-9593 Lots/Block: null/null Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: Elementary School: BANOAK 6942 OLD SHELBY RD Middle School: JACOBS FORK Calculated Acreage: .670 Tax Map: 011 B 02003 High School: FRED T FOARD Township: BANDYS School Map State Road #: 1104 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: COOKSVILLE Zoningl: R-40 Building(s) Value: $83,400 Zoning2: null Land Value: $10,000 Zoning3: null Assessed Total Value: $93,400 Zoning Overlay: WP-O Year Built/Remodeled: 1967/null Small Area: PLATEAU 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 #: 3710266600J Building Details 2010 Census Block: 1010 WaterShed: WS-III Protected Area 2010 Census Tract: 011802 Voter Precinct: P2 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=266701387436&typ=P 8/9/2016 CATAWBA COUNTY `(•41:trA yi 100A SOUTH WEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT 11 I sate' PHONE: 828.465.8399 � , IPP Tuesday, August 9, 2016 1842 snt www.catawbacountync.gov PAYOR: COOKSVILLE VOL FIRE DEPT INC COOKSVILLE VOL FIRE DEPT INC PAYMENTS TRANSACTION NUMBER: TRC-773156-09-08-2016 PAYMENT DATE : 08/09/2016 PAYMENT TYPE: Check 1120 Peter Weinrich NCDL 36107373 exp 3/16/20 dob 3/15/59 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331380 Well Abandonment Fee $100.00 TOTAL PAYMENTS : $100.00 EHPR-08-2016-24474 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 6942 OLD SI-IELBY RD, VALE NC 28168 Applicant PETER WEINRICH, 9260 JACOB FORK RIVER RD, VALE NC 28168 C:8282445133 Owner COOKSVILLE VOL FIRE DEPT INC, 6942 OLD SHELBY RD, VALE NC 28168 B:704-462-2127 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** • receipt 08/09/2016 09.45 Page 1 of