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HomeMy WebLinkAboutEHPR-09-2016-24743.TIF ZEA •C., THIS IS NOT A PERMIT Case # EHPR-09-2016-24743 an.QTEER H CATAWBA COUNTY HEALTH DEPARTMENT ❑' 'rm. � ❑' int "b41Q'iO PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES r r /842 SM Environmental Health Plan Review - OSWP -o: erre‘in NEW WELL g o - n _ti. Land Owner DAMICO BETTY C LIVING TRUST, 550 OAK TREE RD, MOORESVILLE NC 281175919 Owner BETTY DAMICO, 550 OAK TREE RD, MOORESVILLE NC 28168 C:7046623178 NAME TO APPEAR ON PERMIT Betty Dam ico SITE ADDRESS: 8887 REEPSVILLE RD, VALE NC 28168 PIN # 360704811979 NAME of SUBDIVISION: MRS C C CANSLER PROPERTY Lot# PT 4 Section/Block PROPERTY SIZE: Square Feet 488,307.60 Acres 11.21 DIRECTIONS: Hwy 10, Left onto Hickory Lincolnton Hwy, Go past Grace Lutheran Church & Right ontot Reepsville Rd, The property is at the corner of Reepsville Rd & Paint Shop Rd. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: Well Permit Only* Well will serve the purpose of an irrigation well. There may be a future home on the property. Permitting the wet so that it can be used for the future home. Plat attached is a proposed future subdividing. Site plan reflects a potential home location & driveway. 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: ** NO STRUCTURE SELECTED ** FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: Vacant Lot NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: Possible Future Home 46x85 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO 139-ehapplicatuon 09/16/2016 13:47 Page I of 4 aan • CATAWBA COUNTY Case# EHPR-09-2016-24743 .Cy'jilt G Public Health Department Subdivision MRS C C CANSLER PROPER' < � K Environmental Health Division PIN# 360704811979 41- PO Box 389. 100-A Southwest Blvd,Newton. NC 28658 Ig42 s• NAME ON PERMIT: ( BETTY DAMICO), 550 OAK TREE RD, MOORESVILLE NC 28168 ( Betty Damico) Site Address: 8887 REEPSVILLE RD, VALE NC 28168 Property Size: Square Feet 488,307.60 Acres 11.21 Directions: Hwy 10, Left onto Hickory Lincolnton Hwy, Go past Grace Lutheran Church& Right ontot Reepsville Rd, The property is at the corner of Reepsville Rd & Paint Shop Rd. 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: I b — ll, Signature of Applicant or Agent .8,-77-,,,, Q. b'Qwvt.c U) An Environmental Health Specialist will contact you within 5 work\ig days of application date. If you need further information or assistance please call 828-466-7291 AREA2 *....*******.....**...**********.....**.........*..................*****............*.......*.............** I' .,,i �Ifllli I n,r h(I,. I I!! I l lllil 111�I!II»1" J it t I 101 illus;: , l ik nit , u llll .l< FEENAMEt„ iuf �� ll( ililli1 d iLl1 t''' IDATE'�Cr.uiJ FEE AMOUNT Well Permit& Inspection Fee 09/16/2016 $300.00 Ill �jillmoTA4EEskgd N1fi � ,� �I nI I iil ° 1ssoo 0t ) tv aplJ maim. ;iiiii I t..tutti ', %, "15`11=611111r ': +tilmer : WIfx,tlI1WllWtlj _ 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-ehapplication 09/16/2016 13:47 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT ccoouL�nT1L-�...V LJ CATAWBA COUNTY HEALTH DEPARTMENT New,.. Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct❑ Septic Repair ❑ Septic Malfunction Septic Expansion ❑ New Well PermitigReplacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ A F• tion is forNewConstruction C7 Existing Facility 4 Property Address( Y IVII/ 7 Subdivision tc t Lot # Acres JJJ "` Section/Block/Phase Driving Directions to Property �/w z- /0 '/N/-n / ft fir/ , /a 4fy - &rice/M 4,ct 4 A A c,02.v/ /hew 1iu.i R� cc, Gr Lic�hef zn Chi t-c-45 m/ n Zo sv;l//e 41 6operz4i b TK 5 S 5/nJSAof Al (an le-) NAME to APPEAR ON PERMIT? ❑ alivimer ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name T°4-4v C• '7 'AM ; c o Address _50I OOc,_k -ktee R00.J moil reser. 11 e , NC o2Rll'j Phone 70(4- l.174,1.- 3 I '7 R Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site "Lx # of Bedrooms *j Structure Dimensions # of Occupants Basement Ti Yes E. No Basement Fixtures a 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. O Yes JO No Does the site contain any jurisdictional wetlands? in Yes ® No Does the site contain any existing wastewater systems? 0 Yes ® No Is any wastewater going to be generated on the site other than domestic sewage? El Yes ®No Is the site subject to approval by any other public agency? O Yes II/No Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well U Community Well U Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes [✓No , 4 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 0 Any c ATA'II r A THIS IS NOT A PERMIT COUNTY j I CATAWBA COUNTY HEALTH DEPARTMENT ,/„11 Application for Environmental Services Page 2 Proposed Facility Type F Primary Residence ❑ New Residence n Addition to'Residence # of New Bedrooms *j Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures n Yes ® No ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes n No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*T Total#Bedrooms *7 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 I- Community Well Abandonment Type E Drilled D Bored ❑ Dug ❑ 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 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. Signature of Owner or Agent pfl C'. �'Qivl1;s] Date q_/(p_ /67 Printed Name of Owner or Agent Be4-}y 0 . ')',M•LC Catawba County Environmental Health ••/1 # \il er 2 a Jf(j�Jf' V co — eV: ` ,$4 , I��` e,O� 11 45.54 4.� ti°' u Alit , 00.r0 . ey �b� S i (902. - A'Qe to ti0,o 216) 4 I o S,l 8621 'Po Q 0 g V I Cl LU Cr I 141 i it ,ii 1 1, l(3 Ai i1',pf. .,r (340 # 4111111111111111L (70q) tth _�J/) (1031) � • Parcel: 360704811979, VALE, 28168 1 in=150ft 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 09/16/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 360704811979 Owner: DAMICO BETTY C LIVING TRUST Parcel Address: Owner2: City: VALE, 28168 Address: 550 OAK TREE RD LRK(REID): 14883 Address2: Deed Book/Page: 2431/0095 City: MOORESVILLE Subdivision: MRS C C CANSLER PROPERTY State/Zip: NC 28117-5919 Lots/Block: PT 4/ Last Sale: School Information: Plat Book/Page: 20/263 School District: COUNTY Legal: LOT PT 4 PT PARCEL 4 PL20-263 PL 20- Elementary School: BLACKBURN Middle School: JACOBS FORK 263 Calculated Acreage: 11.210 High School: FRED T FOARD Tax Map: 014 J 03008 Township: JACOBS FORK State Road #: 2024 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoning1: R-40 Building(s) Value: $0 Zoning2: Land Value: $88,000 Zoning3: Assessed Total Value: $88,000 Zoning Overlay: DWMH-O Year Built/Remodeled: / Small Area: PLATEAU Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710360600J Building Details 2010 Census Block: 1049 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P3 Agricultural District: Proximity Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina, All rights reserved. Bim) 2412_.2d http://gis.catawbacountync.gov/nomap/parcel_report.php?key=360704811979&typ=P 9/16/2016 y1$A CATAWBA COUNTY A CA 100A SOUTHWEST BLVD imp a NEWTON,NORTH CAROLINA 28658 RECEIPT vir np�oaPa PHONE: 828.465.8399 t,e► Friday, September 16, 2016 \ 78$4' SM www.catawbacountync.gov PAYORORR: Damico, Betty PAYMENTS TRANSACTION NUMBER: TRC-836705-16-09-2016 PAYMENT DATE : 09/16/2016 PAYMENT TYPE: Check 2206 INVOICE NUMBER FEE NAME FEE AMOUNT 09-16-332764 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS : $300.00 EHPR-09-2016-24743 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 8887 REEPSVILLE RD, VALE NC 28168 Land Owner DAMICO BETTY C LIVING TRUST, 550 OAK TREE RD, MOORESVILLE NC 281175919 Owner BETTY DAMICO, 550 OAK TREE RD, MOORESVILLE NC 28168 C:7046623178 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 09/16/2016 1317 Page 1 of 1