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HomeMy WebLinkAboutEHPR-08-2016-24564.TIF N4�,A • THIS IS NOTA PERMIT Case # EHPR-08-2016-24564 ft filo »� CATAWBA COUNTY HEALTH DEPARTMENT ❑° _ 'li:P'fE1 v �' PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 MO Environmental Health Plan Review - OSWP p dh7.o n 4 IMPROVEMENT . • • Applicant DARRIN GROOMS, 207 PERIWINKLE ST, LINCOLNTON NC 28092 C:7045307085 Contractor W.I.T. CONCRETE CONSTRUCTION (MITCHELL EDMONDSON), 396 SHERRILL FARM RD, LINCOLNTON NC 28092- C:7049134471 Owner CAROLYN WATERS SCHRUM, 2275 STARTOWN RD, LINCOLNTON NC 28092 NAME TO APPEAR ON PERMIT Carolyn Waters Schrum SITE ADDRESS: 7128 VINEWOOD RD, SHERRILLS FORD NC 28673 PIN # 460717006611 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 19,602.00 Acres 0.45 DIRECTIONS: Hwy 150, Left on Vinewood Rd &to the end of the road on Right. PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase* Old septic on the property. Wanting to put in a new septic system & use the existing well if possible. 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot(old home has been demo'd) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40x60 #OF NEW BEDROOMS:: 3 BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-eliapplicalion 08/23/2016 09:48 Page 1 of4 svy.:Lcr, CATAWBA COUNTY Case# EHPR-08-2016-24564 ,Ci t.ttiV Public Health Department Subdivision e, isp K Environmental Health Division PIN# 460717006611 ®" -4" PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 /8.2 6 NAME ON PERMIT: (CAROLYN WATERS SCHRUM), 2275 STARTOWN RD, LINCOLNTON NC 28092 ( Carolyn Waters Schrum) Site Address: 7128 VINEWOOD RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 19,602.00 Acres 0.45 Directions: Hwy 150, Left on Vinewood Rd &to the end of the road on Right. 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 re..nnsible for the proper identification and labeling of all property lines and corners and making the site accessible so that as plete site evatator se-be performed. Date: k-.'t 3 "/ L Signature of Applicant or Agent �/ �_ ' An Environmental Health Specialist will contact you withi' . wor ing days of application date. If you need further information or assistance please call 828-466-7291 AREA1 FEENAIEn.,1 —'gm laI'll N,I ji?1ml'J: y a Ti lI i. �IP 2.glt I PIIRIIrsir,"-t _I. W11h4,i,drl li :WI"' , ,�d...dliA, "DATE1 8lil�FEEAMOUNT_J Improvement Permit Fee 08/23/2016 $150.00 'fill '= '11GTOTAL,'FEES ,i' °clilll4;.�4i1+bi11a111llitl'llititliuitlhi lit ;rallil�;.. SI 50.941 �(I Ojlr, .�I?.�imtiil login.as - , muvel111il0111a211 ;: r i;( 211B1W11IBflhi ,:laIIVfi -�Llur'Lluir,, . .al,diiliL FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 139-chapplicalion 08/23/2016 09:48 Page 2 of4 CATAWBA THIS I S NOT A PERMIT _arrcouN, , �, � CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page ? • Improvement PermiK Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion rl New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair H Existing System Inspection (Pre-Approval Required) • ❑ Application is for New Construction X Existing Facility ❑ Property Address 7/a5 Oi 'rye Woo() /4' Subdivision 4 <heal/s 77) i A/A 2447i Lot# Acres _ Section/Block/Phase Driving Directions to Property /370 /ems on- u' 00e' 67-4- A A .4- AA NAME TO APPEAR ON PERtMIT? caner ❑ Applicant ❑ Contractor Applicant Contact Information Name (2l4-ti2,r (a Qoeto S Address ) t7 PCfi , 1O/e St, ,n eQ/rv,v /t( C2jug S �- Phone 7 0 t( - 5e/ p 7 0 CS Cell Phone Owner Contact Information Name C•QQ vi / wA/L,'1 S •$ 1-Ac U�✓�- Address l) 7 S SYAaY9Ju),.✓ j,9. L, � CO bet? A/C' ?ji f Phone Cell Phone 70 ti 5 lJ 7e r Contractor Contact Information Name Al,/chef/ A✓rr!✓r //): �J 4. Address 39& f'heal 159,eM /1/1' L; peel rr.✓ /t/_z. Phone •7o q -4n -t q / Cell Phone 1 o y -qi 3 -y y'7 i - f.Jc.LI7 -.2-3,Sr WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicantontractor Description of Existing Structures on Site S. �,A .i W a. _x. A Al a ". is. •# of Bedrooms *'r Structure Dimensions • of Occupants rM1 (�O Basement 7 Yes ❑ No Basement Fixtures 0 Yes 0 No Jt c 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. El Yes 'Trig-El Does the site contain any jurisdictional wetlands? ® No Does the site contain any existing wastewater systems? Yes OC Is any wastewater going to be generated on the site other than domestic sewage? Ei Yes Olfr Is the site subject to approval by any other public agency? Yes Are there any easements or right of ways on this property? Describe Existing water supply in use a Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ••••11-6— If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): systems can be ranked in order of your erence) ❑ Accepted 0 Alternative Conventional 0 Innovative 0 Other 0 Any CATAVV 17A THIS IS NOT A PERMIT COUNTY - _ CATAWBA COUNTY HEALTH DEPARTMENT No„,;o;„;e` Application for Environmental Services Page 2 Proposed Facility Type 3 p 7 Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *j' Project Description O N Lw h AA- w 0., jc yt c-÷- .4c - t— .4`J Structure Dimensio 1i u t< t # of Occupants 2 Basement es [ No Basement Fixtures n Yes ® No E Accessory Structure(s) Describe # of New Bedrooms *j if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing I— 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 ❑ 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 ❑ 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 roomthat 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Date. Z3 - l Printed Name of Owner or Agent Vt/G t/ fd,ti Catawba County Environmental Health ii a q I nn, Iu t x^tsa. :, i�hs ,f, l• ;,k { y a h ` � , ✓ fl �q�� III .,QG Q8 "t4i Iit 114{• i l i 1 I�` f'fC IIIA II i {t I o li i r e , "------Th.„ i 122) ;U�I�Alt�1�o° � ,� t1 l"r�i I kill �'"�1 .9 2 . :I1 h, n.l .a.s8iil j i I'94. • F ,i�4 r �d� i}i{ i lin 11111E li 1111 1 119ir,ttin .'U, , t4.;�1 ,l,V 11 �I ti , '� II I r% : `kelt LI t , � i4 I 11 09 �; pL'4, . ��U'�' ',r p �� ! '( 1 a11r1. �ff:�1r'U" l �I I �, ti' r �ll II 1 S at 6a1, r5� y4 Ijl 11qp illhl11:4 I i 1{ Ij � t t 11:4 ,�e. iII it'dI�I� I 4' 'ia , !. Ill{ tr J ��it r a e I ,r 1, ,' ' t�, 1�, , �,;,, ope44 LK. LT' 00454.11 II ill CO 16.'4 'en 49 7 If CD I a b ilk 111rJ.1117°MrbibM Ll i4 [ tIkill. '47:11J I ir. tI , cifh7 i1, I III wrwfr ' tp °:.,,. ) 7;11. fi l�l�l I' II LIPII(-? , `IIii I I� s,u� > I g1auti, ig Uyn, hii ill V 0' IA', i,1 aui.,1 ,* I I .1,1 I il ir.1,pr il II n. fl3i I`II it I1 tlt l d G 1 ' 1,1;,''I;I . t�'N�1�1�11 4 t i i1 II; l i t'i 4 •II I 'I L----1 : 1lill{.I i1 �,�i a1 ��' Jr."�IIWWfi� t dib r f 9NN1 Hi jA ,. &' 1v" 'v"d1i111111I1�I.'i''ntN[I.iti •,.:dIV:'t+� Parcel: 460717006611, 7128 VINEWOOD 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 08/23/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460717006611 Owner: WATERS CAROLYN SCHRUM Parcel Address: 7128 VINEWOOD RD Owner2: City: SHERRILLS FORD, 28673 Address: 2275 STARTOWN RD LRK(REID): 70721 Address2: Deed Book/Page: 0940/0249 City: LINCOLNTON Subdivision: State/Zip: NC 28092-9500 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Elementary School: SHERRILLS FORD Legal: LAKE NORMAN Calculated Acreage: .450 Middle School: MILL CREEK Tax Map: 011 X 04007E High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1949 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: $5,200 Zoning2: Land Value: $106,000 Zoning3: Assessed Total Value: $111,200 Zoning Overlay: CRC-O,WP-O,FPM-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 #: 3710460700J Building Details 2010 Census Block: 3035 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 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,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=460717006611&typ=P 8/23/2016 CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N° 0268 / DATE : �� C-; — 3 d OWNERpyzo , -01a ADDRESS BUILDINGGGGGGINCONTRACTOR} g SUBDIVISION LOCATION#/n_-47 -c"d2 /r4/2* VR S�Zn.il s 67 ` LOT SIZE BLOCK OR SE TION �qy; . HOUSE CV MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) n`"4 SEPTIC TANK: (SIZE GALS) WATER SUPPLY: NO. BEDROOMS NO FIXTURES INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT:YES (-T-70 ( ) IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : YES ( ) NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: SQ .FT. POLLUTION : FT. 1) NUMBER OF LINES SEPTIC TANK INSTALLED BY: 2) LENGTH AND WIDTH OF LINES PERMIT FEE $ a) BED SYSTEM ( ) CERT - . AT' OF "M 'L ON BY: b) TRENCH SYSTEM ( ) 3) DEPTH OF STONE IN LINES REMA' - ADEQUATE FALL (GRADE) ON : I) BUILDING (HOUSE) SEWER LINE : YES ( ) NO ( ) 2) NITRIFICATION LINES : DATE INSTALLED: YES ( ) NO ( ) SEPTIC ANK LAYOUT (G/I° ✓� x F U a y/ ✓ F � O HEALTH DEPARTMENT COPY Y'P' CATAWBA COUNTY 7" . ._ O� 100A SOUTHWEST BLVD t Y NEWTON,NORTH CAROLINA 28658 RECEIPT Q1cisre PHONE: 828.465.8399 U �j� Tuesday, August 23, 2016 1842 sM www.catawbacountync.gov PAYOR: W.I.T. Concrete Construction W.I.T. Concrete Construction(EDMONDSON, MITCHELL) PAYMENTS TRANSACTION NUMBER: TRC-796205-23-08-2016 PAYMENT DATE : 08/23/2016 PAYMENT TYPE: Check 3294 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331891 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-08-2016-24564 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7128 VINEWOOD RD, SHERRILLS FORD NC 28673 Applicant DARRIN GROOMS,207 PERIWINKLE ST, LINCOLNTON NC 28092 C:7045307085 Owner CAROLYN WATERS SCI-IRUM, 2275 STARTOWN RD, LINCOLNTON NC 28092 Contractor W.I.T. CONCRETE CONSTRUCTION, 396 SHERRILL FARM RD, LINCOLNI'ON NC 28092- C:7049134471 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/23/2016 09:47 Page I of I