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Home My WebLink AboutEHPR-3-11-10039.TIF �� C�� THIS IS NOT A PERMIT Case # EHPR-3-11-]0039 � `' � CATAW�A COUNTY HEALTH DEPARTMENT v :;: '�' Plan�Revi��v Application for Environmental Services I842 sM Environmental Health Plan Review - OSWP EXS SYSTEM NAME T AP PEAR ON PERM Keith Ward SITE ADDRESS: (971 WORTH ST Sherrills Ford, NC Pir�: 369608994445 NAME of SUBDIVISION:KEN-WOOD FOREST SUBDIV Lot # 9 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.939 DIRECTIONS: 16 South to 150 turn Left go 3 miles to Worth Street / house on right APPLICAI�T OWNER CONTRACTOR Keith Ward Keith Ward 6971 Worth ST 6971 Worth ST Sherrills Ford NC 28673-8341 Sherrills Ford NC 28673-8341 7044898840 7044898840 PRIMARY CONTACT: Owner APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: 36 x 60 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 4 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: 6 EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is **NOT** available for this property. PUBLIC WATER TYPE AVAILABLE: N/A DESCRIBE WORK: 14 x 46 Metal Carport for RV - No electrical - No foundation DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION ACCESSORY STRUCTURES DESCRIPTION: Metal Carport for RV # OF NEW BEDROOMS: STRUCTURE DIMENSIONS: 41 x 46 ACC DWELLING? No PLUMBING? No # OF STRUCTURE OCCUPANTS: 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 empioyees 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 norrexpiring 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 loning Approval prior to locating a home ar structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. �� Date: .3 �� Signature of Applicant or Agent 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 *********************************************************************************************************��*********** Minimum Setbaeks Front: 30 Side: 10 Rear: 5 Side St: Max Height: 03/25/1 1 14:17 va �A , CATAWBA COUNTY Case # EHPR-3-11-10039 � G Public Health Department KEN-WOOD FOREST SUBC ``' a Environmen[al Heal[h Division - Plan Review Subdivision ¢ >:►� `�' PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Lot# 9 �8 2 s» , , PIN# 369608994445 ApplicantlOwner Keith Ward, 6971 Worth ST, Sherrills Ford NC 28673 Site Address: 6971 WORTH ST, Sherrills Ford, NC Property Size: SF 0.939 ACRES Directions: I6 South to 150 turn Left go 3 miles to Wor[h Street J house on right FEE NAME DATE AMOUNT BALANCE DUE Existing Tank Check Fee 03/25/2011 $80.00 TOTAL FEES $80.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 03/25/1 I 14:18 ,� ��, _� THIS IS NOT A PERMIT � CATAWBA COUNTY HEALTH DEPARTMENT G, /(�'�,�J� �� Application for Environmental Services � Page 1 J � �p t 1 84 2 �M ' , Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit 0 Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Ea�isting System Inspection (Pre-Approval Required) �' Application is for New Construction ❑ Existing Facility ❑ Property Address 9 7 � � e✓% L� .1 f Subdivision �,11. e!r' f� �o rc N� 2 b'E �3 Lot # Acres Section/BIocWPh se Driving Directions to Property /�i .s a �}� �t Q /�' a �u �n �. e�� a � A'� ��✓ To W c r7 L. , f'%�'�� - o � � 4.1 � a NAME TO APPEAR ON PERMIT? Owner ❑ Applicant ❑ Contractor O Applicant Contact Information V Name f� e � �a � m Address G 9�l Wc� J J��:' '� fVC 2�'E�� Phone 70�/- �Jb'y �8yo Ce1lPhone 7oy �j7�- /.f�7�1 = Owner Contact Information � Name e ; l.clo i Z Address 6�j'7 / w a t 1 ._J P: f: J ''< < 2�� O Phone 7 0%- y,S' J- ��'`/ � Cell Phone � o y- 97��- /� 4 � Contractor Contact Information W Name � Address � = Phone Cell Phone F► � WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of E�sting Structures on Site o��f � Q # of Bedrooms *� � Structure Dimensions � b' � d # of Occupants � I� Basement [�Yes ❑ No Basement Fixtures ❑ Yes ❑ No � Planned Future Additions or Improvements (Building Permit NOT requested at this time) � Describe � Proposed Future Structure Dimensions # of Bedrooms *�' if applicable Z Are there easements or right-of-ways recorded on this properly ❑ Yes o De Is a public water supply available on or adjacent to the above properly ** ❑ Yes ❑ No Check type available ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Existing water supply in use ❑ Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED E PROCEDUES) �a THIS IS NOT A PERMIT � � a CATAWBA COUNTY �IEALTH DEPARTMENT " d° � Application for Environmental Services Page 2 1g2,� , , Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fi�ures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe 3.� f e �% # of New Bedrooms *�' if applicable Structure Dimensions �� / 6 # of Occupants Accessory Dwelling ❑ Yes�No Plumbing ❑ Yes �'No Describe Plumbing Needed ❑ Multi-Family Residence # Units #Bedrooms per Unit*� Total # Bedrooms *�' Structure Dimensions ❑ Food Service Specify Type # Seats Floor Space -Entire Food Service Facility (Sq Ft) # Employees per Shift # o f S hifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business Retail Floor Space # of Empl 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 ❑ Unknown Well R epair Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial �' 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 betlroom 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. 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. � CHANGE WORK ORDER REQUIItING REDESIGN AND/OR RETRIP WILL INCURE AN � ADDITIONAL CHARGE (SEE FEE SCHEDULE) a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental � Health 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 V specified conditions. Improvement Permits and Well Permits aze transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization o Construct issued by this department is valid for m (5) five years from the date issued and is not transfera � Signature of Owner or Agent �c%�`'`� � Printed Name of Owner or Agent �� l,✓a �O� Date � -' 2 S� � 11 Cataw�a County, North Carolina N Tltis map product was pi•epared from the Catawba Counry, NC, Ceographic /njormntion System. Cntawbn Counry har made s:�bstantra! eJjor�s to ensure the accuracy ojlocatron and labeling injormation contained on this map. Catawba Counry promotes and recommends the independent verification ojany dnta con�ained on thrs map product by the user. 7he Counry oJCntmvba, rts employees, agents and personne! disclarm, and shall not 6e held liab/e for any and all dan:ages, /oss or liabiliry, whether direct, indirect . or conseqt�ential which arises or mnv arise from this map product or 1he use thereojby any person or entity. Legend Selected Parcel Number: 3696-08-99-4445 1 inch = 60 feet Prepared for: .,._._.�..� .,.�..__� ��e � .��.�� (101 co � 1 ��_ .._�_.-----�----�-'""" � '! � � __.. j.�a_ . . ---�----- w l ,,,.- ---- � � � �..__.�------- ._ t �� :. (1 _ � � �` -�-�:; � __ y � f �� ' � � i'� � . � � � ' i �- �. . . . � �� .. ! i � ..+"",�- 1 [ 1 �;� ,� l � ( .� 4`�� t �"� . � i � � .. � �� o� � �; , x N � 5 '4 C\`! � e `� �. ` *, �.. �44 9 '� , 4 .; ° '�; �`� �`�:�. � �,- ` � °--�,,...�,. ; ' i �� : � . ' �,� j � -.."`'--.,,.„.4.�,.��....�,..,r..--...�.=---.:-.-�--°"" � '' � r � � , '�; � . t. � � :�445. � �� - . �� `� � -30 � ,�- 5 �"``A: -�-�- �. �_ .-.--.-y. . � _ �, � ` `�. 1 . � `---_.—�...._.._..... rtN. ``�:.. , � - �,� : -�-�� < ��, . � �, . ��, :� � � 6442 �. `\y �' ` � i '� �`�� "'� ,,� �`'"^� � 1.06A M .......-:.,,rM.-._ . �i �`� � ��., �� , `O ` , � � � �..,,...,.��'".•.W' � '�`..-----.-'~" � O � ;,� : a �� ....,� ,,�,�,�� ,,,, f,-,.,v�+`�' . �.,,,�...-.--- "' ...�:-�'� Y�-� E � ``�- "' � � „,,..�.... z> ti � a. � �•, j�``,� �.. � 't� '", \,` �``.� �•,� = f✓^.'y''� ,,..-,,'��y�_ '` ��.17 Y y`'w•�� O�e",.�,,� . �. �M1 •;:;..,��,�,��,,••^"'�w""'.�"� � w,.'., `"�..�^''"'"��- e .,✓ - .-:..:._--�,� S ��,, "�`-.. ``''' � r '° �,�' �,�"' . ,�. � � „/ ' -�.,..,,,,� � "°*.�.. �� '�- , , . � `��*�/.`` • �; /' . .. ......."+� v >. � �•'''� ,, f � .. . .... '�� ` � y�;,,,✓'� ,.. _.,.._:.:.�..:.✓ : ... .. . � � - -, :. • . .: �� .: �" . .... .. �� . , ,-� r '"`. �� 2 , � �'4C1..;;_: *,,f � ��` ,y . � �.r«; � � �1 ; � , ; ''�:;� l at � 6=24� �,,,_:.�- ` .� - .. � !;. ,� � = � �. ` ��:`` 1 � '� � Q � ''°,.:• f � �� . . . \ �, � ',,:-:.-'� 6 � . � � ��:: /� ^� ��. : � ��"-^-...� 'r ~� � � : �� _ . . � ;.. `�. \ �; ,J . : . �` ,. ��;�, �� f � �, �,,��,� �` 'CHIS IS NOT A LEGAL DOCUMENT `��.,; `' ," Friday, March 25, 2011 02:01 PM `'.` � � ` � .��. �� , � � : � '�..,,,_ v3' ,! f; : CATAWBA COUNTY NC - Parcei Report , Information Regarding Selected Parcel(s) Parcel iD: 3696-08-99-4445 , Name: WARD P KEITH , , Name2: WARD DONNA S Address: 6971 WORTH 5T Address2: City: SHERRILLS FRD State: NC Zip: 28673-8341 Account: 72023000 Calc Acreage: 0.94 ' Tax Map: 017AX 01Q24 LRK: 18127 Deed Book: 2008 Deed Page: 0910 Subdivision Name: KEN-WOOD FOREST SUBDIV Subdivision Block: Lots: 9 � Piat 800k: 16 Plat Page: 242 Building Number: 6971 � St�eet Name: WORTH ST � Site Zip: 28673 • Township: MOUNTAIN CREEK . Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $438,000 Land Value: $157,900 Total Value: $595,900 Year Built: 1999 Year ftemodeled: Last Sale Date: 11/1/1996 Last Sale Amount: $72,000 Neighborhood: 129 • Watershed: WS-IV Critical Area Watershed Split: NO Voter Precinct: P41 E911 District: COUNTY Zoning: R-30 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: CRC,-O,MUC-O,WP-O,FPM-O Zon+ng 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 Schooi Split: NO P&Z Case Number: LOMA 9-28-2000 • Census Tract 2010: 011502 Census Block 2010: 4049 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Friday, March 25, 2011 02:01 PM I ` ��. ��„_ ., _. No 1 / /�y ��;TAY�VVBA COUNTY H�A�TH �IEPAIZTMENT t, �� Telephone {704) 465-8270 TDD (704) 465-8200 � v Improve Permit�Cithorization� to Construct�R�epair Permit Permit�System Type � Owner/Agent_,��J� LrJ/9.Q1� Phane f/(1 �- � 9R - 7�� Addre"ss �q�� ,��,,P7-hc b �' - � Subdivision ��w,�� I, F��/�� Section/Block/Phase Lot.#� Lot Size, � Directions ��' j�^�� Ps�SS L�ti Q�P�,. `S`i�i _svi �-D � �1.aL7_Z."2—L�c! ZZ.��-�7 4 / S �-- G�7- �.n � �� _ _ -- Facility House c/ I�hobile Home Business Other Tax Map # �/-a Multi-family Other �oning Approval # Z �70 # Bedrooms_�#:Seats # Employees Application Rate� GPD Flow �i� Q Hot Tub or Spa yes/�Special Fixtures 100% Repair Are es no Sasement es no Basement Plumbing yes Water Supply Private Well_�/Public , r* , r , r , r , r , r , v+ , r.�«•+. , r , rw+. , r , rr*w , ir** , v«f+w , w* , t , t , r , r , ► , ► , ►*+*«*+«**,rrr,r , r*,w,r**,r*,t,►,r,t*,r+*«,r,t.tw*,tr�.n►,r«w�r***,t,r**** Type of System Trench Pump�Pump/Panel Panel LPP Other Tank Size Septic Tank Size �OOO . Pump Tank Size �()�� Nitrification Field Total Square Feet fa 0 D Deptih of Stone f,.`�� Bed Size Trench Width. u� � Total Length of All Trenches �{� d Number of Trenches .� Individual Trench Length�/�/ � C�/�/,�� Feet on enter�� Maximum Trench Depth � y��L Distance of Nearest Well s� �'F^ � T Il STALL WHEN WET* *�**�..***********.*«� ��** *******�*** .,�*«..«�**#**�,....**�,********,.**�**********..* Topo - Te C.Gi4S�E �_ � v � , Structure �G�/ � Clay Min l � ' �__ .. .- .��. \ - �� SZ"'� _ = _ _ � Soil Wetness " • Soil Depth ��-/- " � ��►'�(� 9'� ��,��1�.� � Restric Hoz at �_�: � ��' -�" - � Available s ace �\`` _- , ~ _ � -; �� Zc �D '�L � P Yes no — �—_— E`TE21r� �N�D �' overall clasa s _ --- '- -- �NS•i �4L(.�,7,�/�N Comments � '� "'� � �iZ � P/� YZ. /i-� � ' — �o�/�� 5 T� t �\ � � � � �o � 3 � :-. p �� o�, � C� � � r � _ _ �o l � s� �; ,� �-��v� r.an�=,e� � , �U� f,� � �/ ` , }� vs� � `f �r�c.c, .�� c �z.9-c. �9 ys �BFFo et �,^ �� ,� w � ` _ „ i , ,�, � ` .�/s�--,�c c� r—a �. F�.n:o T o n/� � � S� � � .� � � (� � lNFv 2r �, ��,d f�' f **NO GU�EE OR W RANT FS PLIED OR GIVEN AS 0 TH PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** a**ix*,r**,►******+,w,r,r***r.**,r*,rr*�r **+.,r*,�,r*a� **+r,r,v**,rrr,r**,rr,r,r**,r,rw,r,►,►,rr,►,wwrkw;r,.r,�.�, i' i *Improvement Permit has no expirati �date and ia n erable, but may be revoked if site plans or intencled use changes for the proposed facility An Authorization to Canatruct is valid for (5) five yeara from date issued and is not transfera '�e� Permit Date Owner/Agent_ � � Sanitarian , y�s � Installed By Date Sanitarian ,� � White - Office' Blue - Building Inspection Operation Permit Yellow - Owner%Agent Green Building Inspection Authorization ro Construct C�ta�vba County, l�Torth Carolina N Thrs map product was prepared from the Catawba Counry, NC, Geographic Injormation System. Catawba Counry has made substantial efforts to ensure the accuracy of locarron and labe/ing informarion contained on this map. Catawba County promotes and recommends the independent verification of arry data contarned on this map product by the user. The Connry oJCarawba, i�s employees, agents and personnel drsclaim, and shal! not be held liable jor arry and a!1 damages, loss or liabr/ity, whether direct, incfirect or consequential which arises or may arise from this map product or the use thereof by arry person or entiry. Legend Selected Parcel Number: 3696-08-99-4445 1 inch = 80 feet Prepared for: � 60 � m �° °° � �� ° .� p o m� ,� a o a . ° @ a o � � m ° � ° a � � � VV� �� o � � p 1 F o ° r ��m.�� ° (101) (101) � � (101) (�00) N N ' 2449 M 3445 M 4445 -. � � � � � N 11 "' � 6442 � � 1.06A "' 31.7p 31.70 5349 � � ' o �� 10 3 cr s ` 'o � 10.50 >>� � � � 11.83 3 SS � 2 v 6 ��0 16.30 Plat 16-24 �--�� 8 o $o �� 14 � �o S 0o s �� /� � � rO o � h� � S � THIS IS NOT A LEGAL DOCUMENT �� Friday, May 06, 2011 08:17 AM % �� 5 °o �.