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HomeMy WebLinkAboutEHPR-08-2016-24543.TIF c;is �� THIS IS NOTA PERMIT Case # EHPR-08-2016-24543 747. mfi il CATAWBA COUNTY HEALTH DEPARTMENT C_.-1 o'.F`. :0 i v 4N. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ti� 4 ' �84Z SM Environmental Health Plan Review - Septic Malfunction o - tip�, IMPROVEMENT . o{'4 0 ' r Owner JAMES& MARGARET SIGMON, PO BOX 222, CLAREMONT NC 28610 C:8284597598 NAME TO APPEAR ON PERMIT James & Margaret Sigmon SITE ADDRESS: 2902 WALTER DR, CLAREMONT NC 28610 PIN # 375220922333 NAME of SUBDIVISION: WALTER YOUNT ESTATE Lot# 1_5 Section/Block D PROPERTY SIZE: Square Feet 25,264.80 Acres 0.58 DIRECTIONS: Hwy 70 East, Left onto Peachtree St, go to the end of the road &turn Left, House is on the corner of Walter Dr& Peachtree. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: IP to determine if existing septic system is on lot beside the home (possible AC required to relocate or easement) & to designate repair area. They are looking to sell neighboring vacant lot. 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 House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 71x42 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 2 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: E9-ehapplication 08/19/2016 13:20 Page 1 of 4 OA , CATARBA COUNTY Case EHPR-08-2016-24543 ¢' r- "limit , Public Health Department Subdivision WALTER YOUNT ESTATE d .--'® ,t, Environmental Health Division PIM, 375220922333 ''8 PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 NAME ON PERMIT: (JAMES R. MARGARET SIGMON), PO BOX 222, CLAREMONT NC 28610 ( James & Margaret Sigmon) Site Address: 2902 WALTER DR, CLAREMONT NC 28610 Property Size: Square Feet 25,264.80 Acres 0.58 Directions: Hwy 70 East. Left onto Peachtree St, go to the end of the road &turn Left, House is on the corner of Walter Dr& Peachtree. 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"3-19—/ and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: p— 9—j (o Signature of Applicant or Agent /\arras tt.o 2 . Lcaren On 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 u i ^m7177 i lff i dln 1 1 It i fi `r"'p +m n., FIEENAME. 1'IIrJI;ii[Iin',b): r �,1i�1Thi lioLW�"falf�!.� Li`bili'IDATEI !Ll` .. IiFEEJAMOUNTgil Improvement Permit Fee ( 08/19/2016 $150.00 ,a r� pit r t' J' 1W1M Ith { i -1 TOTAL FEes f I 11111 9.7511W stso 00 �ih ( it{ 1� i ! ' ,,i. Jd,,,,..,.I� m` �tl I LOQ. '.et ��I�€� ,:k.-,.:4;i“.•.,........ . 11 bh4 w nl e7J�rr:Sii uE > ..3.r'Lnfi w. +s NditiA6 .IltIllh -L;L' Biliklanlii FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 09-ehapplication 08/19/2016 13:20 Page 2 of 4 CATAWBA 'HIS IS NOT A PERMIT coun�n� CATAWBA COUNTY HEALTH DEPARTMENT ties„� Application for Environmental Services Page I Improvement Permit Authorization to Construct❑ Septic Repair E Septic Malfunction ❑ Septic Expansion n New Well Permit❑ Replacement Well ❑ Well Abandonment❑ Well Repair H Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction LJ Existing Facility X Property Address cO 1.2at-enOct N./ Subdivision c2o tAr1Ont N .C;_ ,$(o Lot# Acres Secti nlBlock/Phase Driving Directions to Property H(Alaof l�y �)f- +1-1/4.51,1-xx y� 0 rib Via n i tr'e e .1n� I - S✓o '{D O,n �F' _X- � �I .1 - )11 0(.�- D n C&Ln 4n - r I JP_ Ja.LQ5 (44 t91 Ci3Q1, le)-‘ DrI J c 1 NAME TO APPEAR ON ERMIT? Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name au; -r MargareJ . iCmo�. Addresshpb �px p a - Phone3,V ) 'f-9 7 S 2 Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *1. 3 Structure Dimensions # of Occupants a Basement ❑ Yes VNo Basement Fixtures a Yes �o — 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 ei No Does the site contain any jurisdictional wetlands? el Yes ® No Does the site contain any existing wastewater systems? 0 Yes ® No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes ®No Is the site subject to approval by any other public agency? 0 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 County/City/Township Water Line Is a public water supply available? ** VYes ❑ 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 ❑ Conventional 0 Innovative ❑ Other IV'Any c A T A''CI TLa A THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT moo„ ,e Application for Environmental Services Page 2 • Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *j Project Description Structure Dimensions # of Occupants Basement _ Yes ❑ No Basement Fixtures ® Yes ® No ❑ Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed H Multi-Family Residence# Units #Bedrooms per Unit*j' 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.) ❑ 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 Construction/Abandonment/Repair • Proposed Well Type ❑ Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ] Dug ❑ Unknown Well Repair Requested ❑ 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 comers and makingthe P Ysite accessible so that a complete site evaluation can be performed. Signature of Owner or Agent a G , .da, 0 n. Date b H 9 - (p Printed Name of Owner or Agent Oa rvv e5 )_ , 3/Y, o n Catawba County Environmental Health r / / / / O / / / / / / / / / / / / / 436, 60 / N / / / / / / / / 1 / / • / / / / AX / / / / / / I / / / / / 'yr / 41/4 / oti / / / Ailhhojilih1/4/ .....02 / / sr4111111H--/1110H1/ , / / 'eh / / / / / / / / / / / / / / / / / / / CS)/ ACO / / / / / / / / r1 Orli / / / / / / / / / / / / / / / / 41 lQ, / / / / / / ' / \ / / / / \ / / / / \ / / / / QC- \ kti / / / / / ti v \ \ / / / / P 'it \ / e / / \ \ / / / \ N / I / / O \ \ / �S / / 43. \ \ / 44r N. \ / \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ / \ \ \ / \ \ \ / / \ \ \ / / \ \ • \ • Parcel: 375220922333, 2902 WALTER DR 1in=50ft CLAREMONT, 28610 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 1 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 08/19/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375220922333 Owner: SIGMON JAMES EDWARD Parcel Address: 2902 WALTER DR Owner2: SIGMON MARGARET JEANETTE R City: CLAREMONT, 28610 Address: PO BOX 222 LRK(REID): 68620 Address2: Deed Book/Page: 1376/0888 City: CLAREMONT Subdivision: WALTER YOUNT ESTATE State/Zip: NC 28610-0222 Lots/Block: 1-5/ D Last Sale: School Information: School District: COUNTY • Plat Book/Page: 13/97 Legal: LOT 1-5 1-5D PL 13-97 PL 13-97 Elementary School: CLAREMONT Middle School: RIVER BEND Calculated Acreage: .580 Tax Map: 4206 02001 High School: BUNKER HILL Township: CLINES School Map State Road #: Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: CLAREMONT Zoning District: CLAREMONT County Fire District: All in City Zoningl: R-1 Building(s) Value: $114,800 Zoning2: Land Value: $16,200 Zoning3: Assessed Total Value: $131,000 Zoning Overlay: Year Built/Remodeled: 1984/ 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 #: 3710375200J Building Details 2010 Census Block: 3036 WaterShed: WS-IV Protected Area 2010 Census Tract: 010102 Voter Precinct: P6 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. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375220922333&typ=P 8/19/2016 • G.21-O "4 CATAWBA COUNTY HEALTH DEPARTMENT Ne 5 3 •8 3 Telephon (828)4165-82,,7 DG: (828)465- 0/pl - - VIA Imp. Prmt. Auth. to Const. pr. Print. Opr. Prmt. Sys. Type 1,4- Well Print. Well Rpr. Print. T Owner/Agent C l•e- TM") 3752-z0-92-Z 333 Phone Address Subdivision Secti. Clock/Phase Lot# Lot Size Dire- tons: %SIP sig. ---Ir.S r r?. r _ cJt- 1 — J ! re ADO- . . Facility: House x Mobile Home Business Multi-family . Other: Tax Map or Pin Number Other . Zoning Approval# #Bedrooms .3 # Seats #Employees . Application Rate GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes Water Supply: Private Well Public Semi-Public *****************#*****4*********4***********9***********4****************************************************************4 Type of System: Trench Bed X Pump Pump/Panel Panel LPP Other pp Septic Tank Size Pump Tank Size Nitrification Field: Total Square Feet 406 12- /1fa Depth of Stone � Bed Size /0 X /0 Trench Width Total Length of All Trenches Number of Trenches Trench Length / / / / / Feet on Center Maximum Trench Depth Distance of Nearest Well *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* **************************************************************************************************************************** Topo % Slope Y --/--e4 t'ei- /�r/ye q t;C -c Texture �� G 6Qey Y// �` J incture z Clay Min. d raf,i6 eu /I 1eC • V Soil Wetness V (/ Soil Depth " Restric. Hoz. at " Available space yes/no Overall Class S PS U Comm�e/nts: /J,•,� /DX 1f157t 1.� d U11 \ ah, ._±a' ases Are /1,.4-c fee; (bp kte- \ H 9-as2 6y/� 4122 O -, Z Aland�r A i aderk �/ll i. , /1 / )- itecQraio /A sa� //"a � G Ft,e Ff c „Jai& e(�, , "NO GUARANTEE OR WARRANTY IS IM_LIED OR GIVEN AS TO THE P .R ORMAN4 • t LENGTH OF TIME THIS SYSTEM WILL FUNCTION" k-! , z zee **************************************v"' ******* ************************************************************* *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protec:on fro • knj possibl: sources of contamination. No volume of water is guaranteed at any sitethe Health Department. _ — ,r Permit Date 0 Z� - �o Owner/Agent — . Ic 5 fes]n n Septic Tank Installed/t/ r /i f I '� Date 1-/0yY EHS_-5-g,- Well Installed By r di ell Grout Approval Date Well Headroyal Date Date Sample Collected Date of Results Results EHS White-Office Blue-Building Inspection Operation Permit YelloA-O citer.'Agens, Green-Building Inspection Authorization to Construct i ' CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N° 1361 DATE : 67/5/84( OWNER nvi,P.o re©, ; €��� � / ADDRESS ., � AD uYt a BUILDI G CONTRACTORnUBDIVISION LOCATION/,P, 1Yl (Dfiyn„bit A {A psztu -e-e/ —4'441t 't t LOT SIZE BLO&K OR SECTION / • '( Bir -4 HOUSE '(I ) MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA-VA LOAN ( ) SEPTIC TANK: (SIZE /6'8-1) GALS) WATER SUPPLY : NO. BEDROOMS NO FIXTURES INDIVIDUAL PUBLIC GARBAGE DISP SAL ) UNIT:YES ( NO ( k IF WELL, TYPE : BORED DRILLED DUG AUTO WASHING MACHINE : Y S ( 0 NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: yel 0 SQ.FT . POLLUTION: FT. 1) NUMBER OF LINES 'Sj SEPTIC TAN INSTALLED BY:f4 2) LENGTH AND WID INE II - , 1 if `x ioo PERMIT FE $ 1 a) BED SY EM (() CERTIFICATE OF COMP ETION BY : -- b) TRENCH SYSTEM ( ) 92.4704../12 - -- 3) DEPTH OF STONE IN LINES 0> REMARKS : ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE : YES (X) NO ( ) 2) NITRI CATION LINES : DATE INSTALLED: S // ,S-��d YES ( 1 NO ( ) SEPTIC TANK LAYOUT • \O A W F O 0 r7 / /� I NEALTI4 DEPARTMENT COPY /t S 23* wCPYi ATAWBA COUNTY HEALTH DEPARTMENT 1 IMPROVEMENT PERMIT FOR SEPTIC TANKSI / . Permit No. ,� 4 8 6 4 NAME OF OWNER /L� ) C' ��(.� n4A-0-y1, DATE /"/�/ ��g/� 'I ADDRESS OF OWNER o // d/ / PHONE NAME OF CONTRACTOR 'jC'( i.&cL r `- _<jE&tA2_4 ADDRESS�t� LOCATION V „left 0�,�.c� e . ice'��� / rh ��_(r_�_�_._ SUBDIVISION LOT NO. SECTION OR BLOCK LOT SI? , FHA, VA LOAN Septic Tank Contractor must follow all HOUSE ( j) MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) Details of this permit (layout) NO. BED. OMS ( ) NO. FIXTURES ( ) (' SEPTIC TANK LAYOUT GARBAGE DISPOSAL UNIT: YES ( ) NO (I) PLUMBING UNDER BASEMENT FLOOR: YES ( ) NO (b SIZE OF TANK F 0�� LIQUID GALLONS NITRIFICATION IELD: 1. Number of lines 2. Length and width of lines: !6e' ) a. Bed System yr/ X / er6 I ft. b. Trench system ft. LU 3. Total Depth of stone / 2/ inches ' c. GROUNDWATER INTERCEPTOR DRAIN: -( i (IF REQUIRED) WATER SUPPLY: PRIVATE ( ) PUBLIC ) ip � ' OWNER NOTIFIED TO CHECK ZONING: XES (V) NO ) /� -OWNER AGREES WITH LAYOUT: YES ( I) N�dLL( ) NV , OWNER AGREES WITH SPECIAL INSTRUCTIONS: YES ( ) NO ( ) OWNER OR CONTRACTOR -- —SIGJATURE , - iii . PERMIT FEE S l� ' _ PERMIT VOID AFTER 36 MONTHS / -' ' 1,,,ROVEMENT PERMIT ISSUED""BY ufl SANITARIAN ��: . ______-r HEALTH DEPT. COPY SOIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE gl) UNSUITABLE ( ) SITE FACTORS: 1. SLOPE (%) S - PS - U 7. SOIL PERMEABILITY S - PS - U 2. SOIL TEXTURE (12-48 IN.) S - PS - U UNDER 60 MIN. - OVER 60 MIN. SANDY, LOAMY, CLAYEY 8. OTHER S - PS - U 3. SOIL STRUCTURE (12-48 IN.) S - PS - U (SPECIFY) 4. SOIL DEPTH .(IN.) S. - PS - U 9. SOIL SERIES: 5. RESTRICTIVE HORIZONS (IN.) S - PS - U A. CECIL ( ) B. HrWASSEE ( ) (IMPERVIOUS STRATA, ROCK) C. MADISON ( ) D. APPLING ( ) 6. SOIL DRAINAGE - GROUNDWATER S - PS - U E. PACOLET ( ) F. FLOOD PLAIN ( ) (EXTERNAL - INTERNAL) G. 2-1 CLAY SOIL H. OTHER-SPECIFY Sr ii> y'A. CATAWBA COUNTY cY 412 S A OG100A SOUTHWEST BLVD J H NEWTON,NORTH CAROLINA 28658 RECEIPT s��' PHONE: 828.465.8399 C •1 vase. ,G' Friday, August 19, 2016 41 IR, /842 sM www.catawbacountync.gov PAYOR: Sigmon,James& Margaret PAYMENTS TRANSACTION NUMBER: TRC-790213-19-08-2016 PAYMENT DATE 08/19/2016 PAYMENT TYPE: Check 1727 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331819 Improvement Permit Fee $150.00 TOTAL PAYMENTS : S150.00 EHPR-08-2016-24543 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2902 WALTER DR,CLAREMONT NC 28610 Owner JAMES & MARGARET SIGMON, PO BOX 222, CLAREMONT NC 28610 C:8284597598 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/19/2016 13:20 Page 1 oil