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HomeMy WebLinkAboutEHPR-09-2016-24717.TIF 4g,A • THIS IS NOT A PERMIT Case # EHPR-09-2016-24717 Q CATAWBA COUNTY HEALTH DEPARTMENT0 ' "CO•" .0 la 1 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES T 1842 :M Environmental Health Plan Review - OSWP yPo 3•'0+ tt.o y�. IMPROVEMENT 1.t. o Owner DAVID& RUTH WALTHALL, 6208 SPLITROCK TRAIL, APEX NC 27502 H:919772818313:9192102559 C:919-880-1013 HOME:9197728183 NAME TO APPEAR ON PERMIT David & Ruth Walthall SITE ADDRESS: 8455 SHERRYN RUN, TERRELL NC 28682 PIN # 461601493758 NAME of SUBDIVISION: Lot# 1 Section/Block PROPERTY SIZE: Square Feet 77,014.08 Acres 1.768 DIRECTIONS: HWY 150 to Kiser Island Rd, go abour 1 mile, Right onto Sherryn Rd, 1st house on the left will be in the 2nd curve. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 600 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Subdividing* Mobile home existing on the property will be removed prior to building new home. New home will be 5 BdRms Total. Initial home will be 3 BdRms & in the future the basement will be finished with an additional 2 BdRms. *Existing well will need to be Abandoned & new well will be required. *New Septic for property. 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 DW 28x52 & Shed 8x8 (All to be removed) EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 90x83 #OF NEW BEDROOMS:: 5 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: G9-ehapplicatinn 09/13/2016 15:04 Page 1 of4 „v,A CATAWBA COUNTY Case# EHPR-09-2016-2471 7 ,Q 31 eiS Public Health Department Subdivision „'s, Environmental Health Division PIN# 461601493758 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 /842 :. NAME ON PERMIT: ( DAVID& RUTH WALTHALL), 6208 SPLITROCK TRAIL, APEX NC 27502 ( David & Ruth Walthall) Site Address: 8455 SI-IERRYN RUN, TERRELL NC 28682 Property Size: Square Feet 77,014.08 Acres 1.768 Directions: HWY 150 to Kiser Island Rd, go abour 1 mile, Right onto Sherryn Rd, 1st house on the left will be in the 2nd curve. 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 ru - . I understand that I am solely responsible for the proper identification a d lab ng of all property lines and corners and making the site acee--,.�yr, so a e !, : e-it- e .lu..:.. -.n be performed. Date: 9 /,3 `6 Signature of Applicant or Agent �/ ”///�, Pt An Environmental Health Specialist will contact you within 5 working days of application :ate. If you need further information or assistance please call 828-466-7291 AREA1 .LEE rtA E 16"r$„.11I IiI 1I! 1111c Ji Pr ll FIl .I118111111I' DATEII OFEEAMOIUNITii'` Improvement Permit Fee 09/13/2016 p $150.00 1Tf 'f =TOTAL FES'Ul,pl;i�fl i it�u!p ' ',h ti 1 ! r 6rt .t d I IHIkmv- � d h� �� �uouilu�rraa 1 9I� 1��8ll�llllill'�P� '"`�(�IIEr '�! I $lsoroo �I 1J hit ill yl i.Paiiu.S ,{ lMNIIHIJIIIIP VuIIIIWr i*illiiWJJia., yi mitiilli:i d 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-ehapplication 09/13/2016 15:04 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT Z�O`) cou�Tr V A1t� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I Improvement Permit• Authorization to Construct❑ Septic Repair❑ Septic Malfunction ❑ Septic Expansion D New Well Permit❑ Replacement Well 1 Well Abandonment Well Repair ❑ Existing System Inspection (Pre-Approval Required) ] Application is for New Construction • Existing Facility ❑ Property Address$455.Sherrym.Runh Subdivision Ruth S.and David G.Walthall Family Subdivision Terrell, NC Lot# i Acres 1.768+/- Section/Block/Phase Driving Directions to Property NC Hwy 150 to Kiser Island Rd,South on Kiser Is.Rd approx 1 mile+, Right on Sherryn Run,first house on left will be in the 2nd curve. NAME TO APPEAR ON PERMIT? • Owner Ti Applicant P Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name Ruth S.and David G.Walthall Address6208 Split Rock Trail,Apex, NC,27539 Phone 919-772-8183 Cell Phone David:919-880-1013, Ruth: 919-210-2559 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ] Applicant ❑ Contractor Description of Existing Structures on Site Doublewide mobile home Ito be removed),one e've'shed to be demolished # of Bedrooms *j'3 Structure Dimensions 28'x 52' #of Occupants 2 part time Basement [ Yes L No Basement Fixtures C Yes ;O 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. lithe answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes 0 N Does the site contain any jurisdictional wetlands? CRC-Otwp-O , FPM -0 0 Yes ® No Does the site contain any existing wastewater systems? ID Yes U No Is any wastewater going to be generated on the site other than domestic sewage? e YesNo Is the site subject to approval by any other public agency? ® Yes 0 No Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes Q 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) O Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other E" Any C ATAvv A THIS IS NOT A PERMIT COUNTY L➢L CATAWBA COUNTY HEALTH DEPARTMENT „,� a,\�., Application for Environmental Services Page 2 Proposed Facility Type ❑� Primary Residence ■❑ New Residence n Addition to Residence # of New Bedrooms *t Project Description New 5 bedroom house with walk-out basement,to replace existing mobile home Structure Dimensions -gn'x 83' # of Occupants 2, (plus guests) Basement • Yes n No Basement Fixtures 0 Yes ®No Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions_ # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing L Yes ❑ No Describe Plumbing Needed Multi-Family Residence# Units #Bedrooms per Unit*t Total# Bedrooms *j Structure Dimensions I I 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 ❑ Other Facility Type Specify If Church#of Seats Kitchen n Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑s Individual Well n Semi-Public Well ❑ Community Well Abandonment Type • Drilled LJ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑� No Describe Current well and State setback prevents desired siting of new house. Calculated Design Flow, Commercial t Additional information may he 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 � C � r7:/: S Date '7/f 3,/2O(C, Printed Name of Owner or Agent 4=1)LV 11. 6 - LSA LZ(-(/{. 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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 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 09/13/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461601493758 Owner: WALTHALL DAVID GLENN Parcel Address: 8455 SHERRYN RUN Owner2: WALTHALL RUTH SHERRILL City: TERRELL, 28682 Address: 6208 SPLITROCK TR LRK(REID): 14571 Address2: Deed Book/Page: 3265/1441 City: APEX Subdivision: State/Zip: NC 27502-9778 Lots/Block: 1 & ADJ/ Last Sale: School Information: School District: COUNTY Plat Book/Page: 69/108 Legal: LOT 1 & ADJ PLAT 69-108 Elementary School: SHERRILLS FORD Middle School: MILL CREEK Calculated Acreage: 4.850 Tax Map: 013EX 03005 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 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: $75,400 Zoning2: Land Value: $617,600 Zoning3: Assessed Total Value: $693,000 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1990/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permits for this parcel. Firm Panel #: 3710461600L Building Details 2010 Census Block: 5017 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 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=461601493758&typ=P 9/13/2016 CATAWBA COUNTY ft �� ION, SH CARLVD CAROLINA 28658 0114 PHONE: 828.465.8399 U k vo , C Tuesday, September 13, 2016 1842 SM www.catawbacountync.gov PAYOR: Walthall, David& Ruth PAYMENTS TRANSACTION NUMBER: TRC-831803-13-09-2016 PAYMENT DATE : 09/13/2016 PAYMENT TYPE: Check 9203 INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332626 Improvement Permit Fee 5150.00 TOTAL PAYMENTS : $150.00 EHPR-09-2016-24717 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8455 SHERRYN RUN, TERRELL NC 28682 Owner DAVID& RUTH WALTHALL, 6208 SPLITROCK TRAIL, APEX NC 27502 H:9197728183B:9192102559C:919-880-1013 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 09/13/2016 15.04 Page I of 1