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HomeMy WebLinkAboutRBPR-09-2016-24670.TIF s ‘31%" • THIS IS NOT A PERMIT Case# RBPR-09-2016-24670 ,Q CATAWBA COUNTY HEALTH DEPARTMENT • ) PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES . { 42 SM Residential Building Plan Review - Building New o. 'ro T IMPROVEMENT- AUTH CONST ' J' ' Contractor • ME AS OWNER, , Owner MARK SIGMON, 1862 SETTLEMYRE BRIDGE RD, NEWTON NC 28658 C:828-228-3530 NAME TO APPEAR ON PERMIT MARK SIGMON SITE ADDRESS: 1862 SETTLEMYRE BRIDGE RD, NEWTON NC 28658 PIN # 373005185757 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet Acres 21.6 DIRECTIONS: take Radio Station Rd to Old Conover Startown Rd, right and then proceed to Settlemyre Bridge Rd, left, then 3rd on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Barn with loft apartment, 2688 sf, 2 bedrooms, 2 full baths, no basement 'Sharing well w/ neighboring property. *Newton Zoning on file` 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: Existing 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: 0 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 48x64 Barn with loft Apt #OF NEW BEDROOMS:: 2 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: E9-ehapplication 09/06/2016 11:26 Page I o14 �aA • CATAWBACOUNTY Cases; RBPR-09-2016-24670 .C'iinG� Public Health Department Subdivision 4 g1 ; Environmental Health Division'61PIN# 373005185757 s . PO Box 389, 100-A Southwest Blvd,Newton. NC 28658 /842 w NAME ON PERMIT: ( MARK SIGMON), 1862 SETTLEMYRE BRIDGE RD,NEWTON NC 28658 ( MARK SIGMON) Site Address: 1862 SETTLEMYRE BRIDGE RD, NEWTON NC 28658 Property Size: Square Feet Acres 21.6 Directions: take Radio Station Rd to Old Conover Startown Rd, right and then proceed to Settlemyre Bridge Rd, left, then 3rd on right 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. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 iFEE NAM7 II"I'Itni;� i� i��hllfi� ',;717%( ' D•ATE{Lull I FEE"AMOUNTL a�tW� Authorization to Construct Fee (New/Expansion) 09/06/2016 $150.00 Fee Improvement Permit Fee 09/06/2016 $150.00 �Il�l�ii ° TOTAcIFe Esl'Ju�,nhl � 1�� 'M'` 11! IINill l4Il1ca a;J$300001��� l����" • JCC&,II ilII J�W w W'lud IiL :,r ltluol • . 1fllb SLI y�Mll „ &^m!u 4r: „Nth 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 09/06/2016 11:26 Page 2 of 4 $h THIS IS NOT A PERMIT Case # RBPR-09-2016-24670 rvc Tin d ;faro CATAWBA COUNTY HEALTH DEPARTMENT E , 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 SIA Residential Building Plan Review - Building New OF '' •'•o • t IMPROVEMENT- AUTH CONST A 4•.; kg:_yfAti Contractor SAME AS OWNER__ Owner MARK SIGMON, 1862 SETTLEMYRE BRIDGE RD, NEWTON NC 28658 C:828-228-3530 NAME TO APPEAR ON PERMIT MARK SIG MON SITE ADDRESS: 1862 SETTLEMYRE BRIDGE RD,'NEWTON NC 28658 PIN #. 373005t85757 NAME of SUBDIVISION: ' - Lot Section/Block PROPERTY SIZE: Square Feet Acres 21.6 DIRECTIONS: take Radio Station Rd to Old Conover Startown Rd, right and then proceed to Settlemyre Bridge Rd, left, then 3rd on right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well DESCRIBE WORK: Barn with loft apartment, 2688 sf, 2 bedrooms, 2 full baths, no basement*Newton Zoning on file* 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: Existing 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: 0 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 48x64 Barn with loft Apt #OF NEW BEDROOMS:: 2 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: E9-chap ili cation 09/06/2016 10:40 Page 1 of 4 4p,A CATAWBA •COUNTY Case# RBPR-09-2016-24670 ,7 .I;111 ti Public Health Department Subdivision < 2 "3 Environmental Health Division PIN# ' �KM i- -�i 373005185757 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 /8.2 NAME ON PERMIT: (MARK SIGMON), 1862 SETTLEMYRE BRIDGE RD, NEWTON NC 28658 ( MARK SIGMON) Site Address: 1862 SETTLEMYRE BRIDGE RD,NEWTON NC 28658 Property Size: Square Feet Acres 21.6 Directions: take Radio Station Rd to Old Conover Startown Rd, right and then proceed to Settlemyre Bridge Rd, left,then 3rd on right 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 r. es. I understand that I am solely responsible for the proper identification a )tbellQ°6 all property lines and corners and making the site .cce- =o that comply,- site evalu n can be performed. Date: /61 ( Ip Signature ofApplicant or Agent /.—L IF . ((( An Environmental Health Specialist will contact you within 5 vorking days of applicatl n da . If you need further information or assistance please call 828-466-7291 AREA2 FEENAME Nci ' i i i ii .ti ii i DATE,,:,,,, FEEAMOUNT. i Authorization to Construct Fee (New/Expansion) 09/06/2016 $150.00 Fee Improvement Permit Fee 09/06/2016 $150.00 TOTAL FEES. , , '' _ .. . ,.. t v: $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) E9-chapplication 09/06/2016 10.40 ' Page 2 of 4 CAr''r�fl Tl[.P A THIS IS NOT A PERMIT cLou�nT�'L ,,-- , --,,A CATAWBA COUNTY HEALTH DEPARTMENT "'� Application for Environmental Services Page 1 ` ,.o���o.o -� Improvement Permit Authorization to Construct V Septic Repair _ Septic Malfunction ❑ Septic Expansion n New Well Permit 11 Replacement Well ❑ Well Abandonment❑ Well Repair In Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction g Existing Facility n Property Address 18 Kq7.Se 4-4-(eti re. 3,-.15. Subdivision ' Lot# Acres 'i rq I� ^ 97,d1- Se tion/Block/Phase Driving Directions to Property -fake ;OG h �. 1� I0 00 r`O V PY "CGr4-owT� I ° _ r/�v- �o ' .1.1 • h . voceed - 94'- few ke TPV;c15 e lea . — 1.44 4 —. -J-j ;✓J a kte v i.� r‘.7 .'- NAME TOJIAPPEAR ON PERMIT? V`vner ❑ Applicant 5 Contractor / Applicant Contact Information Name 4 L ',4k,,,st., Address( 3 SP.v IR;4,4 " �pv {� "ye 'D Rd . Aiew`�'oh Phone / I Cell Phone e9 2- - Z7..s - 3 CYo Owner Contact Information Name Co.(,..Q Address Phone Cell Phone Contracto Contact Information Name f✓a k- S,`q W` 3✓) — SO_lM2 Address J Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? VOwner` / (� Applicant U Contractor Description of Existing Structures on Site 110 V..t x -\ \ U.521- 1# of Bedrooms *j' Structure Dimensions #of Occupants Basement 5 Yes '❑ No Basement Fixtures C Yes No - 7 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. © YesF-- o Does the site contain any jurisdictional wetlands? 0 Yes li N``o Does the site contain any existing wastewater systems? 0 Yes Er-No Is any wastewater going to be generated on the site other than domestic sewage? /4 Yes ��N Is the site subject to approval by any other public agency? ICS O Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use [ Individual Well ❑ Community Well ❑ Semi-Public Well El County/City/Township Water Line Is a public water supply available? ** 5 Yes"No 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 0 Conventional 0 Innovative 0 Other Any rM it w( Nosy) v13 ) ypi , S `t`� S ��� THIS IS NOT A PERMIT �cwnACATAWBA COUNTY HEALTH DEPARTMENT u,. --- vo„„c, Application for Enviromnental Services Page 2 Proposed Facility Type n Primary Residence New Residence n Addition to Residence # of New Bedrooms *'j Z Project Description 9Arry Oi'i o,gj. apotr+tem f Structure Dimensions 4f4x '4 # of Occupants 2-- Basement Basement L Yes R.-go Basement Fixtures'rj Yes 2'l�O ❑ Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling IT Yes ]'No • Plumbing n Yes ❑ No Describe Plumbing Needed. Multi-Family Residence#Units #Bedrooms per Unit*j ` • Total# Bedrooms *t Structure Dimensions' IT 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 I ) Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes C No If Daycare Specify Occupancy ' Application for Well Const^.'tion/Ahandonment/Repair Proposed Well Type , , Individual Well n Semi-Public Well 'Community Well Abandonment Type ❑ Drilled ❑ Bored _ Dug • IT Unknown Well Repair Requested ❑ Yes n 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. j 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 L�.�/ _an INN.—tip Date c9XO //�j Printed Name of Owner or Agent a (/ f— l r q " o FYBf Fl �� �t 6 a F $ ' pP9( Qk € Ag. co i °y„ �e V 7 Z a I/ 5 � =w a, r �pp g �t c O i 3 �,5?± FQ G "S° 'lig 4r i4 gi o f al O Q wliko p l !I1II a ! ! t. 1; : i kF F Fl 6 V Be 2V U R v S° ![ 3 ,\ � 0 I11pe pF ¢o , R5i dOV 5i 3 , 1 i p €.4 4 3-• mm o zl'111111E WIZ ° 5 A 1 I €lib A sc / tlpf a N 3 i 2 gg 1sr. Lra„ e t� a ep Z 1 f 1�L3 I .or'I it s i � a € 1 i 2j gar m a �s =-ae 14 m ,,.a I „tit r Al ^Imi 1a 3' I„ 1n i l D111,;;m� 6 ^ p pe 0 �t _ 66�*CfJ.'r 11CO N $I . 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'SETTLEMYRE BRIDGE RD I 1 to 352i lir1 I tr LL o0 11 , _ _ ..... _ �� I . �t 930 s I • 7'0 150.:b ---- �S\ I ~ _N 46.7 9 \ Parcel: 373005185757, 1836 SETTLEMYRE lin=150ft BRIDGE RD NEWTON, 28658 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 2014 Catawba County NC 09/06/2016 Catawba County Environmental Health • 0 �\ `r,, ` '9vf, i 950 ` „sot•,` 940 It 0,94 893 935 O3 910 \o `\c2? rib itili 1 A v) .18111°31161 . I/ ht r 0 4 . 01882 .' :� c i_a;c,_ \Ili 2 an •iSE-n- - Ef • �Lej�EMYRE BRIDGE RD amallist •. H Jpnl� iV• 1 m r ",`_" i17i, . In '''''.\- 1 7C dr• • _ ` a Li.' iii ticii 7----------„,_ c 1 14'x\ \ J '---\ �9 �14 :' Parcel: 373005185757, 1836 SETTLEMYRE lin=300ft BRIDGE RD NEWTON, 28658 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 2014 Catawba County NC 09/06/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373005185757 Owner: SIGMON MARK A Parcel Address: 1836 SETTLEMYRE BRIDGE Owner2: RD Address: 1708 SETTLEMYRE BRIDGE RD City: NEWTON, 28658 Address2: LRK(REID): 25962 City: NEWTON Deed Book/Page: 3165/0570 State/Zip: NC 28658-9558 Subdivision: School Information: Lots/Block: / Last Sale: School District: COUNTY Plat Sale: age: Elementary School: STARTOWN BookMiddle School: MAIDEN Legal: 1836 SETTLEMYRE BRIDGE RD Calculated Acreage: 21.600 High School: MAIDEN Tax Map: 028N 01013 School Map Township: NEWTON State Road #: 1165 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: NEWTON County Fire District: NEWTON RURAL Zoningl: R-20A Building(s) Value: $294,800 Zoning2: Land Value: $125,000 Zoning3: Assessed Total Value: $419,800 Zoning Overlay: Year Built/Remodeled: 1996/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710373000J Building Details 2010 Census Block: 1044 WaterShed: 2010 Census Tract: 011701 Voter Precinct: P40 Agricultural District: 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. ©2016, Catawba County Government, North Carolina. All rights reserved. CCD 2ld2 ) ZLjI goI lcia5 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=373005185757&typ=P 9/6/2016 FILED Calwiba county on Sep 02,2016 at 12:02:00 pm Erase Tax taco (Mc) INST.#15074 DONNA HICKS SPENCER, Register at Deeds eu 03360 rg 0218-0219 Revenue$0,00 Recording Time,Book and Page THIS INSTRUMENT WAS PREPARED BY JOHN H. CHI FY, CORNE & CBI FY, PLLC, ATTORNEYS AT LAW,P.O.BOX 747,NEWTON,NC 28658 ./ Return to: Coyne & Cilley, PLLC NORTH CAROLINA GENERAL WARRANTY DEEDED , THIS DEED,made this,li tdayof August ,2016,by and betwee'n'+MirkA.Sigmon, Unmarried, having a mailing address of 1836 Settlemyre Bridge Road4Newto i NC 28658; GRANTOR; and Mark A. Sigmon, GRANTEE, whose permanent mailing address is 1836 Settlemyre Bridge Road,Newton,NC 28658. a NliteA An. �,J 6y The designation Grantors and Grantees as used herein shall include said parties,their heirs. successors and assigns,and shall include singular,plural,ma culine,fel-Tittle or neuter as required by context. te WITNESSETH, that the Grantor, fora valuable.consrderation paid by the Grantee,the receipt of which is hereby acknowledged,has and'by these presents does grant,bargain,sell and convey unto the Grantee in fee simple, alltfiattViceertain lot or parcel of land situated in Newton Township,Catawba County,North Carolina,�'a,�'�i1fandy� m�y,pore�particularly described as follows: tk Being Lot No. 1 according to a surveehmadelby'Honeycutt Land Surveying, PA,said plat being recorded in Plat Book 76 at Pagei8,Catawba County Registry,which plat and record are made a part hereof and referred to for,a f�urther;description. See deed recordedti_n Book3165 at�Page 570, Catawba County Registry. `,L1C,�+ l�iss The property herein conveyed'does NOT constitute the primary residence of the Grantor herein. NEITHER THEINDIIDUAL NOR LAW FIRM PREPARER OF THIS DOCUMENT PERFORMED ANY TITLE EXAMINATION NOR PARTICIPATED IN ANY CLOSING RELATED TO THE TRANSACTION INVOLVING THIS DOCUMENT. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and z appurtenances thereto belonging to the Grantee in fee simple. 0219 And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in fee simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated. IN WITNESS WHEREOF, the Grantor has hereunto set its hand, or if corporate, has caused this instrument to be signed in its corporat• ame by its duly authorized officer,the day and year first above written. / ,...t a • A %EAL) M k A.Simon IIIVSTATE OF NORTH CAROLINA COUNTY OF I,a Notary Public of the County and State aforesaid,do certify that IA.Sigmon of personally appeared before me this day and acknowledged the execution of the foregoing instrument 70 for the purposes expressed therein. ) 4f Witness my hand and official stamp or �eal the., 31 day of 1143us-I 2016. # 'Af t4 I"%vie"; Notary Public/jereSa LMI,b$ N J' flI My commission expires: 0b I I�Q.a/K 0,1 a, I ,‘„ o��ERESq„„, S O p `�<:. M�0l. ,1?%_' N= _-. B,o Nil, DONNA HICKS SPENCER CATAWBA COUNTY REGISTER OF DEEDS PO BOX 65-NEWTON, NC 28658 PH: 828.465.1573 FAX: 828.465.1911 dspencer@catawbacountync.gov Receipt For : CORNE &CILLEY PLLC Instrument Type : DEED Receipt# : 2016-552063 Instrument# : 15074 Date : 09/02/2016 12:02pm Book/Page : 03360 / 0218-00219 Pages : 2 Document : 1 of 1 1st Grantor : MARK A. SIGMON 1st Grantee : MARK A. SIGMON Description: Description Qty Unit Cost Extended Deed and General Inst - first 15 1 26.00 26.00 pages Document 1 26.00 Grand Total 26.00 Check 8286 -26.00 Balance 0.00 This is a refund of 0.00 to be mailed from the finance department at a later date. Customer Copy ***Op. Permit and/or Cert. Opp Required /6(Must be completed prior to final) NJ? 8 204 CATAWBA COUNTY HEALTH DEPARTMIE / (704) 465-8270 - i 1, Lot Eval. Improve. Permit (--- Repair Permit Cert. of Comp. Permit Oper. Permit', r N Owner/Agent �A . a', _ 1_,64...AI Phone /6 /2---/...?„301, Address /:5'(m �) L Subdivision Section/:lock/Phase Lot# Lot Size g .r ,Direction �' +t t• 5� a}'fr -14-�9. Am, - - ,..,,.. ` i . '- /71,11.,„e__, eye/ -, VO d —fcck) ' �. Facility: House Mobile Home Business . Other: Tax Map # '-• -- / /�� Multi-fame Other . Zoning Approval # ' , Bedrooms ,L5 Seats Employees . Application Rate i GPD Flow . a Hot Tub or Spa yes/no Special FixturesIII . 1001 Repair Area 01;P no REPAIR NOTICE: Basement yeA/no HBeement Plumbi =J_/no . REPAIRS MUST BE WITHIN 30 DAYS OR Water Supply: Private /V Public . DAYS FROM DATE OF PERMIT. Type of System: Trench C�'11ted Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank / DUJ Pump Tank G0 Depth of Stone j rf Bed Size Nitrification Field: Total Square Feet 9p �. Trench Width 3/ Total Length of All Trenches : 010 / Number of Trenches v Individual Trench Length /O//o0/JAO// / Feet on Center 9/1 Maximum Trench Depth je / Distance of Nearest Well Lot Evaluation: Approved yes/no (Void After 24 months) Topo I-3 % Slope i Sketch of lot Evaluation Site - System Design - Final Texture a- NOT (pi .b INSTALL Structure _/9 i of INWHEN WET Clay Min. /� Soil Wetness ,_ _" Soil Depth S Restric. Hoz. a 1 Available space /no, c- Overall Class S U Comments: (, lqk 1 ~ b. 1 por- LJ rs, , —sar .i l 1 a1 -- (YJ'J_ l I I 1, o Yom . ( I / til 11* -\ fes•- �v Septic Tank Contractors _ — MUST contact the Sanitarian BEFOREMill changing permit. **NO GUARANTEE OR WARRANTY[[�� ill ;IS IMPLIED OR c : N THROUGH THE ISSUANCE OF THIS PERMIT** Permit Date f ;7 - -51 - (Improvement Permit void after 60 months) Ade Owner/Agent ✓. �. `/: , ,�, _ -n- arian . • 9/451,1-0--4. Si Installed By , r«� Date ! il,,,_' San tarian l�1 , - - /f•,Ut i (Notr a' changes 'nformation in red or by sketch on back) *******IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL $25 CHARGE. White-Office Blue-Building Inspection Completion Yellow-Owner/Agent Green- Building Inspection IP