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HomeMy WebLinkAboutEHPR-09-2016-24678.TIF THIS IS NOTA PERMIT Case # EHPR-09-2016-24678 < ,, 1 CATAWBA COUNTY HEALTH DEPARTMENT ❑' i• �n �❑' V91 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • • • r ti 3i /8 2 sM Environmental Health Plan Review - OSWP oe `o %I IMPROVEMENT Applicant JOHN VENABLE, 1047 GUS HILL RD, CLEMMONS NC 28673 C:3364621583 Land Owner STANLEY POPE, 109 BELLE RIVE DR,NINETY SIX SC 296669413 NAME TO APPEAR ON PERMIT John Venable SITE ADDRESS: 7162 NANCY LEE CIR, SHERRILLS FORD NC 28673 PIN # 460701066541 NAME of SUBDIVISION: MRS HARRY SHERRILLS UNREC Lot N Section/Block PROPERTY SIZE: Square Feet 25,264.80 Acres 0.58 DIRECTIONS: Hwy 150, Right onto Little Mtn Rd, Right onto Mt Pleasant Rd, Left onto Nancy Lee Circle , Lot is on the Left(almost at the end of the road) PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 480 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: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 50x60 #OF NEW BEDROOMS:: 4 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: IJ-ehapplicaiion 09/07/2016 10:21 Page 1 of 4 ,' CATAWBA COUNTY Case# EHPR-09-2016-24678 .C'~ � y\ Public Health Department Subdivision MRS HARRY SHERRILLS UNR <Ks& Y Environmental Health Division PIN# 460701066541 \" _ / PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 NAME ON PERMIT: (JOHN VENABLE), 1047 GUS HILL RD, CLEMMONS NC 28673 ( John Venable) Site Address: 7162 NANCY LEE CIR, SHERRILLS FORD NC 28673 Property Size: Square Feet 25,264.80 Acres 0.58 Directions: Hwy 150, Right onto Little Mtn Rd, Right onto Mt Pleasant Rd, Left onto Nancy Lee Circle , Lot is on the Left(almost at the end of the road) 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 accessi• = so th, a com.lete site - aluation can be performed. Date: LL((// 7 — aU/ (p Signature of Applicant or Agent _ An Environmental Health Specialist will contact you withi t working days of application date. If you need further information or assistanci'lease call 828-466-7291 AREA1 l FEENAME1n1�LtuiliaZl'il�I"a5i, tl 4y ' ill !1I ,'`iDATE'11GlLit ll9I1 'FEEAMOUNT�^ Improvement Permit Fee 09/07/2016 $150.00 �11ll�lll�il � � y TOTAL FEES l u�li %;���Ii�ln IlIq( �. , 5150000 oh 4WI .o I,°d�u W.LWI' IWidu._.WIII�IIt"s i .,.A,,,r,.S'.uu dwL� ,'."I:xIPH,J10IWIWII�IOiIY", '11��6 Wfllll>;i �iPllllllliltu �:J&:IJII��IL 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-ehappl ication 09/07/2016 10:21 Page 2 01,1 CATAwB e THIS IS NOT A PERMIT COUN Y e' �[ � CATAWBA COUNTY HEALTH DEPARTMENT p.m uA Application for Environmental Services Page 1 Improvement Permit Authorization to Construct❑ Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit j Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 7162 Nancy Lee Cir. Subdivision Mrs Harry Sherrills Unrec Sherrills Ford,NC 28673 Lot# Acres Section/Block/Phase Driving Directions to Property 1 A south exit 38 Hwy 150 tum right.tum right on little mountain rd.,turn right on mL pleasant rd.,turn left on nancy lee or.,lot is on the lett. NAME TO APPEAR ON PERMIT? El Owner ❑t Applicant ❑ Contractor Applicant Contact Information Name John Venable Address 1047 Gus Hill Rd.Clemmons,NC 27012 Phone Cell Phone 336-462-1583 Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner 0 Applicant ❑ Contractor Description of Existing Structures on Site #of Bedrooms st Structure Dimensions #of Occupants Basement El Yes ❑ No 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. C Yes ID No Does the site contain any jurisdictional wetlands? O Yes a No Does the site contain any existing wastewater systems? ❑Yes CI No Is any wastewater going to be generated on the site other than domestic sewage? CI Yes O No Is the site subject to approval by any other public agency? ®Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well Li Community Well Semi-Public Well 0 County/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) ❑ Accepted 0 Alternative 8 Conventional 0 Innovative 0 Other 0 Any CATAWBA THIS IS NOT A PERMIT COUNTY AATat onfor BA CEAABAO HEALTH DEPARTMENT al Services Page 2 Proposed Facility Type U Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *t 4 Project Description New construction 4 bedroom home Structure Dimensio 5 U X 60 #of Occupants 2 Basement 0 Yes 0 No Basement Fixtures O Yes a No LI Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes 0 No Plumbing 0 Yes ❑ No Describe Plumbing Needed U Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions U Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft.) U Business Specific Type of Business Retail Floor Space #of Employees per Shift # of Shifts U Other Facility Type Specify If Church#of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type r Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ 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 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 corners and making the site accessible so that a complete site evaluation can be performed. 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Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this repod.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 09/07/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460701066541 Owner: POPE STANLEY R Parcel Address: 7162 NANCY LEE CIR Owner2: POPE POLLY F City: SHERRILLS FORD, 28673 Address: 109 BELLE RIVE DR LRK(REID): 11810 Address2: Deed Book/Page: 1920/0891 City: NINETY SIX Subdivision: MRS HARRY SHERRILLS UNREC State/Zip: SC 29666-9413 Lots/Block: / Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: LAKE NORMAN Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: .580 Tax Map: 011 BX 01003 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 2700 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: $132,700 Zoning3: Assessed Total Value: $132,700 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: 3010 WaterShed: WS-IV Critical Area 2010 Census Tract: 011501 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 hold 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=460701066541&typ=P 9/7/2016 Y'A CATAWBA COUNTY O� IOOA SOUTHWEST BLVD RECEIPT NEWTON,NORTH CAROLINA 28658 pi►e'u' PHONE: 828.465.8399 U l u' C Wednesday, September 7, 2016 1842 sM www.catawbacountync.gov PAYOR: Venable, John PAYMENTS TRANSACTION NUMBER: TRC-821044-07-09-2016 PAYMENT DATE : 09/07/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332401 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-09-2016-24678 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7162 NANCY LEE CIR, SHERRILLS FORD NC 28673 Applicant JOHN VENABLE, 1047 GUS HILL RD, CLEMMONS NC 28673 C:3364621583 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner STANLEY POPE, 109 BELLE RIVE DR, NINETY SIX SC 296669413 receipt 09/07/2016 10:21 Page 1 of 1