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HomeMy WebLinkAboutEHPR-08-2016-24532.TIF �Y A THIS IS NOTA PERMIT Case # EHPR-08-2016-24532 e uv3.0 r CATAWBA COUNTY HEALTH DEPARTMENT ❑' ,'51 0 ":" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SM Environmental FIealth Plan Review - OSWP �, o IMPROVEMENT • Applicant BRUCE RHYNE, 3587 GORDON ST,TERRELL NC 28682 H:7045300129 C:7045303860 HOME:7045300129 Land Owner ELSIE KALE, PO BOX 957, DENVER NC 28037 NAME TO APPEAR ON PERMIT Bruce Rhyne SITE ADDRESS: 5132 SHERRILLS FORD RD, CATAWBA NC 28609 PIN # 378003325211 NAME of SUBDIVISION: MURRAYS MILL ESTATES Lot# 7 Section/Block PROPERTY SIZE: Square Feet 138,956.40 Acres 3.19 DIRECTIONS: Murrays Mill Rd, go about 2 miles & Left onto Sherrills Ford Rd, Lot is on the Left right before Corn Stalk Ln. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Public Water 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 House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 58'4"x 72"27" NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION #OF NEW BEDROOMS:: 4 BASEMENT? No BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 09-ehappl i cation 08/18/2016 15:13 Page 1 of 4 4aA CATAWBA COUNTY Case 6 EHPR-08-2016-24532 _T '© Public Health Department Subdivision MURRAYS MILL ESTATES 4:7�1 ,"! Environmental Health Division PIN# 378003325211 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 B.2 ,. NAME ON PERMIT: ( BRUCE RHYNE),3587 GORDON ST, TERRELL NC 28682 ( Bruce Rhyne) Site Address: 5132 SHERRILLS FORD RD, CATAWBA NC 28609 Property Size: Square Feet 138,956.40 Acres 3.19 Directions: Murrays Mill Rd, go about 2 miles& Left onto Sherrills Ford Rd, Lot is on the Left right before Corn Stalk Ln. 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 identificatio nd lab ling of all property lines and corners and making the site accessible/�so that a complete site evaluation can be performed. Date: r./477/(2 Signature of Applicant or Agent /�jw.ct. 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 !1 _ liE EENAME LIl,iasii LIDATE 1FEE AMOUNT Improvement Permit Fee 08/18/2016 $150.00 'r'—�1110il 11� ll� h' C' lil.lf4 II ROft it 1 1 I, �� I u4-�TOTA��FEEs ,,�1upill�k!iiVhls�hr�IH41�1!I�R�1RIi1!IfiIi�NBiIR�i' ali,�l��ll�t „aarlr�ilrl�$is000 ii li t1li�il I��IPF. ,,,�� /�i4� iliAA�Y�+� yllLilitllW4rm,. a,u��.nyt911lILu.WIIWWU'"''tl,•.,p,{,,<tillllltllLllLIlWWL71AU �!'J!M�_..tltldulW+` i 10t�i) 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-ehapplicatinn 08/18/2016 15:13 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT coun ,..„,,,...K=-=� CATAWBA COUNTY HEALTH DEPARTMENT Nonbcc Application for Environmental Services Page 1 Improvement Perm Authorization to Construct ❑ Septic Repair E Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well E Well Abandonment Well Repair n Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction X Existing Facility ❑ 1, Property Address 1 32 5%1R4 /4 f0ad Ad. Subdivision C,4-/&J& ;i6 a l Lot# Acres / Section/Block/Phase Driving Directions to Property MUfl44.y #,,/// -lo5//e.Z i4 /f r„ed /.�4d 6-o A n,3 „2,n;/,',,,s,„2,n;/,',,,s,.? , O,tcce /J LI 22,/4 T to/ ALS/ Augn724- LOT /S o/J /et/, /hi ovthe2 0/ ,S/,�n_2, Y4, Fold AC1 AAAI ( Ac s4//. (40)e-- NAME TO APPEAR ON PERMIT? girrOwner Pr-Applicant ❑ Contractor Applicant Contact Information Name a,q jc r Rfyyjut Address 5S7,766,4.Dap c/, %P,2fica() /JC ccF60c2- Phone '20C/ - 530 - bid,7 Cell Phone 20 y -57,1)-,%746 Owner Co act Infor ation Name fit€ fttL i Address .ft Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? I I Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site t - (- # of Bedrooms *t Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes a 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 i3"No Does the site contain any jurisdictional wetlands? ® Yes IQo Does the site contain any existing wastewater systems? C Yes C� �� Is any wastewater going to be generated on the site other than domestic sewage? ri Yes C3'No Is the site subject to approval by any other public agency? 0 Yeso Are there any easements or right of ways on this property? Describe Existing water supply in use H Individual Well ❑ Community Well ❑ Semi-Public Well my/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) 0 Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other Ca'Any C ATAT S MVV 7D A THIS IS NOT A PERMIT COUNTY .. CATAWBA COUNTY HEALTH DEPARTMENT �� N,„„;a,e,� Application for Environmental Services Page 2 ProposedopFacility Type D Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms 'j [� 4 Project Description% )gr Structure Dimensions 5F'y'X ?2 x 22 11#of Occupants Y Basement ❑ Yes 12"—No Basement Fixtures n Yes o ❑ Accessory Structure(s) Describe #of New Bedrooms *j' if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes H No Plumbing ❑ Yes ❑ No Describe Plumbing Needed H Multi-Family Residence# Units #Bedrooms per Unit*t . Total #Bedrooms **I 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 Occupahcy' Application for Well Construction/Abandonment/Repair Proposed Well Type [ Individual Well fl Semi-Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ 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. j 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 /J'u Date �/ // Printed Name of Owner or Agent /3"?Uc 24 v .)c Catawba County Environmental Health • ilPm9,ti.� , P h / / 0 Ni /i ` " �: ! / viNtilwit 58.00 / :.00 51.2 426,01 ,/tVc2 38.41 17.45 ,Ip ilirrtyq) O 7 Z •38.58 01 238.5' �7 1� Z t 1 i8y 'JO 50 722 0 460-°°• 4'-- SH�RRILL5 40R� cm (580) • �g8o -------\\ Parcel: 378003325211, 5132 SHERRILLS FORD 1in=80ft RD CATAWBA, 28609 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 08/18/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 378003325211 Owner: KALE ELSIE LITTLE Parcel Address: 5132 SHERRILLS FORD RD Owner2: City: CATAWBA, 28609 Address: PO BOX 957 LRK(REID): 300330 Address2: Deed Book/Page: 2991/0290 City: DENVER Subdivision: MURRAYS MILL ESTATES State/Zip: NC 28037-0957 Lots/Block: 7/ Last Sale: $40,000 on 2009-09-02 School Information: School District: COUNTY Plat Book/Page: 36/200 Legal: LOT 7 MURRAYS M PL 36-200 Elementary School: CATAWBA Middle School: MILL CREEK Calculated Acreage: 3.190 Tax Map: High School: BANDYS Township: CATAWBA School Map State Road #: 1848 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-20 Building(s) Value: $0 Zoning2: Land Value: $38,100 Zoning3: Assessed Total Value: $38,100 Zoning Overlay: 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 #: 3710378000J Building Details 2010 Census Block: 2005 WaterShed: WS-IV Protected Area 2010 Census Tract: 011501 Voter Precinct: P5 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=378003325211&typ=P 8/18/2016 ,aA Co CATAWBA COUNTY 7 4 ��r� 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT d " "'TVP PHONE: 828.465.8399 L vow, C Thursday, August 18, 2016 /842 SM www.catawbacountync.gov PAYOR: Rhyne, Bruce PAYMENTS TRANSACTION NUMBER: TRC-788842-18-08-2016 PAYMENT DATE : 08/18/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331768 Improvement Permit Fee 5150.00 TOTAL PAYMENTS : 5150.00 EHPR-08-2016-24532 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 5132 SHERRILLS FORD RD, CATAWBA NC 28609 Applicant BRUCE RHYNE, 3587 GORDON ST, TERRELL NC 28682 H:7045300129C:7045303860 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner ELSIE KALE, PO BOX 957, DENVER NC 28037 receipt 08/I8f2016 15.12 Page I of I