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Home My WebLink AboutEHPR-9-10-7247.TIF THIS IS NOT A PERMIT Case # EHPR - - 10 - 7247 H CATAWBA COUNTY HEALTH DEPARTMENT c) '" oio Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP IMPROVEMENT NAME TO APPEAR ON PERMIT ALFORD STANLEY SITE ADDRESS: 4183 CASCADE ST, Terrell, NC Pin#: 461703113904 NAME of SUBDIVISION:THAD AND HAROLD GABRIEL Lot # 15 & ADJ 1 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.509 DIRECTIONS: HWY 150 E/ RT ON SHERRILLS FORD RD/ RT ON HOB LN/ RT ON CASCADE ST/ HOUSE INDIRECTLY IN FRONT AT STOP SIGN APPLICANT OWNER CONTRACTOR ALFORD STANLEY ALFORD STANLEY AMERICA'S HOME PLACE/ STATESVILL 125 NORTHPOND LN 125 NORTHPOND LN 1206 GREENLAND DRSTATESVILLE NC WINSTON -SALEM NC 27106 WINSTON -SALEM NC 27106 704- 872 -4400 336 - 655 -5255 336- 655 -5255 NA ACCOUNT: 5000253 PRIMARY CONTACT: Contractor APPLICATION FOR: New Construction DIM EXISTING STRUCTURE: 40 X 20 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank EXISTING WATER SUPPLY IN USE: N/A CALCULATED DESIGN FLOW: WELL TYPE: Public water is * *NOT ** available for this property. PUBLIC WATER TYPE AVAILABLE: Semi - Public Well DESCRIBE WORK: OLD HOUSE BEING DEMOLISHED/ NEW SINGLE FAMILY RESIDENTIAL DWELLING * *3 Families Sharing a Well ** PROPERTY EASEMENTS: NO PROPOSED CONSTRUCTION PRIMARY RESIDENCE NEW RESIDENCE? New Residence # OF NEW BEDROOMS: 3 # OF STRUCTURE OCCUPANTS: 2 PROJECT DESC: SITE BUILD DWELLING PROJECT DIMENSION: 62 X 40 BASEMENT? Yes BASEMENT FIXTURES? Yes 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 re resentation by you of house or str ct re 1 cation should conform to applicable setbacks. Date: ( Signature of Applicant or Agent Orce 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 09/09/10 16:56 g� . CATAWBA COUNTY Case # EHPR -9 -10 -7247 �s . Public Health De �Q G Subdivision THAD AND HAROLD GABI a Environmental Health Div - Plan Rev d all0 - PO Box 389, 100 - A Southwest Blvd, Newton, NC 28658 Lot# 15 & ADJ LOT i84 % PIN# 4617031 13904 Applicant/Owner ALFORD STANLEY, 125 NORTHPOND LN, WINSTON - SALEM NC 27106 Site Address: 4183 CASCADE ST, Terrell, NC Property Size: SF 0.509 ACRES Directions: HWY 150 E/ RT ON SHERRILLS FORD RD/ RT ON HOB LN/ RT ON CASCADE ST/ HOUSE INDIRECTLY IN FRONT AT STOP SIGN Minimum Setbacks FEE NAME DATE AMOUNT BALANCE DUE Front 30 Side 15 Improvement Permit Fee 09/09/2010 $150.00 Rear 30 TOTAL FEES $150.00 Side St Max Hght CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 09/09/10 16:56 Catawba County, North Carolina N This map product was prepared from the Catawba County NC, Geographic Information Sos/en. A Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this Wrap. Catawba County promotes and recommends the independent verification of OM' . 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 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 0111' person or entity. Legend Selected Parcel Number: 4617 -03 -11 -3904 • 1 inch = 60 feet • Prepared for: so 33' . .. .. Z • ,.. „.... . • .. .. .. 0 0 .0 .:. . ,,...... .--,,,,..‘, __,.., „.... .. ... .. • ,... .. „. 0 - .,•.siL •,,.., 60 5 ,, ..,• ,,, .,, ,s / •„ .. r) . D - „'°'” e p C '.. T , .....' (7 C . :... ,,..„ v. w -9 4 P N ... . •••„ ,,,, _../ • 1,,.cy• A-- • ...0.1 • . •. 1 ; ., `� o 0 ,� ,:, o ®, .� o c 1887 6 O .,... ... • ,,. . , . . ... ___. . . ..... . O t .. ... .... ........... ....... ..... ..,. ..... . ,. .. ........ .. .... " • .... •••"•• ................. "". " .... ."- ...... 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'''. . ., ............. % 486o/ 1 7 - / .. - ZI;r: I... . • THiS N NOT A LEGAL DOCUMENT Thursday, September 09, 2010 04 :32 PM ` • I CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 4617 -03 -11 -3904 Name: ALFORD STANLEY Name2: ALFORD SUSAN Address: 125 NORTHPOND LN Address2: City: WINSTON -SALEM State: NC Zip: 27106 -2577 Account: 185341 Calc Acreage: 0.51 Tax Map: 013AX 01015 • LRK: 14172 Deed Book: 2497 Deed Page: 0582 Subdivision Name: THAD AND HAROLD GABRIEL Subdivision Block: Lots: 15 & ADJ LOT Plat Book: 12 Plat Page: 21 Building Number: 4183 Street Name: CASCADE ST Site Zip: 28682 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $131,700 Land Value: $164,200 Total Value: $295,900 Year Built: 1966 Year Remodeled: Last Sale Date: 8/4/2003 Last Sale Amount: $250,000 • 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,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: Census Tract 2010: 011502 Census Block 2010: 5030 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Thursday, September 09, 2010 04:32 PM \A THIS IS NOT A PERMIT x t ..._•, CATAWBA COUNTY HEALTH DEPARTMENT d "!lg ;t. Application for Environmental Services Page 1 1842 su Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well _ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre- Approval Required) 0 Application is for New Construction A Existing Facility ❑ Property Address 7/83 C'Q ,c`,QL . Subdivision /-fre 11 Nk..- a ,6 (c6 2 -- Lot # /54 A41 ( Acres Section/Block/Phase Driving Directions to Property /So - i P Qti S l I LL ( (dL le° o,n,40 1-(c) (e,A.R__ ua 1, 2 56 , j-� �� , r „�� /1:6 eX s.5' - W a NAME TO APPEAR ON PERMIT? [I Owner ❑ Applicant 1 1 Contractor O Applicant Contact Information V Lu Name 40its:2A. 2 Y otievoVA 1Q fCtith___ CO Address /Z - t'l k ,1.- 54p,.. - c le J** ? 7l Q (A 1.. Phone 33( - (.5s Sz 53'' Cell Phone Owner Contact Information Z Name ' 41 6 Z Address o Phone Cell Phone Contractor Contact Information U Name k. , " H Address I ` i • / r\ I utcx. Jr si l Luz (07`? = Phone 1 70L-1- Ora- quo Cell Phone 1 76 4 / -` l c f t - %VI Z WHO WILL BE THE PRIMARY CONTACT? El Owner ❑ Applicant r/ Contractor Z Description of Existing Structures on Site ViItj6.Q_ O # of Bedrooms *t 3 Structure Dimensions c(pl/ ao # of Occupants 1� Basement ,"Yes ❑ No Basement Fixtures WYes ❑ No Planned Future Additions or Improvements (Building Permit NOT requested at this time) CC Describe 1 &c31.- 4141 ,- itk6e -cY.L vet, 4 tom knUs- Proposed Future Structure Dimensions (oZ - qO # of Bedrooms *t if applicable 3 Z Are there easements or right -of -ways recorded on this property ❑ Yes ckl No Describe Is a public water supply availab or adjacen the above property* Yes o Check type availab) ommunity Wel _ Semi - Public Well County/City/Township Water Line Existing water suppluse _ Individual Well (Community Well ❑ Semi - Public Well n County/City /Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) THIS IS NOT A PERMIT ? CATAWBA COUNTY HEALTH DEPARTMENT ® 7 Application for Environmental Services Page 2 18 82 SM Proposed Facility Type ❑ Primary Residence ❑ New Residence n Addition to Residence # of New Bedrooms *f Project Description Structure Dimensions # of Occupants Basement 0 Yes No Basement Fixtures XYes ❑ No n Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi- Family Residence # Units #Bedrooms per Unit *t Total # Bedrooms *1' Structure Dimensions n 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 Daycare Specify Occupancy Application for Well Construction /Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi - Public Well n Community Well Abandonment Type ❑ Drilled Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ 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. f 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 REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 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 are transferrable, but may be revoked if this information, site CO 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 of tr s ra• Signature of Owner or Agent ir Printed N e of Owner or Agent C Q uo aO w, Date ? CVlb CATAWBA-LINCOLN-ALEXANDER DISTRICT HEALTH DEPARTMENT • HICKORY, N. C.—NEWTON, N. C.—LINCOLNTON, N. C.—TAYLORSVILLE, N. C Phones 345-3883 464-2011 735-5521 632-3101 PERMIT TO INSTALL SEPTIC TANK PERMIT NO PERMIT DA& / c fr e k ,) , ,_(S 196 C Owner ,j.)a t-r-- Ly Ar),,-,,,,, Address /7 / / (,e Tenant Address Installed by ,57- j, 70-e'r- A47-ss Location of Property. .4 0 . ,145---0 /- z,..) . z-<,./..4.,..„6", ..4,,,,,, . , , Kind of tank — Size v 2.-- Length of trench 1.5 a NOTIFY HEALTH DEPARTMENT AS LEAST EIGHT HOURS BEFORE TANK IS TO BE INSPECTED Final Inspection 4 7 — /6 19 66 Approved ( i•-•< Disapproved ( ) Remarks: •--,..‘;' yj . . , F I First five feet of line from outlet from house sh.iiId be of cast iron soil pipe. Z) / . ----------v-I Sanitarian. . , Sketch of tank and line showing distance from dwelling and well on subject property - and on adjoining property. ......----■r--' -- I 1 • �p'A Cpl C CATAWBA COUNTY, NC �� 1 100 -A South West Blvd Newton, NC 28658- PLAN RECEIPT U �� (828)465 - 8399 Thursday, September 9, 2010 184'1 sM www.catawbacountync.gov Plan Case: EHPR -9 -10 -7247 Invoice Number: INV -9 -10- 266830 Environmental Health Plan Review Invoice Date: 09/09/2010 Site Address: 4183 CASCADE ST, Terrell, NC APPLICANT OWNER CONTRACTOR ALFORD STANLEY ALFORD STANLEY AMERICA'S HOME PLACE/ 125 NORTHPOND LN 125 NORTHPOND LN STATESVILLE WINSTON -SALEM NC 27106 WINSTON -SALEM NC 27106 1206 336 -655 -5255 336 -655 -5255 GREENLAND STATESVILLE NC 28677 704 - 872 -4400 NA Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS PAYER: CHAD HOLLOWAY AMERICA'S HOME PLACE, INC Date Pay Type Check Number Amount Paid Change 09/09/2010 Check 11237 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 plan receipt 09/09/2010 17:09