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HomeMy WebLinkAboutRBPR-03-2016-23328.TIF vs$A �G THIS IS NOT A PERMIT Case # RBPR-03-2016-23328 *pi CI - ���,? � CATAWBA COUNTY HEALTH DEPARTMENT � -�"'o '-r`� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES -. �� /843/. Residential Building Plan Review - Modular •n • • G "L Lo AUTH_CONST - NEW WELL o off' . Applicant *CLAYTON HOMES OF STATESVILLE, 2026 NORTHSIDE DR, STATESVILLE NC 28625 B:704-873-2547 C:7046778903 Owner DUSTIN SIGMON, 1794 LINDSEY LN.CONOVER NC 28613 C:828-217-4639 Paid By VINCENT NATHANIEL, 253 W STATESVILLE AVE, MOORESVILLE NC 28115 NAME TO APPEAR ON PERMIT Dustin Sigmon SITE ADDRESS: 1794 LINDSEY LN, CONOVER NC 28613 PIN # 374407793311 NAME of SUBDIVISION: Loth Section/Block PROPERTY SIZE: Square Feel Acres 2.9 DIRECTIONS: Hwy 16 North, Left on Springs Rd, Left on Rector St., Left on Lindsey Lane & lot is down the road 1 mile on the left. # is on mailbox PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 1 story off frame modular with 6 x 6 front deck & 4 x 4 rear deck 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? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF SW mobile home EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 3 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30 x 76 w/6x6 &4x4 rear deck #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: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO • E9-chapplication 03/04/2016 12 34 Page 1 of 5 y$A CATAWBA COUNTY Case# RBPR-03-2016-23328 (¢t r !w% Public Health Department Subdivision ¢ , gig Y Environmental Health Division PIN# +'� 374407793311 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 18.2 w NAME ON PERMIT: (DUSTIN SIGMON), 1794 LINDSEY LN, CONOVER NC 28613 ( Dustin Sigmon) Site Address: 1794 LINDSEY LN. CONOVER NC 28613 Property Size: Square Feet Acres 2.9 Directions: Hwy 16 North, Left on Springs Rd, Left on Rector St., Left on Lindsey Lane & lot is down the road 1 mile on the left.#is on mailbox 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. 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 so- .onsible for the proper identification and labeling of all property lines and corners and making the site accessibl- so that- m. -te : •alua a performed. Date: 3 'eaa Signature of Applicant or Agent ��� An Environmental Health Specialist will contact you within 5 . irking days of application date. If you need further information or assistance please call 828-466-7291 AREA2 ,FEENAME DATE, FEE AMOUNT Well Permit & Inspection Fee 03/04/2016 $300.00 Authorization to Construct Fee (New/Expansion) 03/04/2016 $150.00 Fee TOTAL FEES ,',.r.214. 0.00 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) E9-chapplication 03/04/2016 12:34 Page 2 of 5 CATAWBA THIS IS NOT A PERMIT COUNTY t.. CATAWBA COUNTY HEALTH DEPARTMENT ..,th Application for Environmental Services Page 1 Improvement Permit n Authorization to Coo���n,,,,,,ssss///truct Septic Repair El Septic Malfunction ❑ Septic Expansion ❑ New Well Permit Rep acement Well ❑ Well Abandonment El Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address /7rV t/'t /5Gy /A.JC Subdivision Conover At / 286 t 3 Lot# Acres �" Section/Block/Phase Driving Directions to Property 14 0 I LC( f- SpIls►Z d t le t+ Re ei{zs( �j j- 2 �I kind se Ln■ I mmk- on lcFr NAME TO APPEAR ON PERMIT? (Owner El Applicant I F'Contractor Applicant Contact Information Name & 4.- ,),/:,,,,,eg of eso;He Address /20 24. 466x/+ f4c aide Phone 94 V-CCT- 25-97 Cell Phone 7a/-677—BIDS a'nn;i: Owner Contact Information Name Pue./.v St. .--,....../ r� Address / 7 9y Cri sr �44/c t2 oaicr NC 2&1 I Phone S�8 _ 2i7 —/35' Cell Phone Contractor.Contact Infor ation Name C/A 4,Q 14m'cs- etc co I it License# Address zdz . �iJ�S�'et'e <#971CJ,'/if Phone >a d-en-25°/7 Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Situu o a .a.r .6.; .5 ;.,B it i de, .f MOI i be h{ d #of Bedrooms *t _3- Structure Dimensions J # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No 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 1201(Io Does the site contain any existing wastewater systems? ❑ YY s 2� o Is any wastewater going to be generated on the site other than domestic sewage? .2"Yes o Is the site subject to approval by any other public agency? ❑ Yes No Are there an easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes go 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 ❑ Innovative ❑ Other E Any C A T ADZ 7QA PHIS IS NOT A PERMIT couNTY CATAWBA COUNTY HEALTH DEPARTMENT „,„„G,,a Application for Environmental Services Page 2 ' Pro sed Facility Type Primary Residence New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description -✓ orC r 1ji.,..e r' ftuz Structure Dimensionsc0 j X 760 #of Occupants 3 4-4141 tuft Basement ❑ Yes 111410 Basement Fixtures ❑ Yes ❑3SO IT Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence# Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions ❑ Food Service Specify Type #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift # of Shifts Dining Area (Sq. Ft.) IT Business Specific Type of Business Retail Floor Space # of Employees per Shift #of Shifts ❑ Other Facility Type Specify If Church # of Seats Kitchen ❑ Yes ❑ No If Daycare Specify Occupancy Application for Well Constr ction/Abandonment/Repair Proposed Well Type Individual Well n Semi-Public Well n Community Well Abandonment Type n Drilled ❑ Bored ❑ Dug n Unknown Well Repair Requested IT Yes ❑ No Describe Calculated Design Flow, Commercial t 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 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 house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. t If structure is plumbed but no bedrooms, calculated design flow is required. ** If No, a well permit must be issued with the Authorization to Construct. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 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. 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. • Signature of Owner or Agent —/ /� Date 3-`/- &'t Printed Name of Owner or Agent HneenT ,4T, 1.., c Catawba County Environmental Health / • lir 6.-. 1 5 le-f- / / 634 / / / ta T . . .. / G\ •17•. c) c.... I d Ski N. Z r` V V j 14-.✓c . 3311 C> I. ir . ±) —} a —X.� , o a \ r L N . _ 0 \ij, 0. r l •N r 368.65 1 1 Parcel: 374407793311, 1794LINDSEYLN s] CG 'S 1in=60ft CONOVER, 28613 • 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. Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374407793311 Owner: SIGMON CHRISTIAN JACOBS Parcel Address: 1794 LINDSEY LN Owner2: SIGMON DUSTIN SHEA City: CONOVER, 28613 Address: 1794 LINDSEY LN LRK(REID): 42675 Address2: Deed Book/Page: 3312/0981 City: CONOVER Subdivision: State/Zip: NC 28613-7788 Lots/Block: 2/ Last Sale: School Information: Plat Book/Page: 24/18 School District: COUNTY Legal: LOT 2 PLAT 24-18 Elementary School: LYLE CREEK Calculated Acreage: 2.900 Middle School: RIVER BEND Tax Map: 0900 001136 High School: BUNKER HILL Township: CLINES School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-20 Building(s) Value: $2,000 Zoning2: Land Value: $20,700 Zoning3: Assessed Total Value: $22,700 Zoning Overlay: DWMH-O Year Built/Remodeled: / Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710374400J Building Details 2010 Census Block: 2005 WaterShed: 2010 Census Tract: 010201 Voter Precinct: P33 Agricultural District: PROXIMITY 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. ©2015, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=3 744077933 1 1&typ=P 3/4/2016 • 1 ■ :3 0 � '3O N° 3609 CATAWBA COUNTY HE:AL.TH DEPARTMENT � (.704) 465-8270 Lot Eval. C Improve. Permit t epair Permit Cert. of Comp. PermitX1Opper. Permit Owner/Agent ,L LA I Phone 4c6V-__ (9-3(9 Address /, -L.d 412114W A,;,, ♦ PX. / Subdivision Section/Block Lot# ' L. Size : ,_� Directions: I �� .a _ .`a i._ L 1� � a 2'1', . G . is _sue � /' FA/ .. Facility: House Mobile Home 4 Business . Other: Zoning Appr val yes/no # / Multi-family_ Other . 100% Repair AreaCYes/no Bedrooms 9 Seats Employees_ . GPD Flow 2.09 Application Rate/ Y Hot Tub or Spa yes/e) Special Fixtures . REPAIR NOTICE: REPAIRS MUST BE WITHIN Basement yes/6, Basement Plumbing yes o) . 30 DAYS OR DAYS FROM DATE OF Water Supply: Private Public . PERMIT. Type of System: Trencht!"*Bed PumpPump/Panel Panel T.PP Other Tank Size: Septic Tank 7000 rrzRLlltsm Pump Tank Nitrification Field: Total Square Feet (:)Q Q Depth of Stone tag Bed Size Trench Width ,' r TotalL�eenngth of All Trenches 2.00 Number of Trenches L� Individual Trench Length L//y'� 7 / / Feet on Center g c Maximum Trench Depth 3( %." Distance of Nearest Well MO* Lot Evaluation: Approved yes/no (Void After 24 months) Topo 3 % Slope Sketch of lot Evaluation Site - System Design - Final Texture CatyQ4i Structure Clay Min. 77 Soil Wetness /in- " Soil Depth [et- " Restric. Hoz. at f•Y'"' Available space 401/no Overall Class StikfrU >� Comments: t ww 11 � O t r' ii **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THE ISSUANCE OF THIS PERMIT'. Permit Date 7 —. 7-41 I (Improvement Permit void fter 60 months) /� / owner/Agent" �j/, ..0 r/� ,/S� e Sanitarian 24r, i i.yg.,4 S. Installed By U-IL ' i e • dr. .Date z4-/9/Sanitarian . lgalltjln (Note any chances/information 9n red or by sketch on hark) White-Office Blue-Bldg. Insp. Comp. Yellow-Owner/Agent Green-Bldg. Insp.I.P. g CA TA W BA COUNTY OVA: 0 Case# LO1N IMPV-12-2015- 067122 2 � YPO ubBlic ox H3e8a9h 1D0e1pA artSmoeuntt hvest 31vd, Nevton. NC `• •�� Subdivision I Environmental Heald Division h' S PIN// 374407793311 � 28658 0 n.1' L NAME ON PERMIT: DUSTIN & CHRISTIAN SIGMON, 1794 LINDSEY LN, CONOVER NC 28613 Site Address: 1794 LINDSEY LN, CONOVER NC 28613 Property Size: Square Feet: 126,324.00 Acres:2.9 Directions: Hwy 16 North, Left on Springs Rd, Left on Rector St., Left on Lindsey Lane & lot is down the road 1 mile on the left. # is on mailbox improvement Permit Facility: Primary Residence - mobile home Permit Category: New Septic Bedrooms 3 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: 111G -OTHER NON-CONY TRENCH SYSTEMS Permit Conditions: REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: MG - OTHER NON-CONY TRENCH SYSTEMS Landscaping or other site alterations that potentially diver,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 Mar all Catawba County Planni tietoning arid Building Inspections requirements are met. 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 'Lars and Rules for Sewage Treatment and Disposal Systems' (15A NCAC ISA .1900). 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, Megen McBride 12/01/2015 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 11/30/2020 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Deportment. elipennit 12/0120]5 08:25 Page I of3 ZP LHPK•lo-Lois-aas&o 17H Lindse7 ( 44 Cvna■Jer *.This UrV'4 r5 rnvl rv(ety ed. foe se f c. Iv'ch L+Ctiltk prpoYS . Do rte ckvc, 3rude, Cu; , Of fl (ie✓ ej(-1-c, area. -f ,) I T4-I +6 k rerAoJec! - Ne ,.1 M-1 vii(k have new xr{iL, s s1er, O. c) atr'Jl hew well. Y 1.1 1, 65' 2 iv; '4 loo' J q/ ,p_ � — -----so_ p ' �, p bc/ in a> /D. X7O M � a1 c Pr° osrd eQr 9' M , p- 1 ° iz ;7,� c _! er,s rx 7u 7;Beil MN C. EXiS�i M� Rehr T'Eger, currerAt %es A �'"°red I 51 PCS54 , Well foc.-EC� br At `II' r� T„'5 r�ro fer+i Czi r 'I r S_ / 4r Pat 1 Ln ey 60, DEPARTMENT OF ENVIRONMENT AND NATURAL RESDULCES Shed_of DIVISION OF EWIRONMFATAL HEALTH PROPERTY ID N: O:-SRE WASTEWATERSECTION COUNTY: SOIL/SITE EVALUATION for I N-SITE WASTEWATER SYSTEM OWNER:• U 1 11 ' IF Y ar i• or, •PLICASIONUATE In IG 15 EHP�-Ib-�GIS- 2 5�p• ADDRESS: DATE EVALUATED: ff J7-16, I1-IY15 PRDPOSFDFACII.ITY: 3 BP-P^ PROPOSED DS1GN FLOW(.19;9): 340 . PROPERTYSD-E: D•9ttcns WrH, ' IACAIION OP SITE 179 Lin ctj Ln e (Mnk r PROPERTY RECORDED: MC., WATER SUPPLY: ® Private 0 Pr fie d Well II spring II O::.c: EVALUATION METHOD: 0 AugrrBodng g lift. U cut . TYPE OF WASTEWATER: p Sewage 0 Ind:r-=j=Press U 1.,i:;,..3 •----� ----...._----._._.. _......,., .._..rte .::__,_._: .—. $(� P}�511:iO1 ()l , C11 LK_ T".:__._^._"t J_ 1_ • Ili �.—. — (3943j .. . .. _ ' -• ) .II I;•5>:�C0t5-1 - f _ _ __ . _. =.;=...71'-',”:,=-H-,--9�D__ -_ a_s _.:r__..._._:_::::::=,::::=7;::_: _. .; _ :_r_..._:..... :;:::::a::s=:cii:v.=aa - ::asr_e:r_' :—= :__s :� ' '1;;'•.::t52alt=-: .:.i_—:__ _ z: :°: 'i_ocEi[!a! :[s-____ � 1901 � ult_- . 'C94# 1➢55 .i�dd Dec ggv./ S:d4" URtr o;cLSrEt.cr tss,'-:E7 - S7tp,-',= n0 a2 3TArk _ L--7.(a _.. T a, _ . ■tttArtit n n o•t- ..DEE pai. lr4 _ -SfYTh r 0•y L, j• I I.1s,59x:0 I .. 1 5 15 t[ GL ,' Sy L' ; -V�p yg _ • J PS Iti 9. `-4-- . . .. ' t0,} O. a5 Sumo, Ps 2 y — • I 0.251 I sic, y s P5 3 _ . • . DESCRIPTION f II.RTIAt SYST40 i RIPAA':' O:'HFR F' .1945): PS I Ps SiIE CLAS. ON(.194S): Available Spa=(.1905) 1 . s rSxC) �� -:'ALUAT Ae5eh nrf-e. t .rte Call — O:TIER(S): ;T: • . . Site LIAR 0. 15 p.: coMMarls: 1 Ski 14 Coldenihi USIND vwcLI on aaittct - . \Ik: WWII be. clrdto J► .ew / well -Fov hekd wHN .) \c):31 ` { -1W Lintc (\ 1b (t) Iiiatl7jot ,t,�+. q T0. 'px .. 5. .f r� jir1. i • . ;i ; " 1 . 'Y."a?:'=� . '�: Y'�..__ 1��.E. ..x..f:�� �L �:h'r, �7 ..-' MYe`r'e. . ��'•",Si.`,