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Home My WebLink AboutEHPR-11-09-2497.TIF ti A Cpl THIS IS NOT A PERMIT Case # EHPR-l 1-09-2497 CATAWBA COUNTY HEALTH DEPARTMENT U qp `C Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - Repair APPLICANT OWNER CONTRACTOR KAELUE GERSICH KAELUE GERSICH 7023 TALLENT CT 7023 TALLENT CT SHERRILLS FORD NC 28673 SHERRILLS FORD NC 28673 828-315-1030 828-315-1030 NAME TO APPEAR ON PERMIT KAELUE GERSICH Pin#: 369704945833 SITE ADDRESS: 7023 TALLENT CT, Sherrills Ford, NC DIRECTIONS: HWY 16 S - TURN LEFT ONTO HWY 150 - TURN LEFT ONTO MT PLEASANT CHURCH RD - TURN RIGHT ONTO TALLENT CT - 4TH HOUSE ON RIGHT (GRAY WITH BURGUNDY SHUTTERS) NAME of SUBDIVISION: HOLIDAY PARK Lot # 5 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.629 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home X Dimension of Structure Bedrooms 3 Basement: No Water Using Fixtures in Basement:No No. in Family Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1 st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: NO Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well X Community Well Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this properly. Any representation by you of house or structure location s ouId c nform to applicable setbacks. Date: ` r I ci C' Signature of Applicant or Agent L An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front FEE NAME DATE AMOUNT Side Authorization to Construct (Repair) F 11/03/2009 $300.00 Rear TOTAL FEES $300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 11/03/09 11:58 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ I . Name to Appear on Permit C,~.U C i L-L 2. Permit Requested By mess hone 13 Address -1 0 D, 3 e ~ Home Phone 7l 010 -L 9 4'- 15 ?~J 3. Property Owner S A b~ 2 Business Phone Address Home Phone 4. Name of Subdivision 0 it I~ Lot # Section/Block/Phase Property Address 762,3 ons to Property: 530 G A=> T '7-'e-,' MT P fl~rli XD b -A e Dir ac.U th f - 6'e- On K~ 1'+J1 CC, 44 Ad 24 .1 1 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home_ C Dimension of Structure Bedrooms*J *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 confinned by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for system size increase in the future. Basement: yescw-) Water Using Fixtures in Basement: yes/no No. in Family Whirlpool Tub yes ~ Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units tJ A, Total Number of Bedrooms DAY CARE: Number of Children V-~ A RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1 st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility? Yes If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes < If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes 10. Is a public water supply available on or adjacent to the above property? Yes Check type that is available: [ ] Co munity well [ ] Semi-public well [ ]County/City/Township water line **If No, a Well Permit must be ' sued with the Septic Permit.** ] l . W . [ Individual well [ ] Community well [ ] Semi-Public well I understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. **IF A P RMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE P PERTY, THERE IS AN ADDITIONAL CHARGE.** [ ~b~ D P1 ~ Date ` Signature of Owner or Agen - 'c.Vv Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification oft ny data contained on this map product by the user. The Countv 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 product or the use thereof by any person or entity. Legend Selected Parcel Number: 3697-04-94-5833 1 inch = 60 feet Prepared for: o IT CT~ 110 ~ • tulo0 _ 782 T,4.0 (60 0 141 c~ X29 7. 00 Pla 3930 o~ __I C 3 48270 4 .00 5833 ~0 5 2 6748" 0 ON ~ 6.00 10 131 65 _ _ 0 77~ 175.1 23.6 C2 o •0 o THIS IS NOT A LEGAL DOCUMENT Tue, November 03, 2009 11:41 AM ~ / l l I l l/ CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3697-04-94-5833 Name: GERSICH KAELUE M Name2: Address: 7023 TALLENT CT Address2: City: SHERRILLS FORD State: NC Zip: 28673-9763 Account: 23831900 Calc Acreage: 0.63 Tax Map: 011AX 03006 LRK: 11763 Deed Book: 2824 Deed Page: 1388 Subdivision Name: HOLIDAY PARK Subdivision Block: Lots: 5 Plat Book: 13 Plat Page: 80 Building Number: 7023 Street Name: TALLENT CT Site Zip: 28673 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $158,600 Land Value: $64,300 Total Value: $222,900 Year Built: 1995 Year Remodeled: Last Sale Date: 3/27/2007 Last Sale Amount: $274,000 Neighborhood: 129 Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P31 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC-O,WP-O,FPM-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1):0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: SHERRILLS FORD Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: VAR-127A; LOMA 6/12/2003 Census Tract 2010: 011502 Census Block 2010: 3029 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Tue, November 03, 2009 11:41 AM CATAWBA COUNTY Public Health Department Case # WLS2007-00752 Environmental Health Division Subdivision HOLIDAY PARK ;J PO Box 389, 100-A Southwest Blvd. Newton, NC 28658 SecUBUPh/Lot # 5 (828) 465-8270 FAX (828) 465-8276 TDn (828) 465-8200 PIN# 369704945833 Applicant/ONvner: KAELUE GERSICH Site Address: 7023 TALLENT CT SFIERRILLS FORD NC Property size: SF .63 ACRES Directions: 16S/ LEFT 150E / LEFT MT PLEASANT RD / FIT TALLENT CT / GO 1/10 MILE ON RIGHT EXISTING SEPTIC SYSTEM INSPECTION REPORT Site/System Diagram t ~r 1 iType of Facility: House Mobile Home X # Bedrooms I_ Business Specify Other Specify Proposed Additions / Accessory Structures: t2 k ~L1 6?-d Of Approved Not Approved Reason Evidence of system malfunction: YES NO System Type/Description Authorized State Agent: DATE:" 00 NOT FOR LOAN APPROVAL Form E r:\TiAemvAlForm.MVLSnnn. tif~ CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT Newton, NC 28658- 0 (828)465-8399 Tuesday, November 3, 2009 I g 42 sM www.catawbacountync.gov Plan Case: EHPR-11-09-2497 Invoice Number: I NV-1 1-09-256928 Environmental Health Plan Review Invoice Date: 11/03/2009 Fee Name Fee Amount Authorization to Construct (Repair) Fee Adjustable $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/03/2009 Credit Card -1 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 I:ni cccipt; 9r) kle- 3ru-ddc1-81?;h-I:icc11R3~7's; ipt 11/03/2009 11:56