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HomeMy WebLinkAboutRBPR-07-2013-17752.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2013-17752 CATAWBA COUNTY HEALTH DEPARTMENT EMAI ~ PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New IMPROVEMENT - AUTHI CONST - NEW WELL �0 Owner ZACHARY MCMILLAN, 6320 AUTUMN CREST CT, SUMMERFIELD NC 27358 H:704-609-0888 C:704-609-0888 HOME: 704-609-0888 ZMCMILLAN@TRIAD.RR.COM NAME TO APPEAR ON PERMIT ZACHARY MCMILLAN SITE ADDRESS: 8771 PENINSULA DR, TERRELL NC 28682 PIN # 461704629804 NAME of SUBDIVISION: C BALLARD AND M SHERRILL Lot # 4 Section/Block B PROPERTY SIZE: Square Feet Acres 0.61 DIRECTIONS: 8771 Peninsula Dr PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New 55 x 50 home with 3 bedrooms 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? APPLICATION FOR: New Structure STRUCTURE TYPE: FACILITY TYPE: Single Family Residence DESCRIPTION OF None EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: PRIMARY RESIDENCE OTHER DESCRIPTION: # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 55 x 50 # OF NEW BEDROOMS:: 3 Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: CONVENTIONAL: YES ANY: . APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO EQ - chapplieation 07/30/2013 14:04 Page 1 of CATAWBA COUNTY Case # RBPR-07-2013-17752 Public Health Department Subdivision C BALLARD AND M SHERRILL Environmental Health Division PIN# 461704629804 U n�yv "C PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 SM NAME ON PERMIT: ZACHARY MCMILLAN, 6320 AUTUMN CREST CT, SUMMERFIELD NC 27358 Site Address: 8771 PENINSULA DR, TERRELL NC 28682 Property Size: Square Feet Acres 0.61 Directions: 8771 Peninsula Dr Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. 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 anq labeling of all property lines and corners and making the site accessible s at aplete site evaluation can be performed. Date: 1 i� Signature of Applicant or Agent — - An Environmental Health Specialist will contact you within 2 workin ys of application date. If you need further information or assistance please call 828-466-7291 AREA1 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: 1101911l Authorization to Construct Fee (New/Expansion) Fee Improvement Permit Fee Well Permit & Inspection Fee TOTAL FEES DATE FEE AMOUNT 07/30/2013 $150.00 07/30/2013 $150.00 07/30/2013 $300.00 $600.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 69 - chapplication 07/30/2013 14.04 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT 1-1 %5cA ci�UN'rY CATA.WBA ❑COUNTY HEALTH DEPARTMENT —►�,� �,, a M. Application,for Environmental Services Page 1 improvement Permit Lid Autbori7Ati+i,n to Cons (2" Septic Repair [3 Septic Malfunction F-1Septic Expansion [I New Well Permit [3placement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing, System Inspection (Pre -Approval Required) ❑ Application is for Ni•w Construction ,2 Existing Facility ❑ Property Address__,6_1-7 J -PCt-)(0'5 ,L, k X91 QC— Subdivision G t�A I2P .._._.7 -ST 1aZ Lot # A- Acres . !©1 SectionlBlocklPhase Driving Directions to Property 1.1 vtV 1 ai ' ASTI (�..1&�0 ,J 14 kSC�' k 3t.A4,-1i7 RD, NAME TO APPEAR ON PERMIT? O'Ow-,er ❑ Applicant ❑ Contractor Applicant Contact Information } Name ZI ARCM t U.PrO Address p.o. U'0X'XUD NG .2-73Se } Phone -1 cel - (pog - og80 Cell Phone -7nH _ 4�qo9 08,81& Owner Contact Information Name } Address } Phone Cell Phone Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? PrOwner Applicant ❑ Contractor - - Description of Existing Structures on Site _,, # of Bedrooms *1 _ - Structur Dimensions # of Occupants Basement ❑ Yes �a No Basement i ixtures ❑ Yes ZNo The Applicant shall notify the local health depa rt ment upon subm ttal of this application if any of the following apply to the property in question. If the answer to any q i .estion is `yes", applicant must attach supporting documentation. ❑ Yes f a"No Does the site contain a; y jurisdictional wetlands? El Yes ,I o Does the site contain x y existing wastewater systems? ❑ Yes ,2rNo Js any wastewater going to be generated on the site other than domestic sewage? El Yes ONo is the site subject to ap i. nroval by any other public agency? 0 Yes E2rNo Are there any easemen 13 or right of ways on this property? Describe Existing water supply in use A' J ' .Individual 'Well H Community Well U Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑ No If applying for an Improvement Permit or A, 4hori7ation to Construct, Please Indicate Desired System Type(s)- (systems can be ranked in order of your prefers- ice) Q Accepted El Alternative Convent i anal 0 Innovative 0 Other 0 Any CrI'AW"BA ATAWBA COi I KTY HEALTH DEPARTMENT Application for Envir, nmcntal Services Proposed Facility Type ❑ Primary Residence IN New Residence Addition to Residence # of New Bedrooms *t Project Description C - (.—I:vin t LY SSI DG—r4`n A -(— Structure Dimensions 55 ,c. C # of Occupants Basement ❑ Yes No Baseme,.,.t Fixtures ❑ Yes N No U Accessory Strneture(s) Describe # of New Bedrooms IT if applicable _ Structure .Dimensions # of Occupants Ace ssory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed U Multi -Family Residence # Units Total. # Bedrooms *f U Food Service Specify Type #Bedrooms per Unit*t Structure Dimensions # Seats Floor Space -E fire Food Service Facility (Sq Ft) # Employees per Shift # of Shifts Dining Area (Sq. Ft.) ❑ Business Specific Type of Business # of Employees per Shift [J Other Facility Type Specify # of Shifts If Church # of Seats Kitchen ❑ Yes ❑ No Retail Floor Space If Daycare Specify Occupancy Application for Well Construction/Abandonrrtent/Repair Proposed Well Type '12kJndividual Well ❑ Semi -Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested ❑ Yes ❑ No De i..ribc Page 2 Calculated Design Flow, Commercial f Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. *Any room that will be intended for sleeping at the t ne of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedroom, will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the no :d for septic system size increase in the fbture. T if structure is plumbed but no bedrooms, calculab- I design flow is required. ** if No, a well permit must be issued with the Auth :Azation to Construct. SYSTEM REDESIGN AND/OR .RETRTP V iLL INCUR AN ADDrFIONAL CHARGE (SEE FEE SCHEDULE) improvement Permits issued as a result of this inforn i rtion are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by : its department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits we transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed fin ;ility. 1 have read this application and certify that the infmn ation provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessa F y inspections to determine complianoc with applicable laws and rules. 1 understand that 1 am solely responsible for the prope, identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be p{ rfbrmed. Signature of Owner or Agent F r ,. � ��f'� Date . - 0 Printed Name of Owner or Agent _7 ?�-y Catawba Co',iitnty, North Carolina Tills mapprodtrct rmc prvparerl from . aCnrmvlNrCnrnrgt NC; Gcogrophiclnfrrrvwuroa Swrenr. N CarmvbmCounryhas made subsfanrinlef. alnencarethe ncarragv4?flotnrronarid lnbelinginjorrnotion carrtarned nn this asap. Catm%dm Cbungr, i »nrotes and rccommcnds the Indepandent verfearion of nmr data coaraim;ri on this map product by. 6c uxar 77re Cmrrrtt, ofCmmvb(r, iuf emple uw--. agents and prixoonel &Tclalrtt, andshall riot Im held llnh' forany and all damarm. Incs or•llabilit). edrether direa, Indirect at. cotrstr/nerrtial whoch nrises rn•amy arise i -om this map producrnr dra tum drercaf by any pei mn or calihr, Selected Parcel Number- 4617-04-62-9804 1 inch equals 81 feet Prepared for- C\4 or- o�, ..... N 7184 7 `a oo pyo° 190.48 ,' - 0) -- M s 1180 t O N N oo A 7073 6c 9034 O� 183.;? 0 3 �6' 5 r 7961 �� 0931 9° 4° . ib 20 N.r 2 0 N ''� �� 1751 5 a Plat 12-9 � 7678 4' n �- 0655 Cz 5 A THIS 1S NOT A LEGAL DOCUMENT V Wednesday, Mny 31, 2006 11 -.52 AM -- -- I N -1 1 inch = 50 feet \7073 183.7 lei �s2 Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map 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 product or the use thereof by any person or entity Selected Parcel Number: 4617-04-62-9804 Prepared for: \ 903 „-o. 35 w 876,3 � 5 y ,4. 093 � rrCO- Platt-2-91 76'\ �' x THIS IS NOT A LEGAL DOCUMENT 1 � � �(Q) '��/ CQP�� 9 I IF 8772 `\ OI Date: 7/30/201= Time: 1:34:31,PM65--5 �-► 1 1 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 4617-04-62-9804 Name: MCMILLAN ZACHARY L Name2: MCMILLAN PAULA S Address: PO BOX 637 Address2: City: SUMMERFIELD State: NC Zip: 27358-0637 Account: Calc Acreage: 0.61 Tax Map: 013DX 02004 LRK: 14487 Deed Book: 2766 Deed Page: 0774 Subdivision Name: C BALLARD AND M SHERRILL Subdivision Block: B Lots: 4 Plat Book: 12 Plat Page: 96 Building Number: 8771 Street Name: PENINSULA DR Site Zip: 28682 Township: MOUNTAIN CREEK Fire Dist: SHERRILLS FORD City/Tax: State Road: Total Bldgs Value: Land Value: $50,900 Total Value: $50,900 Year Built: Year Remodeled: Last Sale Date: 7/18/2006 Last Sale Amount: $58,000 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 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: 011504 Census Block 2010: 5013 Small Area Plan: SHERRILLS FORD Agricultural District: Printed: Tuesday, July 30, 2013 01:31 PM