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HomeMy WebLinkAboutEHPR-09-2016-24695.TIF "g,A OG THIS IS NOTA PERMIT Case # EHPR-09-2016-24695 CATAWBA COUNTY HEALTH DEPARTMENT 'a • • �EI 4'!/1///� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES • /184 G sm Environmental Health Plan Review - OSWP rN IMPROVEMENT { 'cii vo11`; � Applicant J &Z PROPERTIES (JOAN IEREMCIUC), 2488 BRANCH RIDGE DR, LINCOLNTON NC 28092 C:9802415423 Land Owner RONALD BENFIELD,4895 HICKORY LINCOLNTON HWY, LINCOLNTON NC 28092 C:8286388923 NAME TO APPEAR ON PERMIT J & Z Properties (loan leremciuc) SITE ADDRESS: 3438 SWEETGUM LN, LINCOLNTON NC 28092 PIN # 361702565719 NAME of SUBDIVISION: BLACKBURN RIDGE PH 2 Lot# 30 Section/Block PROPERTY SIZE: Square Feet 20,037.60 Acres 0.46 DIRECTIONS: Hwy 321 South to Startown Rd, Right onto Blackburn Bridge Rd, Right onto Woodgreen Dr, Right onto Sweetgum Rd, 2nd House 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:: House 50x60 #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: 19-ehapplication 09/09/2016 10:37 Page 1 of4 CATAWBA COUNTY Case# EHPR-09-2016-24695 T Alai Public Health Department Subdivision BLACKBURN RIDGE PH 2 Environmental Health Division PIN# 361702565719 PO Box 389, 100-A Southwest Blvd.Newton.NC 28658 18.2 SM NAME ON PERMIT: J &Z PROPERTIES ( LOAN IEREMCIUC),2488 BRANCH RIDGE DR, LINCOLNTON NC 28092 J & Z Properties ( loan leremciuc) Site Address: 3438 SWEETGUM LN, LINCOLNTON NC 28092 Property Size: Square Feet 20,037.60 Acres 0.46 Directions: Hwy 321 South to Startown Rd, Right onto Blackburn Bridge Rd, Right onto Woodgreen Dr, Right onto Sweetgum Rd, 2nd House 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, d rules. I understapolfta(I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complets.sitevaluation can be performed. Date: 9. �J- l6 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 AREA2 FCENA�1NIEl . �� 11Pr I �ii��IIIE I ) 1st 111II JjgDATE � FEE"AIMOUNIF 111 1 v 1:i. 1i�� IIS dh�hl ul inF uI�,I��i ill���du� llif 1"411 F PA inJ Improvement Permit Fee 09/09/2016 $150.00 , t �'lh +'ql i 'illillllll(NVii�"' l iIhih}lrlI ' '{lir 1''$1 so'oo,r; u.t jl TOTALPEES��Iiklllll�llllIIII11tlilfl IIIIiIIIPaI���IIT1, 11111i I allhi, , -x.11 r? .1 tdG .' .;k 1{Walllii `"'1�u n u,lLihl➢6NV111U�hJ 11111/11 6 t y3,��.n t2lthl111UIW,lIa"' aan11111SklbJ tl ill°4LliWa�IWL.tlILIIN'° FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN ANDIOR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplicatinn 09/09/2016 10:37 Page 2 of4 CATAWBA THIS IS NOT A PERMIT couNry CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit Authorization to Construct ❑ Septic Repair E Septic Malfunction ❑ Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment E. Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction Existing Facility ❑ Property Address 3 ci j rS S7 Ub.,E t C U /t'\ L::t^. Subdivision Q LAh k nu R. hl R 6 L Lot# 3 CJ Acres Section/ lock/Phase Driving Directions to Property 3 1 I 4L )\,* cA- $ NAME TO APPEAR ON PERMIT? ❑ Owner ❑k Applicant ❑ Contractor Applicant Contact Information Name ,d Q Address '(. L</ yrS' iS 2 (N;0 IAC 1 H R1-Q C Phone Cell Phone 5s 0 2 to 15 el ? .3 Owner Contact Lrformation Name (L 0 I\ la. B t I Address Phone ,( if t; 2 — 2 Cell Phone a)2 J C 3 E S 2 '3 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? [ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site \AASArtf - # of Bedrooms *j. Structure Dimensions #of Occupants Basement ❑ 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. Yes 0No Does the site contain any jurisdictional wetlands? fl Yes 0 No Does the site contain any existing wastewater systems? fl Yes ' No Is any wastewater going to be generated on the site other than domestic sewage? ® Yes I ,No Is the site subject to approval by any other public agency? io Yes tiNo 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 ❑ 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) U❑ Accepted 0 Alternative IXConventional 0 Innovative 0 Other 0 Any CATA A THIS IS NOT A PERMIT COUNTYV 1JLy CATAWBA COUNTY HEALTH DEPARTMENT „c„;,—;;;;;;;-,...., Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence Ti New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions .50., 60 #of Occupants Basement Yes ❑ No Basement Fixtures ® No L Accessory Structure(s) Describe #of New Bedrooms *1* if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence ft Units #Bedrooms per Unit*t Total # Bedrooms *t 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 n 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 fiiture 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 pennit 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 l 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 — Date - 1. /6/ Printed Name of Owner or Agent 7 04 N T ft L I-( C ,Lu-e Catawba County Environmental Health 0 832 -f h. t ' ��1, EI�liiy!I ir0 Am. S ittr kt. " e, �If i i�iryr m¢YI Midi � .q� nphti. ;t 7 ppi ��11Y' I it I �l rt�c v � Ifs .IIB�� �� !• I i . 1'IIi��illitto �' ire `tiii II� �, : , I i' 19 . r • i (t'ta'65nm0 ,, �l '��� - � li �Q -Op 4 101'W'(i .344s Al.IIlli ;'tsi�� ` i�r� �t�i ielI rill Ail' I! J Ihii �l .I �1iii h9H 'i` 1l r I giPI Ito 14 iRatta '144, I. e `"Cl Cp ,1 '" lit . ti I( Irl �( I HH fl;�'�� °"/3;�f In 1111;C ul"' ' 122 0011. 3438 4. 0 1� j`• / * 86.93 El/ SWEETGUM IN 105.06 92.75 11.0cr) 64.47 84.70 sy ai R .3439 I •342 Parcel: 361702565719, 3438 SWEETGUM LN lin=50ft LINCOLNTON, 28092 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 09/09/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 361702565719 Owner: BENFIELD RONALD D Parcel Address: 3438 SWEETGUM LN Owner2: City: LINCOLNTON, 28092 Address: 4895 HICKORY LINCOLNTON HWY LRK(REID): 700481 Address2: Deed Book/Page: 2721/0030 City: LINCOLNTON Subdivision: BLACKBURN RIDGE PH 2 State/Zip: NC 28092-5803 Lots/Block: 30/ School Information: Last Sale: Plat Book/Page: 47/39 School District: COUNTY Elementary School: BLACKBURN Legal: Calculated Acreage: .460 Middle School: JACOBS FORK Tax Map: High School: FRED T FOARD Township: JACOBS FORK School Map State Road #: 2134 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $15,000 Zoning3: Assessed Total Value: $15,000 Zoning Overlay: ED-O Year Built/Remodeled: / Small Area: STARTOWN Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710360600J Building Details 2010 Census Block: 1042 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P3 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=361702565719&typ=P 9/9/2016 4'p' CATAWBA COUNTY �{r 100A SOUTHWEST BLVD E-7( a$� t NEWTON,NORTH CAROLINA 28658 RECEIPT �ppx�y�,Rj PHONE: 828.465.8399 O y: �r Friday, September 9, 2016 `ti4�18www.catawbacountync.gov PAYOR: J & Z Properties 18:.Z Properties(Ieremciuc, loan) PAYMENTS TRANSACTION NUMBER: TRC-824415-09-09-2016 PAYMENT DATE : 09/09/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332497 Improvement Permit Fee $150.00 TOTAL PAYMENTS : 5150.00 EHPR-09-2016-24695 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3438 SWEETGUM LN, LINCOLNTON NC 28092 Applicant J &Z PROPERTIES, 2488 BRANCH RIDGE DR, LINCOLNTON NC 28092 C:9802415423 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Land Owner RONALD BENFIELD,4895 HICKORY LINCOLNTON HWY, LINCOLNTON NC 28092 C:8286388923 receipt 09/09/2016 10:37 Page 1 or I