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HomeMy WebLinkAboutEHPR-12-2022-42921.ti .r4$A • THIS IS NOT PERMIT Case# EHPR-I2-2022-42921 Q , 1111. CATAWBA COUNTY HEALTH DEPARTMENT 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 18. 2 sM Environmental Health Plan Review-OSWP REPLACE WELL ABANDONMENT POISCC1 Applicant GREGORY&SUSAN POLLAK,7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 C:7046088962 GREGTALKS @ AOL.COM NAME TO APPEAR ON PERMIT Gregory & Susan Pollak SITE ADDRESS: 7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 PIN# 460602868255 NAME of SUBDIVISION: MOONLITE BAY Lot# 23&ADJ Section/Block PROPERTY SIZE: Square Feet 26,571.60 Acres 0.61 DIRECTIONS: E NC 150,right Slanting Bridge,left on Tradewind Dr PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well -IBE woR • 1/20/2023 revise to add well abandonment for existing 2"well replacement well • - ATION 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? Yes 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF residence EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 66x 62 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES APPL lQN.FOR WELL ABANDONMENT ABANDONMENT TYPE: Drilled ,happliratn,n 01/20/2023 10:23 Page 1 of7 0 a . CATAWBA COUNTY Case# EHPR 12 2022-42921 1~(.....t ii Public Health Department Subdivision MOONLITE BAY < Environmental Health Division PINY 460602868255 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (GREGORY&SUSAN POLLAK),7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 (Gregory&Susan Pollak) Site Address: 7971 TRADEWINDS DR,SHERRILIS FORD NC 28673 Property Size: Square Feet 26,571.60 Acres 0.61 Directions: E NC 150,right Slanting Bridge,left on Tradewind Dr 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 AREA5 *******t******tit***********************************************tt**t*****ttit***t*******t****t****t*tt***** FEENAME DATE FEE AMOUNT Well Permit&Inspection Fee 12/01/2022 $300.00 Well Abandonment Fee 01/20/2023 $100.00 TOTAL FEES S400.00 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) chapplicau,m 01/20/2023 10:23 Page 2 of 7 .�13A • CATAWBA COUNTY ETy M IOOA.SOUTI-IWEST13LVD 1 NEWTON,NORTH CAROLINA 28658 RECEIPT 'Cr /� '' ' PHONE:828.465.8399 ll� Friday,January 20,2023 18 42 sm www.catawbacountync.gov PAYOR: Pollak,Gregory&Susan PAYMENTS TRANSACTION NUMBER: TRC-55859519-20-01-2023 PAYMENT DATE: 01/20/2023 PAYMENT TYPE: Credit Card 300071972 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 01-23-417099 110-580200-663000 Well Abandonment Fee $100.00 TOTAL PAYMENTS: $100.00 EH PR-12-2022-42921 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 Applicant GREGORY&SUSAN POLLAK,7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 C:7046088962 GREGTALKS a AOL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 01/20/2023 10:22 Page 1 of 1 y1 'A • THIS IS NOTA PERMIT Case# EHPR-12-2022-42921 L CATAWBA COUNTY HEALTH DEPARTMENT 'C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 18 2 SM Environmental Health Plan Review- OSWP REPLACE WELL Applicant GREGORY&SUSAN POLLAK,7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 C:7046088962 GREGTALKSCAOL.COM NAME TO APPEAR ON PERMIT Gregory & Susan Pollak :"!:r!l SITE ADDRESS: 7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 PIN# 460602868255 NAME of SUBDIVISION: MOONLITE BAY Lot# 23&ADJ Section/Block_ PROPERTY SIZE: Square Feet 26,571.60 Acres 0.61 DIRECTIONS: E NC 150,right Slanting Bridge,left on Tradewind Dr PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: replacement well 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? Yes .•- •- 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: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF residence EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: 66x 62 NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? No PLUMBING REQUIRED? EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES ehapplication 12/01/2022 14:25 Page I of3 • • • • CATAWBA COUNTY Case EHPR-12-2022-42921 .7 4. ,., Public Health Department Subdivision MOONLITE BAY 70 H Environmental Health Division PIN# 460602868255 \ * S� PO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (GREGORY&SUSAN POLLAK),7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 (Gregory&Susan Pollak) Site Address: 7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 Property Size: Square Feet 26,571.60 Acres 0,61 Directions: E NC 150,right Slanting Bridge,left on Tradewind Dr 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: /0 d/ o?oZZ Signature of Applicant or Agent 411/ If you need further information or assistance;le call 828-465-8270 AREA5 FEENAME • • DATE. FEE AMOUNT Well Permit& Inspection Fee 12/01/2022 $300.00 TOTAL FEES $300.00 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) ehapplicarion 12/01/2022 14:25 Papa 2 of 3 catawba county public Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction 54 Existing Facility ❑Improvement Permit ❑Authorization to Construct ❑New Septic El Septic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑Existing System Inspection or Reconnection I ❑New Well IN Replacement Well ❑Well Abandonment ❑Well Repair Property Address 97l /RADEw�v1QS /�r21 Ve- , $hEieg,//s iced A . . _.Ptm73 Acres A(v I Subdivision /460,4)/, Ae?y / /� Lot# 3 Driving Directions to Property f'Ro t/ l5'D '7 v �w i i CJwf wr pD 2i��c? d Ar6 (Snsu-4i4) neess eye( Describe work /'�C'e lace Ex, we//Lo/' .UP.eo t "/i)e/� CEX / i37iA+�Au-tis Pt Applicant Name glee a e /-,,2.1.o1C J� Applicant Address 79 /�A � l � t,c�s' ;U��v� QA /4 C_•c,Za'‘,7 3 Phone ]O'—608_ ?9 Z_ I Email 44,El ,j,//c• /114,1. H Owner Name -e -ester _ii /1,rK ff Owner Address 7/7/ 7.ei tor+df vRtvz, �ShFR/�''//s hater /VL' 2f>>3 Phone 704/— 2oi'-:r9 (Email Gie f/1Cs AL.4ef-t Contractor Name "' D (Rsss��,� IPQJG,upirere t,a7//b,¢,//..t�) Contractor Address ,t,ve-,Q �/.r / Phone 7O L.2440-2z9O / Email nt?Lka,44'..A.(t)e,n, c;„.0 Name to Appear on Permit? igj Owner ❑Applicant ❑Contractor Who will be the Primary Contact? ®Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms*t #of Occupants Project Description Structure Dimensions,also specify dimensions of decks&porches (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Structure(s)Describe Sttucture(s)Dimensions Plumbing 0 Yes ❑No Describe Plumbing Needed (Choose One) El Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions (Choose One) ❑Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ® Individual Well El Semi-Public Well ❑Community Well Abandonment Type I Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑Yes ® No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?®Yes ❑No Environmental Health Existing Structures on Site _ Describe G4sidet7CP_ ( 0sine), Oa Azle f 462'j -e. ,y t6 Structure Dimensions „Dee ( 2 S" #of Bedrooms* 3 • I1 of Occupants 2- Basement 54 Yes ❑ No Basement Plumbing ❑Yes ig No Existing Water Supply 21 individual Well ❑Shared Well—Number of Connections ❑Community Well ❑County/City/Township Water Line Is a public water supply available?" ❑ Yes rg No Commercial ❑Proposed New Construction ❑Existing/Change of Use ❑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 it of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other Information L 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 the answer to any question is"yes",applicant must attach supporting documentation. ❑Yes (X No Does the site contain any jurisdictional wetlands'? )'t Yes 11 No Does the site contain any existing wastewater systems? ❑Yes B.No is any wastewater going to be generated on the site other than domestic sewage? ❑Yes ga No is the site subject to approval by any other public agency? ❑Yes al No Arc 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) ❑Accepted ❑Alternative ❑Conventional 0 Innovative 0 Other ❑ 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 EH 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 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. T 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 prop or legal agent of. owner. Signature of Owner or Legal ;; A _Zd Z Z gn g Agent �(.Jt ,y Date a catawba county Geospatial Real Estate Search MAKING. IIYIM(i. SITTER Information Services /--- 265.04 y _% 42.84 iJ k --k, O A.. cA7* , /D,D Ij,a /46,9 S6P7f L 6 7qN k- s 1:4.0f 1.---/ 113.27 / y op"o�vt 5`' l Pous i P i A S silicp �� ( S7/� • !-Ll /z( 'red,.we//A4 us, �� —J(/ew Gc�1/ LDC492aN - //��'ts°M /loAcQx z, p2,�,€41/IINe (86) 12161).702z 4 gal-C..-- w-. - E 1 in-40ft S Parcel: 460602868255, 7971 TRADEWINDS DR SHERRILLS FORD, 28673 Owners: POLLAK GREGORY J, POLLAK SUSAN H Owner Address: 7971 TRADEWINDS DR Values- Building(s): $285,500, Land: $259,900, Total: $545,400 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 ...............i a:,..�..:... ...,a..ti..n...., ,,,k..ia c,.tii.,a,.....,...,.,,a i a........,,,� I,.....,.,c..tii:,,. ,..ti..,i,,., a:.,.,.. ...a:.,.,..,.. .,.....,..,i..,I,:.,, ..,..........,..,. 12/1/22,2:21 PM Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 460602868255 Owner: POLLAK GREGORY J Parcel Address: 7971 TRADEWINDS DR Owner2: POLLAK SUSAN H City: SHERRILLS FORD, 28673 Address: 7971 TRADEWINDS DR LRK(REID): 19147 Address2: Deed Book/Page: 2938/1031 City: SHERRILLS FORD Subdivision: MOONLITE BAY State/Zip: NC 28673-9274 Lots/Block: 23 & ADJ/ Last Sale: $125,000 on 1984-06-01 School Information: School District: COUNTY Plat Book/Page: 12/23 Elementary School: SHERRILLS FORD Legal: LOT 23 + ADJ MOONLITE PL 12-23 Middle School: MILL CREEK Calculated Acreage: .610 Tax Map: 018AX 05006 High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: 1950 TaxNalue 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: $285,500 Zoning2: Land Value: $259,900 Zoning3: Assessed Total Value: $545,400 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1976/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710460600J If available, Building Permits for this parcel. Septic 2010 Census Block: 4026 links are not permits. 2010 Census Tract: 011504 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: WS-IV Critical Area Voter Precinct: P41/Voting Map 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. ©2022, Catawba County Government, North Carolina. All rights reserved. gis.catawbacountync.govinomap/parcel_report.php?key=460602868255&type=u 1/1 N 1 i I NI a t N. 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Z a zZo3- gA� Z U 4,A • CATAWBA COUNTY y Q Ink c' 100A SOUTHWEST BLVD y NEWTON,NORTH CAROLINA 28658 RECEIPT V a „ �, PHONE:828.465.8399 Thursday,December 1,2022 1$42 sM www.catawbacountync.gov PAYOR: • Pollak,Gregory&Susan PAYMENTS TRANSACTION NUMBER: TRC-52354548-01-12-2022 PAYMENT DATE: 12/01/2022 PAYMENT TYPE: Check 1999 NCDL 4955429 EXP 2/14/25 DOB 2/14/1947 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 12-22-415416 110-580200-663000 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS: $300.00 EHPR-12-2022-42921 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 Applicant GREGORY&SUSAN POLLAK,7971 TRADEWINDS DR,SHERRILLS FORD NC 28673 C:7046088962 GREGTALKS@AOL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 12/01/2022 14:24 Page 1 of 1