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Home My WebLink AboutEHPR-12-09-2952.TIF THIS IS NOT A PERMIT Case # EHPR-12-09-2952 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 ski Environmental Health Plan Review - Septic Malfunction EP_MALFUN APPLICANT OWNER CONTRACTOR IRA GENE SHERRILL IRA GENE SHERRILL 3053 MT RUHAMA CHURCH RD 3053 MT RUHAMA CHURCH RD MAIDEN NC 28650 MAIDEN NC 28650 (828)464-9785 (828)464-9785 NAME TO APPEAR ON PERMIT IRA GENE SHERRILL Pin#: 366804620546 SITE ADDRESS: 3053 MT RUHAMA CHURCH RD, Maiden, NC DIRECTIONS: 16 SOUTH. RIGHT ON MT RUHAMA CHRUCH RD. 6/10 MILE ON RIGHT NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 3.339 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 80 X 24 Bedrooms 3 Basement: Yes Water Using Fixtures in Basement:No No. in Family 2 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 Ist 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 property. Any representation by you of house or structure location should conform to applicable setbacks. Date: Signature of Applicant or Agent ' 7 4A 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,12/01/2009 $300.00 Rear TOTAL FEES 5300.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 12/01/09 16:38 THIS IS NOT A PERMIT WLS # CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair 0 Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit - _51~ ffA H 1, i f / - I- 2. Permit Requested By S4 M Business Phone Address 6.5- 3 Rij -4 C fI. Al/ Home Phone gg V- 6 F 7 jLj= 3. Property Owner .SA M ~ Business Phone Address Sy M E Home Phone /g j/ -`17X3 4. Name of Subdivision Lot # Section/Block/Phase Property Address _5~ A 1\4 j5 Directions to Property: s o 071 f Tn Mrlfu ff,4 Ch(. f' 1G If j - -m A' e i# 7- 5. Property Size: Square Feet ;;I~Ed y Acres _,R -F' I/ Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure 53D `x ~5r' Bedrooms* *Any room that.will be infended' for. sleeping atthe -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 houseplans•as.a bedroom at the time of building permit Nsuance.,This'may prevent'the need for system size increase m, the. future. Basement: ~no Water Using Fixtures in Basement: yeso No. in Family -2 Whirlpool Tub yes/no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children 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 / No If so, describe: 8. Has any grading, removal, or addition of soil been done to this property? Yes / o If so, describe: 9. Are there easements/right-of ways recorded on this property? Yes / No 10. Is a public water supply available on or adjacent to the above property? Yes /(9 Kkq e Wet( Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well I understand that this is a formal application for a well pennit, 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 PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE." Date / ` O Signature of Owner or Agent Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geographic Information System. 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 of anv data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for anv 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: 3668-04-62-0546 1 inch = 100 feet Prepared for: , cn E • v57 61, (8 t d '`3.34°;A 0. , p 4 r S 7.58A r 9,34E _ r ~ , t j 1 .l t a t t 1 t r i } THIS IS NOT A LEGAL DOCUMENT Tuesday, December 01, 2009 04:19 PM t ~ 1 r ~ \ 1 S CATAWBA COUNTY NC - Parcel Report Information R6garding Selected Parcel(s) Parcel ID: 3668-04-62-0546 Name: SHERRILL IRA GENE Name2: SHERRILL NANCY A Address: 3053 MT RUHAMA CHURCH RD Address2: City: MAIDEN State: NC Zip: 28650-8904 Account: 60546000 Calc Acreage: 3.34 Tax Map: 005 K 02010 LRK: 4837 Deed Book: 0927 Deed Page: 0227 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 3053 Street Name: MT RUHAMA CHURCH RD Site Zip: 28650 Township: CALDWELL Fire Code: BANDY'S City Code: COUNTY State Road: 1876 Total Bldgs Value: $175,900 Land Value: $25,500 Total Value: $201,400 Year Built: 1970 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS-II Protected Area Watershed Split: NO Voter Precinct: P1 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: TUTTLE Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011600 Census Block 2010: 2006 Small Area Plan: BALLS CREEK Agricultural District: PROXIMITY Printed: Tuesday, December 01, 2009 04:19 PM A Cpl CATAWBA COUNTY, NC 100-A South West Blvd PLAN RECEIPT r- Newton, NC 28658- (828)465-8399 Tuesday, December 1, 2009 Ig 4'L SM www.catawbacountync.gov Plan Case: EHPR-12-09-2952 Invoice Number: INV-12-09-257645 Environmental Health Plan Review Invoice Date: 12/01/2009 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 12/01/2009 Check 354 $300.00 $0.00 Total Paid: $300.00 Total Due: $0.00 plan receiptfha'Adfh5-5(125-a101,1 G;.rpl 12/01/2009 16:37