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Home My WebLink AboutEHPR-3-10-4244 (2).TIF THIS IS NOT A PERMIT Case # EHPR-3-10-4244 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 sM Environmental Health Plan Review - OSWP IMPROVEMENT APPLICANT OWNER CONTRACTOR JACOB LEE CLINARD JR JACOB LEE CLINARD JR 4331 EDWIN GURLEY DR 4331 EDWIN GURLEY DR SHERRILLS FORD NC 28673-8350 SHERRILLS FORD NC 28673-8350 704-483-3317 704-483-3317 NAME TO APPEAR ON PERMIT JACOB LEE CLINARD JR Pin#: 460606399457 SITE ADDRESS: 4331 EDWIN & GURLEY DR, Sherrills Ford, NC DIRECTIONS: HWY 16 S/ HWY 150 E/ CROSS BRIDGE/ GO TO TOP OF HILL/ TURN RT ON STONEWALL ST/ MNT CREEK MARINE NAME of SUBDIVISION: Lot # Section/Block/Phase PROPERTY SIZE: Square Feet Acres 2.68 Date Platted/Recorded TYPE OF FACILITY: House Mobile Home Dimension of Structure 46 X 42 Bedrooms 3 Basement: No 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 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: 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 sttrr yture location should conform to applicable setbacks. / Date: ~ Z 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 AREA 1 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 10 Improvement Permit Fee 03/09/2010 $150.00 Rear 30 TOTAL FEES $150.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 03/09/10 09:29 THIS IS NOT A PERMIT WLS # rfl/~9-3-1d -4kklql~l CATAWBA COUNTY HEALTH DEPARTMENT PAuthorization plication for Environmental Services Improvement Permit to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ 1. Name to Appear on Permit C C e-- C ti a v^,~ 11 . 2. Permit Requested By Business Phone Address Hom Phone ICJ y - V~ 3 - ? 7 3. Property Owner c o k l- e 1 Nam-.. Zus P one 3 36 -,2 09-Y1 35 Address ~3 3 1 iti h G r y .6r, 5h e v~-i Ms cry 1, ld Home Phone 4. Name of Subdivision Lot # Section/Block/Phase Property Address Directions to Property: H w (o v,L 6 C_v o S b i J J 1~ I T -j' 4 Z .o a. r P_ 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House Mobile Home Dimension of Structure Bedrooms* *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 pen-nit issuance. This may prevent the need for system size increase in the future. Basement: yes/tu Water Using Fixtures in Basement: yes/ o~i~ No. in Family _ Whirlpool Tub yes/no Gallon Capacity ~.J 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 Faci it Yes / No ////If so, describe: `T~0 Y Zr_ r ~ `7 8. Has any grading, removal, or a dition of soil been dorr6 to this property? Yes No If so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes / o 10. Is a public water supply available on or adjacent to the above prope y? Yes No 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 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 PERMIT HAS TO BE REDESIGNED ANDIOR RETRIPS MADE T THE PROPERTY, RE IS AN Bff~ITIONAL CHARGE.* L Date a L~ U k Signature of Owner or Agent c~ -Z Al ~ Catawba County, North Carolina FN This map product was prepm ed from the Colowba County, AIC, Geographic h formolion Scsiem. Calawba Camrn has mocle substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promoles and recommends the independent reriijimlion of am Bola conjoined on this map producl by the user. The Comity of Catawba, its employees, agents and personnel disclaim, mid dull not be held liable for any and all donioges, loss or liabilav, whether direct, indirect or emtsequetuial which arises or moy m ise f om this map product or the use thereof by only person or enlav. Legend Selected Parcel Number: 4606-06-39-9457 1 inch = 60 feet Prepared for: 101 % 451 rOO c 7733 11 + a~ f 2-A 'Plat 60-98` r ~l t t ~.R { (210) 220 ~-el" f tf Ll Ii-`"I 212.2!` i' ; " ' I ! 1 204.34 EE:: i ter- \ p 1 t 1 s::: + THIS IS NOT A LEGAL DOCUMENT Tuesday, March 09, 2010 08:41 AN7 0 U t Catawba County, North Carolina FN This map product was prepared f+•om the Catawba County, A7C, Geographic Information Svstem. Catawba County has made subslantiol efforts to ensure the accuracIv of location mid labeling i+formotioa crnuained on this map. Catawba Counlt, prmnoies and recommends the independent verificatiml of any' data co111ained on this map product by the user. The Counfi of Catowbo, its emplo'yees', agents and personnel disclaim, and shall not be held liable for ai v and all damages, loss or liabilih+, whether direct, indirecl or cmtsequemial which arises or inav arise f+-om this mop product or the use thereof bn miv person or entih'. Legend Selected Parcel Number: 4606-06-39-9457 1 inch = 256 feet Prepared for: IV r.,i/ f L~ f~za tjj \ 0474 I i S'(ONEWALL V ,y 1 _ f~ ~ w - by + y, ,•rn t o\ 5335 dig 17 ' ~ ~ ~ 7o.t f GJRLEYDn ` 7077 9asi f . ; I t P1.36-n0 _.-{BRFP TtEY t a S 2(150 16 \ 1 ; M2 f tH2 P I tt ~ ]8 l1 No; /r .,,6 r v b i P1.1 38-110* \ + 1 0727'' ;7 F fio 9 i• F,•~, ~r1.~''rF) 'k 1?'~. e .r-fit ,r ~ 2 ~ ~ + I !c:~ P~60-t61i y r i+ o-~l nose ' A 1 ) \s 9671 f f ' l rr J a; 1 2MA' Pig 57.110 t f 1b~1 • , 9457 ~4 A J7 "j 1403 PIe1 47-tiny ' T \ ,11 j a~W :.1206 I ! 1 ` ` , 1 ;059 , J l THIS IS NOT A LEGAL DOCUMENT .f Tuesday, March 09, 2010 03:48 At'\9 , CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID.- 4606-06-39-9457 Name: CLINARD JACOB LEE JR Name2: CLINARD DOROTHY S Address: 4331 EDWIN GURLEY DR Address2: City: SHERRILLS FORD State: NC Zip: 28673-8350 Account: 193965 Calc Acreage: 2.68 Tax Map: LRK: 802309 Deed Book: 2546 Deed Page: 0850 Subdivision Name: Subdivision Block: Lots: Plat Book: 57 Plat Page: 110 Building Number: 4331 Street Name: EDWIN & GURLEY DR Site Zip: 28673 Township: MOUNTAIN CREEK Fire Code: SHERRILLS FORD City Code: COUNTY State Road: Total Bldgs Value: $261,400 Land Value: $137,000 Total Value: $398,400 Year Built: 2005 Year Remodeled: Last Sale Date: Last Sale Amount: 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: 4005 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Tuesday, March 09, 2010 08:39 AM I } UV S CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (828) 465-8270 TDD: (828) 465-8200 WLS #aQd~/- d/~y Improvement Permit AC V, Repair Permit. Operation Petmit.X System Type3 ell Permit. Replacement Well Owner/Aient G~/V r! Phone Subdivision AaZkss 6133 / • d NC Section/Block/Phase Lot# Lot Size c?,(okAz Directions: P e Property Address Facility: House Mobile Home Business Multi-family Other: Pin Number Other . Zoning Approval # # Bedrooms_ # Seats # Employees Application Rate e 3S GPD Flow l3 Lo /no Hot Tub or Spa yes/no Special Fixtures Basement Ya 100% Repair Are Basement Plumbing yes/no Water Supply: Private Well , V Public Semi-Public Type of System: Trench Bed Pump X Pump/Panel Panel LPP Other fqS~e G'~e Septic Tank Sizc_JIMA~j Pump Tank Size JJZQ Nitrification Field: Total Square Feet r7 n. Depth of Stone Bed Size Trench Width ,3&I Total Length of All Trenches Number of Trenches Trench Length Feet on Center Maximum Trench Depth Wnce of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WF.I.i. RECQRD RE4OUIRED AT COMPLETION* w lc Topo ' % Slope Texture Structure dv e6 3 4^ Clay Min. Soil Wetness_o~S Soil Depth" Restric. Hoz. at I T a'9 3 Available space no Overall Class U Comments: • , ~ I x,- I ~s- I I I 10 Filter Required Riser required when I 7y~ I tank is more than 6 I l inches deep. ~,~g **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO ~RMAAWGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. sources of contamination. No volume of The siting of the well by the Health Department staff is to provide protection from 4knowibl.e water is guaranteed at any site, by the Health Department. Permit Date EH S Septic Tank Instal Bt e- Date - / s Owner/ gent Well Grout Approval Date Well Head / . By EHS ' Well Installed Approval. D to Date Sample Collected Date of Results Results EHS White - Office Yellow - Owner/Agent Pink - Building Inspection Authorization to Construct g,A C~ CATAWBA COUNTY, NC south West Blvd PLAN INVOICE Newton, NC 28665858- - Q+ ~ 0 (828)465-8399 Tuesday, March 9, 2010 j $ 42 sM www.catawbacountync.gov Plan Case: EHPR-3-10-4244 Invoice Number: INV-3-10-260210 Environmental Health Plan Review Invoice Date: 03/09/2010 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 03/09/2010 Check 419 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 plan m4nice;cl'c5'4tt?-IdJ8-4.a>ir-3t~3f-(~f?ch6le~d0;.rpt 03/09/2010 09:46