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Home My WebLink AboutRBPR-09-2021-38802.TIF f14t,A .....mcti, THIS IS NOTA PERMIT Case# RBPR-09-2021-38802 , r� CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES12 sM Residential Building Plan Review-Building New • IMPROVEMENT-AUTH CONST- NEW WELL I(03 Mdisiti Applicant MICHAEL&RAGAN COOKE,P.O.BOX 1382,DENVER NC 28037 C:7045199494 RAGANCOOKE@HOTMAIL.COM Owner JENNIFER ROWE,2190 MOLLY BACKBONE RD,SHERRILLS FORD NC 28673 NAME TO APPEAR ON PERMIT Michael & Ragan Cooke SITE ADDRESS: 2242 MOLLYS BACKBONE RD,SHERRILLS FORD NC 28673 PIN# 460904907927 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 2.63 DIRECTIONS: Sherrills Ford Rd,left onto Mollys Backbone,private drive on right,property on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GAL$PF DAY: 360 WATER SUPPLY: Private Well SCRIBE WORK: 4/10/23 REVISE HOUSE SIZE TO 51X49 3 BEDROOM. NO BASEMENT, DETACHED GARAGE OR FUTURE POOL. NEW FEE COLLECTED FOR IP ONLY AT THIS TIME. IF CAN NOT ISSUE AS GRAVITY SEPTIC SYSTEM CHECK WITH OWNER BEFORE ISSUING AC. PREVIOUS DESCRIPTION: IP/AC, new well,360gpd/60x60 3-bedroom new single family dwelling, no basement,and attached 60x35 garage thats attached by breezeway 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? Yes Are there any easements or right-of-ways on this property? Yes Property Easements Description: Duke Power APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence 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? 54 X 49 house,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: YES OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO ehapplication 04/10/2023 I5:26 Page 1 of 3 ,syi`e CATAWBACOUNTY Case# RBPR-09-2021-38802 d(. l ,y Public Health Department Subdivision . `j Environmental Health Division PIN# 460904907927 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 w NAME ON PERMIT: (MICHAEL&RAGAN COOKE),P.O.BOX 1382,DENVER NC 28037 (Michael&Ragan Cooke) Site Address: 2242 MOLLYS BACKBONE RD,SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 2.63 Directions: Sherrills Ford Rd,left onto Mollys Backbone,private drive on right,property on left 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 828-465-8270 AREA4 SETBACKS: 30ft from right of way FEENAME :DATE FEE AMOUNT: Authorization to Construct Fee(New/Expansion) 09/13/2021 $150.00 Fee Improvement Permit Fee 09/13/2021 $150.00 Well Permit&Inspection Fee 09/13/2021 $300.00 Improvement Permit Fee 04/10/2023 $150.00 TOTAL FEES $750 00:` 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) ehapplication 04/10/2023 15:26 Page 2 of 3 . _ Catawba county Noe- public teak. RECEIVED Application for Environmental Health Services THIS IS NOT A PERMIT APO 6 2023 __. ' . ._._._._ .. _:_A-pplica ►stton for _ New Construe-ion__._❑.Exi!stmg Factliti- _ . - ._._.r_._._. ..._._._. [iimprovement Permit ❑Authorization to Construct [glifew Septic ❑Septic Repair/Malfunction ❑ Septic Relocation ❑ Septic ExpansioEnvironmental Health ❑'existing System Inspection or Reconnection irrNew Well_�_ �❑ Replacement Well____ _❑Well Abandonment _.._..._._.. ._.._ ,_._._-._ Well Repair_..._.._..._..._._._. Proper Address /� �j t r rid �� Tll-.-1' ht- � (n 7 _._._.__ Acres •(D Subdivision7 Lot# Driving Directions to Property/ Zf E f??-6it .13 2,Car ,- e-n ,c ntt/A sett f4VC-/b, I ei9-en tiyvrr , ad circl,,. /D r'a t c MI / / L'Y7 (ci7Prr1l/5'/ it/, /,fit-riyy t?'l�Ct'..[f S Ig�r/irfim.,#e,1:- escribe work Ore G v a'4�V, - !fir P. 4x,?...�r i7 5 .,-_-- •. mac, . ��C'Gc��t; �yr�m \n/�nf fb Ap#licant Name ' �' rs``xsn �-te% � 1'_.'��..s Cam, _ CSC I hC. Cl.Vbt� 00/4 Applicant Address 3 f.` L 4/- f'. F,/ r?trot...- i,f�f:c R"6 /3 E Septic, Phone ' -(4tfLl--gb ? U Email IAioyi t 1 U/Ylact(sinhti rrha.Le rs. ceri-r) Owner Name Al, a {, ./1 i ZCCjf7 (L Jt ^�iq i4 i Meet ' Owner Address ,,?�y,9, /}'1 G LC .r-�C t;'Yt..P f2 ti 3. err1 . S rz. 3 Phone � �- c' c � �� T f 9(.4.) -t'p /5-ci Email ' / tez,c ,_� Ci:2'rl Contractor Name ry-)a t.c,) .,Dyne bu.c.ec , s Contractor Address .30 /`/C` 1i 57;t4[t3 .5/€ .,c-/C S Co h e[v`e( tC .(` ��:(J,� Phone f -. h' �f(��( :� 'I Email r,(r • rp- �/ 7iit 5'e kne ,ti i x S , Curti Name to Appear on Permit? [Owner 0�., �A�p licant 0 Contractor Who will be the Primary Contact? 0 Owner l. pplicant 0 Contractor Proposed New Construe `on Residential Primary Residence [PNew Residence ❑ #of New Bedrooms*Addition to Residence r _ t .."3 #of Occupants_� Project Description yl; �.�t 61-C 172)au Hem Structure Dimensions,also specif dimensions of decks&porches 51 % q (Choose One) 0 Basement Ltatra31 Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' 0 Yes Fre'No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' 0 Yes. 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing 0 Yes 0 No Describe Plumbing Needed (Choose One) ❑Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' 0 Yes 0 No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total# Bedrooms in Structure*t_ #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' 0 Yes 0 No Well Construction/Abandonwnt/Repair rropuscu well type mdivuqual Well LJ Semi-Public Well 0 Community Well Abandonment Type 0 Drilled ❑ Bored 0 Dug 0 Unknown Well Repair Requested 0 Yes 0 No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?0 Yes 0 No Environmental Health Catawba County Government Center,25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site Describe Structure Dimensions #of Bedrooms* #of Occupants Basement ❑Yes ❑ No Basement Plumbing ❑ Yes ❑ No Existing Water Supply ❑Individual Well ❑Shared Well -Number of Connections ❑Community Well ❑County/City/Township Water Line is a public water supply available? ** ❑ Yes ❑No Commercial 0 Proposed New Construction ❑Existing/Change of Use 0 Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift — #of Shifts Church #of Seats Daycare ❑Yes ❑No #of Children _ #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen ❑Yes ❑No Daycare#of Children #of Employees per Shift____ #of Shifts Business/Other Specify Type_ _ Structure Dimensions 1___ __ _ _ Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by EH 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 t answer to any question is"yes",applicant must attach supporting documentation. ❑Yes Does the site contain any jurisdictional wetlands? ❑Yes Does the site contain any existing wastewater systems'? ❑ Yes o Is any wastewater going to be generated on the site other than domestic sewage? [+.' es 0 No is the site subject to approval by any other public agency? ❑Yes llo 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) ccepted 0 Alternative 0 Conventional 0 Innovative 0 Other 0 Any *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 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 AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground. Property owner/applicant is responsible for marking all underground utilities, including but not limited to: underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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 upplieuuu,vYttn.phut chunges or tithe uitctrucu use for the oposed iacUity changes.rerrnits may be revoked 11"site condttions are altered such that they.effect ermit 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. 1 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 pia ty or leg' >ent of the owner. Signature of Owner or Legal Agent 7 Date 1 6 Printed Name of Owner or Legal Agent . c a aw a county Geospatial Real Estate Search YAlifin tIVING. 'MIA, nf_ motion rJery _s • Re le' • Ws � ., N 02142 • 0 I .� 1 2 63A ib `"41927 00 ow • S�'�.'�'o Nti »s.... '/ (4°S) / XS yvJV •r. 1�" /, (10) • So 1. we 1 in=100ft s Parcel: 460904907927, 2242 MOLLYS BACKBONE RD SHERRILLS FORD, 28673 Ownors; COOKE MICHAEL ALAN, COOKE RAGAN MOLINDA Owner Address: PO BOX 1382 Values - Building(s): $0, Land: $13,700, Total: $13,700 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. Copyright 2023 Catawba County NC 03/16/2023 . 14'A � CATAWBA COUNTY /�� 100A SOUTHWEST BLVD RECEIPT / NEWTON,NORTH CAROLINA 28658 R �► PHONE:828.465.8399 �V " '4� '� Monday,April 10,2023 \ J8 2 sM www.catawbacountync.gov PAYOR: Cooke,Michael&Ragan PAYMENTS TRANSACTION NUMBER: TRC-61582384-10-04-2023 PAYMENT DATE: 04/10/2023 PAYMENT TYPE: Credit Card 303561772 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-421031 110-580200-663000 Improvement Permit Fee $150.00 TOTAL PAYMENTS: $150.00 RBPR-09-2021-38802 CASE TYPE: Residential Building Plan Review WORK CLASS: Building New SITE ADDRESS: 2242 MOLLYS BACKBONE RD,SHERRILLS FORD NC 28673 Applicant MICHAEL&RAGAN COOKE,P.O.BOX 1382,DENVER NC 28037 C:7045199494 RAGANCOOKE a HOTMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** Owner JENNIFER ROWE,2190 MOLLY BACKBONE RD,SHERRILLS FORD NC 28673 receipt 04/10/2023 15:43 Page 1 of 1