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THIS IS NOTA PERMIT Case# EHPR-04-2018-29013
d r �-3 CATAWBA COUNTY I-IEALTI-I DEPARTMENT ❑'yc� Jr?❑°
` ���� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti'
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Environmental Health Plan Review-OSWP i4
4Y1ckL2z IMPROVEMENT 1- y r
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Applicant GLEN TUCKER,354 GEORGE LILES PKWY STE 40,CONCORD NC 28027
0:7047915667
Owner RUTH HOLI3ROOKS HEIRS C/O STEVE HOLI3ROOKS, 109 BERGERON WAY,C.ARY NC 27519
C:9192186478
NAME TO APPEAR ON PERMIT
Ruth Holbrooks Heirs c/o Steve Holbrooks
SITE ADDRESS: 8347 DRENA DR,SIIE121ZILL3 FORD NC 28673 PIN# 461601286348
NAME of Slfl3DIVISION: RALPH M SIGMON Lot 6 Section/Block A
PROPERTY SIZE: Square Feet 28,314.00 Acres 0.65
DIRECTIONS: NC 16 S,left on NC 16 Business S,left on NC 150.go 4.6 mile then right on Slanting Bridge,go 0.4 miles then left on
Drena Rd,go 0.8 miles,then on right
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 - —. WATER SUPPLY: Private Well
DESCRIBE WORKC IP Only for 60x30 4 BR house
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? Yes
Property Easements Description: overhead utilities
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: 4
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 60x30 hosue
#OF NEW BEDROOMS:: 4
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES
OTHER: INNOVATIVE: ANY:
Other described:
ehapplicatian 04/27/2018 10:55 Page 1 of4
v gA THIS IS NOTA PERMIT Case# EHPR-04-2018-29013
CATAWBA COUNTY HEALTH DEPARTMENT ❑' ,CI
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES •
1842 sg Environmental Health Plan Review- OSWP t
IMPROVEMENT .
W
61.1,4
Applicant GLEN TUCKER.354 GEORGE LILES PKWY STE 40,CONCORD NC 28027
C:7047915667
Owner RUTH HOLI3ROOKS HEIRS C/O STEVE HOLBROOKS. 109 BERGERON WAY,CARY NC 27519
C:9192186478
NAME TO APPEAR ON PERMIT
Ruth Holbrooks Heirs do Steve Holbrooks
SITE ADDRESS: 8347 DRENA DR,SPIERRILLS FORD NC 28673 PIN # 461601286348
NAME or SUBDIVISION: RALPH M SIGMON Lot# 6 Section/Block A
PROPERTY SIZE: Square Feel 28,314.00 Acres 0.65
DIRECTIONS: NC 16 S,left on NC 16 Business S,left on NC 150,go 4.6 mile then right on Slanting Bridge,go 0.4 miles then left on
Drena Rd,go 0.8 miles,then on right
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 WATER SUPPLY: Private Well
DESCRIBE WORK: IP Only for 60x40 4 BR house
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? Yes
Property Easements Description: overhead utilities
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: 4
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 60x30 hosue
#OF NEW BEDROOMS:: 4
BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED?Yes
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL: YES
OTHER: INNOVATIVE: ANY:
Other described:
ehopplication 01/26/2018 16:17 Page 1 oft
CXIAWBA COUNTY Cases EHPR-04-2018-29013
.1z Public Health Department Subdivision RALPH M SIGMON
G .. ' -3 Environmental Health Division PINK 461601286348
two
PO Box 389, 100-A Southwest Blvd.Newton,NC 28658
NAME ON PERMIT: (RUTH HOLBROOKS HEIRS C/O STEVE FIOLI3ROOKS), 109 BIERGERON WAY.CARY NC 27519
( Ruth Holbrooks Heirs do Steve
Site Address: 8347 DRENA DR.SHERRILLS FORD NC 28673
Property Size: Square Feet 28,314.00 Acres 0.65
Directions: NC 16 S,left on NC 16 Business 5,left on NC 150,go 4.6 mile then right on Slanting Bridge,go 0.4 miles then left on
Drena Rd,go 0.8 miles,then 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.
Date: Signature of Applicant or Agent
If you need further information or assistance please call 828-466-7291
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FEENA,\IE DATE FEE ANIOtJN'I'
Improvement Permit Fee 04/26/2018 5150.00
'I'O'1'AL FEES $150.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT 1S MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
elwpplicarion 04/26/2018 16:17 Page 2 oro
CATAWBA BA THIS IS NOT A PERMIT
couwAwrn CATAWBA COUNTY HEALTH DEPARTMENT Q90/3
„....�.\ Application for Environmental Services �J
'^` ,;A. .lscationrrs for •;g ;L FNew&Construction ,�,_ - ,❑.Esisbn aFacili[yi i� ;
improvement Permit ❑Authorization to Construct
New Septic 9 Septic Repair/Malfunction 9 Septic Relocation 9 Septic Expansion
❑Existing System Inspection or Reconnection
9 New Well 9 Replacement Well 9 Well Abandonment 9 Well Repair
Property Address 8341 Drtna Dr- Subdivision
Sherr its co rot 7$t-t'3_ Lot# Acres
Driving Directions to Property J\J4 11,, 3aw-h I Left nn NC_I_la Bus.tncsssa a)
N I_5UC0�f__V rxi I
Applicant Contact information
IName elrker
Address 3sy (�eurae- Li ��c �kvs 54a40 Concord t1 28027
Phone y' Cell Phone Toy - 7c\_ 566"7
Owner Contact Information
Name L . . . . ke o S--eVE 14._
Address t o 9 [far•J -�-e_coif Crn r_r�"�y(^ fl 5, 4
Phone I Cell Phone c,I q z IR—b41
Contractor Contact Information
Name I License#
Address
Phone 1 Cell Phone
Name to Appear on Permit? g Owner 9 Applicant ❑Contractor
Who will be the Primary Contact? ❑Owner gApplicant ❑Contractor
FEx sttng�f
:StructuresrorSlte?.;:;. .^k,'�tt`..Y "'yM1. ..,M : arrc_t r+, . ^" .r isS 1:K v.!w",:`iC '. rZk%`,AV.,
9 Yes XI No If yes,describe
#of edrooms" of Occupants Structure Dimensions
Basement ❑Yes 9 No Basement Plumbing 9 Yes 9 No
rEr^ wtveWaterr.S-1usPh �tV .; gsk f fK " WI ,a :a x
2c.
aiWt
Individual Well 9 Community Well 9 County/City/Township Water Line g— rnarKr4 Surrey
-1s a public water supply available?" 9 Yes 4-NoW hu G -RAA-u.rC well
,R;eII,Construction/Abandonment/R'epair""L i5 rz;.?r , , M't;,; m- , -.
Proposed Well Type 9 Individual Well 9 Semi-Public Well 9 Community Well
Abandonment Type 9 Drilled 9 Bored ❑ Dug 9 Unknown
Well Repair Requested 9 Yes ❑No Describe
Will Certified Well Contractor install Water Line or Electrical Line from Well[lead to Pressure Tank? 9 Yes 9 No
CATAWBA THIS IS NOT A PERMIT
CATAWBA COUNTY REALTH DEPARTMENT
Application for Environmental Services
aProposedNAvConstructln Residcnhal Y; /#3104v.-`-' e r ,' -tots44x<'
Primary Residence S New Residence ❑ Addition to Residence #of New Bedrooms*t y
Project Description '_estr3le 4 nn 1 17 fey Ld _r r',\
Structure Dimensions 6D s.3D #of Occupants '4
Basement 'Yes ❑ No Basement Plumbing .E Yes ❑ No
Accessory Structure(s)Describe h/A Structure Dimensions
Plumbing 9 Yes 9 No Describe Plumbing Needed
Accessory Dwelling 9 Yes 9 No #of New Bedrooms*t it of Occupants
Proposed'NelsgConstrucuons'Commerclal� rt y tt j ,�' ^ ,' t
Food Service Specify Type
#Seats Floor Space-Entire Food Service Facility(Sq.Ft.)
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 9 Yes ❑No
If Daycare,#of Children
If Multi-Family Residence,#of Apartments #Bedrooms per Apartment*t 'total it Bedrooms*t
Other Information
Calculated Design Flow,Commercial t (This value will be determined by Ell stall)
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 g.No Does the site contain any jurisdictional wetlands?
❑Yes Z.No Does the site contain any existing wastewater systems?
❑Yes $No Is any wastewater going to be generated on the site other than domestic sewage?
❑Yes p3.No Is the site subject to approval by any other public agency?
iiI,Yes 0 No Are there any easements or right of ways on this property? Describe See our v Cy
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)
0 Accepted 0 Alternative ,Convectional ❑Innovative 0 Other 0 Any
'Any room that will be intended for sleeping at the time of construction or for future consideration should he noted as a bedroom and counted
on all applications.The number of bedrooms will be confinrad by rooms identified on floor plans as a bedroom at the time 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 be determined by Eli Staff
**If No,a well permit must be issued with the Authorization to Construct
RETRIP TO'THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR A_NADDITIONAIFIARGE(SEE FEE SCHEDULE)
Completed applications are valid for a period oft 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 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 weer.
J
Signature of Owner or Legal Agent Date t{ ! Z3 J i g
Printed Name of Owner or Legal Agent C,(ens I
NI \
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T /f 4 . ' - i is
L
L-14 JUSTIN R.WILLIA.ILS,r F.S. 'fit'
�} frill,, , 183350LD STATESVILLE ROAD L.4 42 erlik;
M c •
SUITEA v �l • �i
Ot 'us* 2 CORNELIUS;N.C. 28031Gf •. SUK"�.•'P�'+y„ J ` (704)765.5134 �N R. WIL�
>---19811,18`?
1
LINE BEARING DISTANCE •
Li S 501754' W 99.67'
L2 S 601700' W 40.00'
DRENA DRIVE •
• 60' PUBLIC R/W (MB. 12, PG. 16) •
/T
20''ASPHALT ROAD WDTH
PSI //e/ EDGETj FrrAlIEMENT
V _411E)• �TE� a
N 8g 4SS F� Er N{ _ _ L
70079,4_ F L2.
/ 60.12'00 E
•
/. �aJR IRON PIN FOUND
7'12' 2'
N O.a3
MQ:UFIPT IDV I N
1dV.vd•:.OF W' rq LT
Q I O'FRONT Sa BACK" m ? 4616-0128-7457
V Dwight I.Gantt -
O
O DB1925,Pg257
N,B.12,PG.36-LO 5
^QF m_ s
a616-0328-5325 ♦ 'm m
/ Janooko Family Trurt y., O a ly pDI OIYFKS ant:PAD
D93271,P9973 y - �'--r—aw•.vooa nl�
Ma. 12,PG:16-are CY LOT 6 "
/ BLOCK •
3.
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3 / 29,143 SQ. F'. _� APPARENTADJOIN Etts
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�n074- `"I- -- "30'LAKE BUFFER
�..—..____
29 W PEVA SET
' IIS 652001 ' W 187.72' ) la4R'WRAF
•
t•IRON P:N FOUND tea LOCATED MO
0.3C'ONLINE LAI CONTOUR
NOTES:
LAKE 1.NO NCGS MONUMENT FOUND WITHIN 2000'.
• NORMAN 2.PROPERTY MAY BE SUBJECT TO OTHER COVENANT'S,
LEGEND: RESTRICTIONS,EASEMENTS OR RIGHTS-OF-WAY THAT
_ MAY BE OF RECORD.
¢4 REBAR FOUND O `J
#4 REBAR SET O ' WOOD DCCT: 3.SETBACKS SHOWN WERE PROVIDED BY CATAWBA
COMPUTED POINT • &PIER COUNTY PLANING DEPT.4-4-18.
CONC. MONUMENT FOUND D
IRON PIN FOUND 0 4"TUE PROPERTY IS SUBECT TO A 30'UNDISTURBED
UTILITY POLE " jY LAKE BUFFER FROM TILE 760 LAKE CONTOUR,PER TIC
SUBJECT PROPERTY LINE DEPARTMENT OFENVIRONMENTAL QUALITY. '
ADJOINER PROPERTY LINE CONTACT:ALLAN JOHNSON(704)663-1699.
BUILDING SETBACK — • — " —
OVERHEAD UTIUTIES OU 5.PROPERTY MAY BE SUBJECT TO TUE DEED
760 CONTOUR (RESTRICTIONS RECORDED IN DB.621,pa.267 OF THE
CATAWBA COUNTY REGISTRY
Graphic Scale
50 25 0 50 6,CONSULT WITHGOVERNING AGENCY FOR
k�72/�l //7777-)m-,-..---1
PREVAILING LAND DEVELOPMENT AND ZONING
ll// Scale Aoi Drawing Ilvch=SO Feet REQUIREMENTS PRIOR TO DESIGN OR CONSTRUCTION
\ 6OF ANY IMPROVEMENTS.
7 Physical Survey of Lot 6, Block A, of the Ralph M. Sigmon Property •
Professional •
Property • Site Address:
Surveyors,Inc. Property of: As Recorded in:
Dron18335 Old Statesville Road Ste.A • Heirs of Map Book 12,Pg 16 8347 Ford, Drive
Cornelius,N.C.28031 Ruth L.Hoibrooks Deed Book 1585,Pg 445 Shereills Ford,\C 28673
704-765-5134 Phone(Fax Catawba County •
Firm License:C-3666
032918-01 JI& 2 1:1_,0000 1"=50' 4616-0128-6348 HOLBROOKS I of 1 4/020'018
Job No. Prepared By Error oClosure Drawing Scale Tax ParcelNumher Drawing Pile Name Sheet Number Date j
�,�A CATAWBA COUNTY
Li11 100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
e�►® ('HONE:828 465.8399
`Co �jsv, `� Thursday,April 26,2018
1842 Sm www,catawbacountync.gov
PAYOR:
Tucker.Glen
PAYMENTS
TRANSACTION NUMBER: TRC-3491646-26-04-2018
PAYMENT DATE: 04/26/2018
PAYMENT TYPE: Credit Card
203206352
INVOICE NUMBER FEE NAME FEE AMOUNT
04-18-352281 Improvement Permit Fee $150.00
TOTAL PAYMENTS: 5150.00
EHPR-04-2018-29013
CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP
SITE ADDRESS: 8347 DRENA DR,SHERRILLS FORD NC 28673
Applicant GLEN TUCKER.354 GEORGE LILES PKWY STE 40.CONCORD NC 28027
C:7047915667
**NO I'EOI'LESOFr ACCOUNT ASSIGNED**
Owner RUTH HOLBROOKS HEIRS C/O STEVE HOLBROOKS. 109 BEIRGERON WAY.CARY NC 27519
C:9192186478
receipt 04/262018 16:16 Page I of 1