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HomeMy WebLinkAboutEHPR-08-2016-24488.TIF fY A THIS IS NOTA PERMIT Case # EHPR-08-2016-24488 a CATAWBA COUNTY HEALTH DEPARTMENT CPS' .c1- 1:1 Nt`-N49' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES TMJ I. •i 842 sM Environmental Health Plan Review - OSWP `° o IMPROVEMENT •• •Ff o, - } , Applicant JOAN E GARDNER, 8736 POPULAR LN, SHERRILLS FORD NC 28673- C:7046622045 Land Owner JAMES ASI-ITON, 635 W 8TH ST,NEWTON NC 28658 H:7047377660 C:7046637660 HOME:7047377660 NAME TO APPEAR ON PERMIT JOAN E GARDNER SITE ADDRESS: 8760 DOG LEG RD, SHERRILLS FORD NC 28673 PIN # 461902659208 NAME of SUBDIVISION: SHERWOOD SHORES Lot# 8 Section/Block B PROPERTY SIZE: Square Feel 29,620.80Acres 0.68 DIRECTIONS: Hwy 150 West onto Sherrills Ford Rd, Right onto Mollys Backbone Rd, Right onto Azalea, Left onto Dog Leg Rd, Lot is on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 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:: 41x37 #OF NEW BEDROOMS:: 3 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: E9-chapplieauon 08/10/2016 11:48 Page 1 of 4 ,aA CATAWBACOUNTY Case4 EHPR-08-2016-24488 .77- Public Health Department Subdivision SHERWOOD SHORES • aik<�- ne ,..c; Environmental Health Division PIM461902659208 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 g.2 ,M NAME ON PERMIT: (JOAN F GARDNER), 8736 POPULAR LN, SHERRILLS FORD NC 28673- ( JOAN E GARDNER) Site Address: 8760 DOG LEG RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 29,620.80 Acres 0.68 Directions: Hwy 150 West onto Sherrills Ford Rd, Right onto Mollys Backbone Rd, Right onto Azalea, Left onto Dog Leg Rd, Lot is on the 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 accessible so th t a co plete site evaluation can be performed. Date: G ) Signature of Applicant or Agents..—.) (5'502k (,v wt/ 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 illiIFEENAME1L��ubI b Ihi� .'y._u'wll��h�ll'llal�'�i ilo':i'�I 1!.11,4,1j1DATE r�u�i�IflEIIIti.FEE'fAMOUNT Improvement Permit Fee 08/10/2016 5150.00 h�pll.�r ,TOTALIFEEsimlL�hlii�illJ�l4ldlh��a.inic �' �u�r.. Jal II71u. 111i�II IIIu:;' $150 ooiyji .,t ���, r dl{Pf1161tlhI4G C W WW111LIhu�8G1 0 _ r' WIL'H41u;IWI11;2:r d I9 1 R� whilIi P e,°,iilil.d 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) E)-ehapplication 08/10/2016 11:48 Page 2 of4 CATAWBA BA CHIS IS NOT A PERMIT counry .,, CATAWBA COUNTY HEALTH DEPARTMENT sko,h—c;;;;;;C, Application for Environmental Services Page 1 Improvement Permit QQ Authorization to Construct Septic Repair n Septic Malfunction❑ Septic Expansion ❑ New Well Permit +.epfacement Well fl Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ 7Application is for New Construction a Existing Facility ❑ Property Address l (Q 0 DilMS 5 gel ' Subdivision S th,1 ShblitS Lot# Acres S ction/Bloc hale Driving Directions to Property ` -) ,UJ S -A-IrC�� o I i 2 , LW 1,�.� 4 t Xoc S�1Q , c,+ , ISA 9? Ifez , k 15, 1 cerjet) • k QsT 61) Loc - U NAME TO APPEAR ON PERMIT? H Owner IK Applicant E. Contractor Applicant Contact Information 4. Name p‘ e crece-m\ie p____ rr,, Address 2b 7 - ..)to e r `u, S wry,u,s � c\ C N to Phone "1tLi . Lap -J 1E)\--\ c Cell Phone r) . k a- ' ,� hUC Owner Contact Information Name C}a(ce c . ptVijLA) iAddress Phone ✓n t;4- - 1 r7 - — 1 (? (.e b Cell Phone 31 01) „ Leli.a _ "1 (p (p 0 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site WIALSTAII Ji #of Bedrooms *j Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ® 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. C Yes 'o Does the site contain any jurisdictional wetlands? C Yes 'o 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 o Is the site subject to approval by any other public agency? En Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ YesjNo 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 V CATACZ11J7 T[?A Ti-US IS NOT A PERMIT COUNTY j.VVVV CATAWBA COUNTY HEALTH DEPARTMENT ‘....•veee ,,,„��a,a„�a Application for Environmental Services Page 2 Proposed Facility Type aa ❑ Primary Residence ❑ New Residence D Addition to Residence # of New Bedrooms *j' _3 Project Description Structure Dimensions 'II 7 Occupants Basement ❑ Yes EC No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ] No Plumbing ❑ Yes ❑ No Describe Plumbing Needed E Multi-Family Residence# Units #Bedrooms per Unit*jt 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 ❑ 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 P Unknown Well Repair Requested 7 Yes n 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 Plow 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. • i Signature of Owner or Agent s G C9-(A4, nA - Date 0 ' ) l Printed Name of Owner or Agent ,� 0 PVA E. ( 1 e1~foE (� Catawba County Environmental Health irO 536.97""I Ili 1 r �� Jr . 125.00 85.00 l r .;.02 i 830 1 • / 1 I m r \ p I N f-- i 820 "11*******. 'Ls' oAI IN n� cn mlli 4jjj:jj 7. l D � re1/4° ' • • 805 125.°a aw151.51 lilt DQGLEG p cict, 70.2 95.00 r Parcel: 461902659208, 8760 DOG LEG RD 1 in=50ft 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 08/10/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461902659208 Owner: ASHTON JAMES C Parcel Address: 8760 DOG LEG RD Owner2: City: SHERRILLS FORD, 28673 Address: 635 W 8TH ST LRK(REID): 3990 Address2: Deed Book/Page: 1398/0172 City: NEWTON Subdivision: SHERWOOD SHORES State/Zip: NC 28658-3816 Lots/Block: 8/ B Last Sale: $6,000 on 1985-05-01 School Information: Plat Book/Page: 15/37 School District: COUNTY Legal: LOT 8 SHERWD SH PL 15-37 Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: .680 Tax Map: 004AX 02008 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 2713 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: $0 Zoning2: Land Value: $31,000 Zoning3: Assessed Total Value: $31,000 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: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710461900K Building Details 2010 Census Block: 2005 WaterShed: WS-IV Critical Area 2010 Census Tract: 011503 Voter Precinct: P31 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,arid 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/repos 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=461902659208&typ=P 8/10/2016 CATAWBA COUNTY ��A c ,, IOOASOUTHWESTBLVD " ' ' NEWTON, NORTH CAROLINA 28658 RECEIPT RTiirtG, _.FI d ��V►�,. PHONE: 828.465.8399 V ,411 `C Wednesday, August 10, 2016 K., �� / 1842 sM PHONE: PAYOR: GARDNER,JOAN E PAYMENTS TRANSACTION NUMBER: TRC-775128-10-08-2016 PAYMENT DATE : 08/10/2016 PAYMENT TYPE: Check 3068 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331432 Improvement Permit Fee 5150.00 TOTAL PAYMENTS : S150.00 EHPR-08-2016-24488 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8760 DOG LEG RD, SHERRILLS FORD NC 28673 Applicant JOAN E GARDNER, 8736 POPULAR LN, SHERRILLS FORD NC 28673- C:7046622045 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner JAMES ASHTON, 635 W 8TH ST,NEWTON NC 28658 H:7047377660C:7046637660 receipt 08/10/2016 11:48 Page 1 of I