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HomeMy WebLinkAboutEHPR-04-2018-28984.TIF vv�ti .G 'IBlS IS NOTA PERMIT Case# EHPR-04-2018-28984 d -1 CATAWBA COUNTY HEALTH DEPARTMENT ' ay` PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :I ti3i 1842 Environmental Health Plan Review- OSWP IMPROVEMENT • r . .r# , El Applicant TRACY ISAACS.251 RUSTWOOD DR.N10012FSVILLE NC 28117 C:7042241289 NAME TO APPEAR ON PERMIT Tracy Isaacs SITE ADDRESS: 4960 SURF\VOOD DR.SHERI2ILLS FORD NC 28673 PIN# 460604846000 NAME of SUBDIVISION: MOONLITE BAY I.ot# 69 Section/Itlock l'ROI'EI2'1'Y SIZE: Square Feet 20,473.20 Acres 0.47 DIRECTIONS: Slanting Bridge Rd,left on Vista View,left on Surfwood,2nd lot on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP Only for 40x76 3 BR house with attached garage SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40x76 house with attached garage • #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: ehaprlicatio,i 114/25/2018 09:06 Page 1014 /4 ' CATAWIIACOUNTY Case EI-IPR-04-2018-28984 ^s rtmitiL Public Health Department• Subdivision MOONLITE BAY G\) ! ap+ "0 Environmental Health Division PIN# 460604846000 \'4' + PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /842 : NAME ON PERMIT: (TRACY ISAACS).251 RUSTWOOD DR.MOORESVILLE NC 28117 (Tracy Isaacs) Site Address: 4960 SLJRFWOOD DR,SI-II BRILLS FORD NC 28673 Property Size: Square Feet 20,473.20 Acres 0.47 Directions: Slanting Bridge Rd,left on Vista View,left on Surfwood,2nd lot on right Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. /]�J/��� /� • Date: H/2 6/ 1g Signature of Applicant orAgent V /till(�l4 .0.0 If you need further information or assistance please c 28-466-7291 AREAI 444444444444441444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 L,F11 NASIE DATE FEE AMOUNT Improvement Permit Fee 04/25/2018 SI50.00 rTOTAL FEES 5150:00 — — — . i FEES ARE NON—REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) ehspplication 0425/2018 09:04 Page 2 of4 CATAWCATAWBA THIS IS NOT A PERMIT BA CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services A. lication is for: New Construction Existing Facility Improvement Permit ❑ Authorization to Construct New Septic ❑ Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic Expansion f Existing System Inspection or Reconnection New Well 1/62 620 Well ❑ Well Abandonment ❑ Well Repair `7�l Property Address 620 �u 111--( woC:L4 br Subdivision moon Lite ENA- 1 Sher'r+'IIS ford MC 286913Lot#_a(�� Acres 0,WO Driving Directions to Property S i i vi hr . I, , • d [-@ '1 / 13 Ovt I C U. N , r . a. Applicant Contact Information Name ' ctc ei acs Address 2-5i U5 Ooc �r n� oresv; Le Nc 2S>llq/ Phone ��1� . 924- '2 &' ( ( k l[ ) Cell Phone Owner Contact Information Name (Same, (.1 (nine ) Address Phone Cell Phone Contractor Contact Information Name License# • Address Phone Cell Phone Name to Appear on Permit? ❑ Owner ZApplicant ❑ Contractor Who will be the Primary Contact? ❑ Owner Applicant ❑ Contractor Existing Structures on Site? ❑ Yes igj No If yes, describe #of Bedrooms * #of Occupants Structure Dimensions Basement ❑ Yes ❑ No Basement Plumbing ❑ Yes ❑ No Existing Water Supply? ❑ Individual Well ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes 4 No Well Construction/Abandonment/Repair Proposed Well Type , Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type U Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well I-lead to Pressure Tank? ❑ Yes ❑ No C ATAWp ATHIS IS NOT A PERMIT couyrt CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Proposed New Construction - Residential Primary Residence igj New Residence ❑ Addition to Residence # of/ tt NeAw Bedrooms *t Project Description g I'] 2 ii YGklQV-2 V- vtr`atite Structure Dimensions 0 X Cc # of Occupants U 2- Basement ❑ Yes ® No Basement Plumbing ❑ Yes No Accessory Structure(s) Describe Structure Dimensions Plumbing ❑ Yes ❑ No Describe Plumbing Needed Accessory Dwelling ❑ Yes ❑ No #of New Bedrooms *t # of Occupants Proposed New Construction - Commercial Food Service Specify Type #Seats Floor Space-Entire Food Service Facility(Sq. Ft.) N Employees per Shift # of Shifts Dining Area (Sq. Ft.) Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts If Church#of Seats Commercial Kitchen ❑ Yes ❑ No If Daycare, #of Children If Multi-Family Residence,# of Apartments #Bedrooms per Apartment*t Total # Bedrooms *'C Other Information Calculated Design Flow, Commercial t (This value will be determined by El-1 staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes No Does the site contain any jurisdictional wetlands? ❑ Yes f0 No Does the site contain any existing wastewater systems? ❑ Yes 0 No Is any wastewater going to be generated on the site other than domestic sewage? O Yes ZNo Is the site subject to approval by any other public agency? O Yes 1 No Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) O Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other Any *Any room that will he 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 he confirmed by rooms identified on floor plans as a bedroom at the lime of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will he determined by Eli Staff ** If No,a well permit must be issued with the Authorization to Construct. RETRIP'I'O THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL.CHARGE(SEE FEE SCHEDULE) Completed applications are valid fix a period of 2 years. Improvement Permits are valid: with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid. Permits may be revoked if the infitmmtion on this application/site plan changes or if the intended use fur the proposed facility changes. Permits may he revoked if site conditions arc altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can he performed. The undersigned is the owner of tl - pronerzt, or legal age t f the owner. "'�� L 1 1 p Signature of Owner or LegalAgen• Date I Printed Name of Owner or Legal Agent —1-71"/1 C� 7.7.Selei CS tx474P-i a - PH Pt Q g v 0, N. C...) 0,o :: b N z CO CCIr4 • / 0 .a , itimpkigoor S' . ,Z£'£9 'k5„9£00o 1 Z g c ,ZL'86a ta. rii,•$S,bS00i s v ai ,1&.601 5 Cr 00 LlN,. V~j 1/40 h b o O cs N f W � � C.) z J . o U til t ^ 8� Q N. 0 < ^ a II1/40 . SrT tri2 f I ciairazDrfq P4 0/IN q tirOZI ., � a. Alia ,s0,£soor •• La ,09 J LT.) I ?in CIOO_`h•q2If1S E¢-, o. to --1 . J Catawba County Environmental Health 1ao.ao i S i 8 8 •0 0 8 Lt c 162.92 0 O O 180.00 D m CD I cc) t m N 8 m 60 114.93 ` .77 125.37 VISTA VIEW DR • (77) (75) \ ./(/// -... Parcel: 460604835899, 7870 VISTA VIEW DR 1 in=50ft SHERRILLS FORD, 28673 This map/report product was prepared from the Catawba County,NC Geospatial Informalion Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 04/25/2018 Parcel Report Page 1 of 1 • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460604835899 Owner: DIETZ AMY L Parcel Address: 7870 VISTA VIEW DR Owner2: City: SHERRILLS FORD, 28673 Address: 3950 STONEY CREEK DR LRK(REID): 19132 Address2: Deed Book/Page: 3438/0768 City: LINCOLNTON Subdivision: MOONLITE BAY State/Zip: NC 28092-6105 Lots/Block: 70/ School Information: Last Sale: $36,500 on 2018-02-05 School District: COUNTY Plat Book/Page: 12/23 Elementary School: SHERRILLS FORD Legal: LOT 70 PL 12-23 Middle School: MILL CREEK Calculated Acreage: .460 Tax Map: 018AX 04012 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1952 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: Land Value: $24,100 Zoning3: Assessed Total Value: $24,100 Zoning Overlay: CRC-O,WP-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710460600J Building Details 2010 Census Block: 4027 WaterShed: WS-IV Critical Area 2010 Census Tract: 011504 Voter Precinct: P41 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2017, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=460604835899&typ=P 4/25/2018 �.� CATAWBA COUNTY Et .Qe Case It IMPV-06-2017-086907 ILAN Public Health Department Eta.AD Subdivision MOONLITE BAY Min" 4, Environmental Realm Division PINK 460604846000 PO Box 389, 100-A Southwest Blvd, Newlon,NC8658 -R'fflaer+� t 1 LOT/ 69 • If ISL NAME ON PERMIT: BRIDGE PROPERTIES GROUP LLC, P. O. BOX 1497, CONOVER NC 28613-1497 Site Address: 4960 SURFWOOD DR, SHERRILLS FORD NC 28673 Property Size: Square Fed: 20,473.20 Acres:0.47 Directions: Slanting Bridge Rd, left Vista View left Surfwood on right Improvement Permit f IP : elitHIS'PERMIT ISINOTM FOR'SEPTIC'NINSTALLATION >` ' ,Ut z Facility: Permit Category: New Septic Bedrooms 4 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 480 g.p.d Proposed Wastewater System: 25% REDUCTION Type: I11G - OTHER NON-CONN "FRENCH SYSTEMS Permit Conditions: Keep all parts of septic system minimum: 50' from any well, 10' from property lines and home. Lines to be installed on contour. Do not grade drive or fill over system or permit will be revoked. Lot is repair exempt and space is severely limited due to setbacks to neighboring wells on rear property line. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Not Required Proposed Wastewater System: Type: "•' no system class assigned "" Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are[net. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Lows and Rues for S'enetee Treatment and Disnnsa/Systems' (I5A NCAC ISA .190t1). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Jason Boyd 06/16/2017 AUTHORIZED STATE AGENT ,APPROVAL DATE Permit Expiration Date: 06/16/2022 No grading or construction activity is allowed in ureas designated for system and repair without approval of the Health Department. chpernut 0623/2017 16:51 .—".. • ter-_-„. SURFWOOD DR 60' RJW U, 0-3 > :_. ..... N 10°53'08"E I1'0210 {� 7' . . .. . ....... .... 120.11'� : ;:-5 ill .S10 iit 70 7d r a‘ Le 50' �7 w '� C L . .p ;• 2� 4J t o zq - 5r ,01 "411 5: "I' L.2? ke.U3-Aht. 0 NIPT 41 ' ! i tri -44 oa i cn;w • 1 y) S 10°5•4158"W X3 3 . 1 1 511 '1 . SI653 - I — w? I) sd ra Sa tie 76 . . fora / �✓GIf 'v • I i ...., 'y (-4 0 . ,„ g:.., ---cn 01, 51 th 1-el I • ttil IAo 0 _. r • Y. V *tr. M I CHAO..A'I'HANAS & ASSOCIATES LICENSED SOIL SCIENTIST 56i Ennis Rd. Weddington, NC 28173 (704) 576-3887 Reference: Data Sheet for 49611 Surfwood Dr, Sherrills Ford, Moonlite Bay Lot 69 House Footprint: 50' x 40' Setbacks: 30' from/rear, 15' side Water Source: Private well Number of Bedrooms: 4/480 CPD Proposed LTAR: 0.25 GPD/FT2 Proposed System Type: 25% Reduction Proposed Repair System Type: Limited (deeded 1963) Distribution: Gravity-End cap/Drop box Septic Tank Size: 1000 gallons Proposed Trench Bottom: 24" Line Design Length Actual Length Pink 1 96' 96' Orange 2 96' 96' Yellow 3 96' 96' Blue 4 96' 96' Pink 5 96' 96' Initial System: 480' Repair System: Limited Comments: This lot was deeded in [963. There is limited repair and the lines can be 5' to the property line but must be 20' form any other septic system. ' Sheer I 01_7_ PROPERTY ID ii:16060.1846000_ • COUNTY:Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Coniplcic all Iicl ds in nil I) OWNER: Bridge Properties Group LLC APPLICATION DATE ADDRESS: PO Box 1497, Conover, NC 28613 DATE EVALUATED: PROPOSED FACILITY` 4 BDRM_ PROPOSED DESIGN FLOW(.1949):_450 GPD PROPERTY SIZE: 0.47 AC LOCATION OF SITE:_4960 Surpwood Dr, Sherrils Ford, Mounlite Buy SD, Lot 69 PROPERTY RECORDED: 8/8/1963 WATER SUPPLY: E Private ❑ Public 0 Well 0 Spring U Other EVALUATION METHOD: .=Auger Boring 0 Pit 0 Cul TYPE OF WASTEWATER: E Sewage ❑Industrial Process ❑Mixed P 1 r f • 1r • • oSOIL MORPHOLOGY OTHER F (.1941) PROFILE FACTORS I .1940 L LANDSCAPE. HORIZON • . • P. -POSITION/ DEPTH . 1912 �I PROFILE. a' SLOPE% (IN.) .1941 .1911 SOIL I .1913 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE! WETNESS/ SOIl. SAPRO RESTR & LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ LS 6% 0-33 RCSDK FR SS SP SEM. N/A 48" Nrn PS 0.3 F-C SAP 31-15 R CI,WSIJK FR 55 SI'SEM' I 1 i LS 9% 0-6 DrSCI.WSDK FR SSSI'SEXP 48" N(A N/A PS 0.25 6-48 RCSDK FR SS SP SEM' pl monks 2 LS 6% 0-3 Dr CL WSK FR SS SP SEXP 48" N/A N/A PS 0.275.0.25 Few YB 3.36 R C SDK FR SS SI'SIiXP 3 36-48 R CL WSIIK FR SS SI'SF.XP I 1 I ' 4 - •1 1 I DESCRIPTION INFFIAI.SYSTEM REPAIR SYSTEM OTHER FACTORS (.1946): SITE CLASSIFICATION(.1948): PS Available Space(.1945) 1440 FT2 LIMITED —'- EVALUATED BY: MA&A System T)pclsl 25% Reduction _ OTHER(S) PRESENT: _ Site LTAR 0.25 COMMENTS: r CATAWBA COUNTY HEALTH DEPARTMENT p954d Telephone: (828)465-8270 TDD: (828)465-8200 WLS #tots c225-OO263 Improvement Permit X ACfRe air Permit. Operation Permit.__System Type Well Permit. Replacement Well Owner/Agent np rfN tr— at„...�e.✓,,,,,, _, _ Phone � - Address 130 ZMM ttc Subdivision r d� fSb I- (3fa Lk'- id l? kic. Section/Block//Phase Lo 41 Lot Size , r] Dire-tionsCU 1 50 0 51;:i- -S lir i d�y C VK hi lite') cSu.-.- • nn ri / i0'} Ru -__ U Property Address 1/47 () t-32erfwodggl r Facility: House X Mobile Home Business Multi-family Other: Pin Number 0-(1/0.-470011- 3 /—(cale) Other . Zoning Approval H • it Bedrooms ,3 q Seats # Employees . Application Rate ,3S GPD Flow 3/n/) Hot Tub or Spa yes/no Special Fixtures Basement yes t& . 100% Repair Are /no Basement Plumbing yes/no Water Supply: Private Well K. Public Semi-Public *************************************************************************** ******************************************** Type or System: Trench Bed Pump Pump/Panel Panel X LPP Other Septic Tank Size (QQO/ Pump Tank Size Nitrification Field: Total Square Feet s/S Depth of Stone w7q- Bed Size j n.{'Trench Width 3 4' Total Length of All Trenches /13 Number of Trenches Trench Length__ _ __. 7 / / / / / Feet on Center Maximum Trench Depth 3G Distance of Nearest Well sa *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo % Slope ' Texture . 11 L ) S Cia,l e — /— S O StructureC'''Clay Min. (.l+V tAX n loll A.-t .- Soil Wetness ^ _5 *+r( - Se-004ett- New Inetb Soil Depth Restric. Hoz. at •' -C---;e- Available w Available space yes/no flea OverallClass5PSU ?FIbPS 'S�/'t'f Comments: Sy6kw,- ., titi � I tlii�`r Ivl I Ira I • SQ30 I( ILS ' 3d • 5 5 Z+ Filter Required ( J Riser required when -5tv,•k,r6oC D t tank is more than 6 I t inches deep. • **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, hut 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. The siting of the well by the Health Department staff is to provide protection front kno ssihle sources of contamination. No volume of rm is guaranteedany siteby the Health Department. n Permit Date at�// EHS `!l/ 1 Owner/Agent. ,� Septic Tank Instilied By Date EHS Well Installed By Well Grout Approval Date Well Head Approval Date Date Sample Collected • _ Date of Results Results EHS White-Office Yellow-Owner/Agent Pink- Building Inspection Authorization to Construct r $A CATAWBA COUNTY fifi �� IOOA SOUTHWEST BLVD Y � NEWTON.NORTH CAROLINA 28658 RECEIPT - pe PHONE:828.465.8399 b �h" it Wednesday,April 25, 2018 v '9�$'n V 4 D SM w'S5''5'.catawbacounlync.gov PAYOR: Isaacs.Tracy PAYMENTS TRANSACTION NUMBER: TRC-3479775-25-04-2018 PAYMENT DATE: 04/25/2018 PAYMENT TYPE: Check 950 NCDL-8374090 DOB- 11/24/67 EXP- 11/24/23 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352186 Improvement Permit Fee $150.00 TOTAL PAYMENTS: 5150.00 E H P R-04-2018-28984 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4960 SURFWOOD DR,SI IERRILLS FORD NC 28673 Applicant TRACY ISAACS.251 RUSTWOOD DR.MOORESVILLE NC 28117 C:7042241289 **NO PEOPLESOFT ACCOUNT ASSIGNED" receipt 0.1/25/20 I8 08:53 Page I of I