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HomeMy WebLinkAboutEHPR-09-2016-24652.TIF G THIS IS NOTA PERMIT Case # EHPR-09-2016-24652 Ell CATAWBA COUNTY HEALTH DEPARTMENT 0 • •c h•t0 "! , : ti � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r mit 1842 sM Environmental Health Plan Review - OSWP • e 'o o r _ _ 1 .1 IMPROVEMENT o pato ' Contractor HE OAKS GROUP, PA (KATHLEEN SAUNDERS), 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I Land Owner CAROLINA CENTERS LLC, PO BOX 3608, MOORESVILLE NC 28117 H:704-799-9770 HOME:704-799-9770 Owner BLUESHORE DIRECT INC, 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 C:7048978500 NAME TO APPEAR ON PERMIT Blueshore Direct Inc SITE ADDRESS: 4075 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 PIN # 460715627763 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 205,603.20 Acres 4.72 DIRECTIONS: Hwy 150, left onto Cheviot Hills, Lot is the first one on the LER PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing* 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: 8 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60 #OF NEW BEDROOMS:: 4 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: 1.9-eliapplicallon 09/02/2016 15.44 Page 1 of4 435 N CATAWBA COUNTY Cased EHPR-09-2016-24652 :cc-yamGA Public Health Department Subdivision �®y, ,Hs, Environmental Health Division PIN# 460715627763 °tiH' PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 1842 S. NAME ON PERMIT: BLUESHORE DIRECT INC ( ), 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 Blueshore Direct Inc ( ) Site Address: 4075 CHEVLOT HILLS RD, SHERRILLS FORD NC 28673 Property Size: Square Feet 205,603.20 Acres 4.72 Directions: Hwy 150, left onto Cheviot Hills, Lot is the first one on the LER 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. Date: 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 AREA1 11'�r!.;k,""i Ii'�Tj„.�"7'�IhI'll�l��lii�nl'Li4t �111 '11�ill��l�rd'M�' -` 11i1i %�D`ATEar' �lii' FEE AMOONT,s b1FEENAME- irll� � ' ���� lliklmca ,w; � ', >rll�d��a� �� �d1�� ���S�J Improvement Permit Fee 09/02/2016 $150.00 �� TOTAI)'FEESI 111 s 114 i VI�p� 11111 ilpal n i al 1 1 d 011 l3o 00 a� `q�; ; I •. �i1u,�ICh ' 6119 IVIIii(hillllf,ill(I,�biIVlNtt�k ;1i16llili �1��� f; �'� I" .il •'mar ✓`w IIIA iir in " .r.LiGI 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-chapplicaiton 09/02/2016 15:44 Page 2 of 4 .4.\\,,A • THIS IS NOTA PERMIT Case # EHPR-09-2016-24652 -;.E"Ya►:m CATAWBA COUNTY HEALTH DEPARTMENT ❑' r.o " 1t( ?" PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICESPli ' 1842 sM Environmental Health Plan Review - OSWP * chero o f IMPROVEMENT _0 Contractor THE OAKS GROUP, PA (KATHLEEN SAUNDERS), 121 HOLT LN, MOORESVILLE NC 28117 C:704578495I Land Owner CAROLINA CENTERS LLC, PO BOX 3608, MOORESVILLE NC 28117 H:704-799-9770 HOME:704-799-9770 Owner . BLUESHORE DIRECT INC, 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 C:7048978500 NAME TO APPEAR ON PERMIT Blueshore Direct Inc SITE ADDRESS: , PIN # 460715627763 NAME of SUBDIVISION: Lot# 7 Section/Block PROPERTY SIZE: Square Feet 67,822.92 Acres 1.557 DIRECTIONS: Hwy 150, left onto Cheviot Hills, Lot is the first one on the LEft PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing* 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: 8 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60 #OF NEW BEDROOMS:: 4 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-ehapplication 09/02/2016 10:23 Page 1 oro Alai CATAWBA COUNTY Case# EHPR-09-2016-24652 hf4 ,y Public Health Department Subdivision C ;w�q ,; Environmental Health Division PIN# 460715627763 w PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 /8.2 ,M NAME ON PERMIT: BLUESHORE DIRECT INC ( ), 16415 NORTHCROSS DR SUITE B, HUNTERSVILLE NC 28078 Blueshore Direct Inc ( ) Site Address: Property Size: Square Feet 67,822.92 Acres 1.557 Directions: Hwy 150, left onto Cheviot Hills, Lot is the first one on the LER 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 acc ssible so that a codaite evaluation can be performed. Date: P12_//y) 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 AREA1 718 tii01 . '�) t$ i m..--a �Iproir* v:rFEENANIE ',l l#jllh.!1;121uw„d ;;IlitndI�IL.'�11 II' ” I( ` m DATC # !ul�i�FEE'AMOUN�T Improvementp�yyPermit Fee 09/02/2016 $150.00 lifir lifir TOTAL FE;ESIt�liiI illi lirillllrhli� M �' ,fie lla AI till.. _ ai { �i� e: al I x ri ��IsH� h l I 1_ ILJi v i i. YlU i, V i r i1st I IIf iii till �' we, . .gin Mr,,la r ul� .�ufu�8,dl g' u1p�IpI211II' ay,u�ru It r 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-ehappli cat ion 09/02/2016 10:23 Page 2 of 4 CAT ® THIS IS NOT A PERMIT cnu"ry 1 CATAWBA COUNTY HEALTH DEPARTMENT • • Application for Environmental Services Page I Improvement Permit Authorization to Construct❑ Septic Repair ❑ Septic Malfunction 0 Septic Expansion 0 New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction jtExisting Facility Property Address (.ileo /t ± /-4I I I S Subdivision N/P Sheri IIS lord, 1JC 2?(e73 Lot# 7 Acres / SS7 Section/Block/Phase Driving DitectioustoPtopeaty ISC,, 1 er-i cn (Nevi fr ni iS / /of is ZhCI oy-� sect NAME TO APPEAR ON PERMIT? A.42wner [ Applicant ❑ Contractor Applicant Contact Information Name HGr2 Di rec4 Trre Address Roti h Qr-4 CrOSS Dr s—te B Nuivi ts-cr f/e NC, 2 .3p78 Phone Cell Phone 70C/- gq7_ S oo Owner Contact Information Name Sar--e as Ct(:I�IiC�n+ Address Phone Cell Phone Contractor Contact Information Name nIC€en S w,vi(ler S / €inn-,a NeI-roe Address y i Fcl-F t n-icereSvi lte Phone Cell Phone 10 — 7 - 4957 WHO WILL DE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant 5TContractor Description of Existing Structures on Site S I- #of Bedrooms *j' 4 Structure Dimensions (001dOCl #of Occupants n-4c Basement ❑ Yes allo Basement Fixtures Q 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. ® Yes ,'No Does the site ontain any jurisdictional wetlands? El Yes liNo Does the site ontain any existing wastewater systems? fl Yes .No Is any waste ater going to be generated on the site other than domestic sewage? ® Yes ,ItlNo Is the site sub'ect to approval by any other public agency? ® Yes TING Are there any easements or right of ways on this property? Describe Existing water supply in use dividual Well ❑ Community Well Li Semi-Public Well County/City/Township Water Line Is a public water supply available? ** ❑ Yes '®,No If applying for an Improvement P mit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of yotir preference) ❑ Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other 0 Any CATAWBA_ THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT • norn+Wnllnn : Application for Environmental Services Page 2 Proposed Facility Type 121- Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description SEt Structure Dimensions SC 'i1 # of Occupants Q y-1461x Basement E Yes No Basement Fixtures ® Yes CM No Lf Accessory Structure(s) Describe #of New Bedrooms *j if applicable Structure Dimensions # of Occupants Accessory Dwelling _ Yes ❑ No Plumbing ❑Yes No Describe Plumbing Needed 1] Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *j' Structure Dimensions L Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area (Sq. Ft.) 1_1 Business Specific Type of Business Retail Floor Space #of Employees per Shift #of Shifts 0 Other Facility Type Specify If Church#of Seats Kitchen E. Yes No If Daycare•Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well 0 Semi-Public Well 0 Community Well Abandonment Type ❑ Drilled ❑ Bored 0 Dug [ 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 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 fume. t If structure is plutribedbut 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 '" ` � 1 Date 9/2//(43 Printed Name of Owner or Agent E m PY\w He /ten ..`9 16Nzr ,y�/.w ,.. ..-.... - - ^`yt'-f �I fie'i +'a _ - E. 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L..z �/ FP' i 1:. .I ptttptt tt„,,,,,„,,,,t,,,,,...,Ttettl.,tt tnett:tt,,,,,,,,-tt,p,tetptp6tet,:ty,6,,tpt,„.„ A og;E„6 OP e:c.6„„ 1rZ• \; I, pee, GRAPHIC SCALE II 7.1 _� �� .....---c.... `?„.r. m srm—��ca i �om_® ms = 777 FWL 1t 6606-667P Cn6.60 5Y .,„,....,..„55.„.,:„..: 5,555.5„.......55„,_....,„.55.55, i SURVEYAND IMP PREPARED BE I ER z i, LAKE NORMAN SI:RVF,YI\G I -mss S.T .td L{f U1 1Al. 63 PG. 12% .I S MAPPING PLLC . r, ..e.= _ ac e. /J/ ^. Jenny g Rd. 'I CATAV EA ✓ I Efale nIl \orl aroma 28525 II ° "•°-,`• F C. 1. AUG ..,e 'iI (Jo4) 573 ,5o Fox (70.) 076-4451_1i It'p)m N UN�waE N 4 I � zzwz IN i ' '.� I W 1 KW) A r .-.m p. 0N 1--o Q Z o Sgt 3rti„9j za�OoCCN W W S `^\ tot U co Q V) 0 I p y" 5 01 M/ 8t NI ro m ce . ' W wre r �p Qg •�.09 Sod St \ J a' I a rZ}°'°- mi a• 1-7 tNI/ U +IJgi 996L & 1 --\84 V'r^ O nOiL3.Z_I a2 ,, 'toy aS --\- ZIG'i 05 OOOa W W = la r / G3 i= I CC ) 0 a ,.: co sv �.2 r --\ a V r, ) /4 0C qC3 yr • M•<d b��L " \ - 2 �*Q. "'w,/�0 7-....„„ ' i) N b 'b I o t6' ....•^ • ..1$_,-Z- 710 _ cI't• a • �* L 6'1> CV 0) a 173 I I�es. / l • �m f _ �1b101) FIN". / .Y A cow 1 ''~ v .(vg]o N � 0 ‘.1.1 (002 � nao we • • � � . % w71 �`DQZz /�c1 I— G5 sr7 / E"E., 0Nw Qrn / z0 N z 00 ," - w<4osv 0o 0! • z U Q o E-,-, wZ � � a� m "�: f d a u o 1 r zv) my ¢p N "� .J O W h4p9Eair h F .int. `q ../ 0o.-1 za0 16' .050 . Q�' ,�? 1:4 C14 o z l 1 _ Sl7s c1 : l `nom / J U� ce F' 01� --r' 1 fn d J 6l u / ..rnC`,j' , OSi • / ' / I � coo CL3«� 6Lty / /' . / 3 ./ O / N 49 . 0`9� ' ,' M V Z ^O,,' DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet_of DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#: ON-SITE WATER PROTECTION BRANCH COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) OWNER: B(UESkktovt 'aired- APPLICATION DATE ADDRESS: DATE EVALUATED: ql( (I(p .S PROPOSED FACILITY: FR PROPOSED DESIGN FLOW(.1949): 1-48U PROPERTY SIZE: /,55 Ac' LOCATION OF SITE: °A U\in fir-taw. PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public *Well 0 Spring 0 Other EVALUATION METHOD: l,Aueer Boring ❑Pit 0 Cut TYPE OF WASTEWATER: „M Sewage 0 Industrial Process 0 Mixed a P i SOIL MORPHOLOGY OTHER 1 (1941) PROFILE FACTORS .1940 LANDSCAPE HORIZON POSITION/ DEPTHo PROFILE n SLOPE% (IN.) .194 CLASS .1941 .1941 SOIL .1943 .1956 .1944 STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SAPRO RESTR &LTAR • (V\to MINERALOGY COLOR DEPTH CLASS HORIZ - e 4 1 1.\to 7.79..5-_ L rc, ir., 1? 34 . koc _ -tQ n ' I( ( L F- scisp (? C :�.z. y� 141 ESO �I}i l'.'��V.I' '.al:.F t.1 c-- Jr-) 0 - :0 MoC;?, ._ '. H .. .. ". sr,- 2 a�9 L f t qq r ' r11 -, • ^ 7 2 5 .. �J DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): SITE CLASSIFICATION(.1948): Ps' AvailableSpace(.1945) —�- EVALUATED BY: 01S System Typds) y 1-7" OTHER(S)PRESENT: F L F-[ Site LTAR v �j Q,� COMMENTS: Updated February 2014 Parcel Report Page I of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460715627763 Owner: CAROLINA CENTERS LLC Parcel Address: CHEVLOT HILLS RD Owner2: City: SHERRILLS FORD, 28673 Address: 227 WEST TRADE ST STE 1000 LRK(REID): 802968 Address2: Deed Book/Page: 1898/0427 City: CHARLOTTE Subdivision: State/Zip: NC 28202 Lots/Block: / School Information: Last Sale: Plat Book/Page: 63/127 School District: COUNTY Legal: PL 63-127 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: 4.720 High School: BANDYS Tax Map: Township: MOUNTAIN CREEK State Road #: 1985 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: $0 Zoning2: Land Value: $64,900 Zoning3: Assessed Total Value: $64,900 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: / Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460700J Building Details 2010 Census Block: 3010 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P31 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees.agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. NQw &brsscLIogS Cheuk3f- —fi)b - ft{\ 1r55r) (.o ; 0 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460715627763&typ=P 9/2/2016 �$ k CATAWBA COUNTY � p IOOA SOUTHWEST BLVD ` �7 y NEWTON, NORTH CAROLINA 28658 RECEIPT a� eag PHONE: 828.465.8399 c) c% '0 41 Friday, September 2, 2016 1$42 sm www.calawbacountync.gov PAYOR: The Oaks Group, PA The Oaks Group, PA(Saunders, Kathleen) PAYMENTS TRANSACTION NUMBER: TRC-812842-02-09-2016 PAYMENT DATE 09/02/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332288 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 CASE TYPE: WORK CLASS: SITE ADDRESS: receipt 09/02/2016 10:21 Page I al 1