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Home My WebLink AboutEHPR-3-11-10034.TIF �� ` � THIS IS NOT A PERMIT Case # EHPR-3-11-10034 �' �" � CATAWBA COUNTY HEALTH DEPARTMENT v �`��;t ?;; ''C Plan Review Application for Environmental Services I842 SM Environmental Health Plan Review - OSWP IMPROVEMENT NAME TO APPEAR ON PERMIT ROY SIGMON s�TE A��RESS: 3425 SIGMON DAIRY RD, Newton, NC Pin#: 363705292887 NAME of SUBDIVISION: Lot # Section/B1ocWPhase PROPERTY SIZE: Square Feet Acres 4.73 DIRECTIONS: 321 SOUTH, LEFT AT ROME JONES RD,LEFT ON SIGMON DAIRY, 1 MILE TO MOBILE HOME ON RIGHT APPLICANT OWNER CONTRACTOR ROY SIGMON ROY SIGMON 3610 9TH STREET DR NE 3610 9TH STREET DR NE HICKORY NC 28601 HICKORY NC 28601 828-327-3129 828-327-3129 PRIMARY CONTACT: Owner APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 14 X 70 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 3 SEWER TYPE: Septic Tank NUMBER OF EXISTING OCCUPANTS: � EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: Public water is **NOT"" available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: DESIGNATE REPAIR AREA... STORAGE BUILDING ADDED TO PROPERTY. EXISTING MOBILE HOME USED FOR STORAGE WILL BE REMOVED DESCRIPTION OF MOBILE HOME EXISTING STRUCTURES ON SITE (IF ANY) PROPOSED FUTURE ADDITIONS NONE OR IMPROVEMENTS: PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION ACCESSORY STRUCTURES DESCRIPTION: STORAGE BUILDING # OF NEW BEDROOMS: 0 STRUCTURE DIMENSIONS: 160 X 20 ACC DWELLING? No PLUMBING? No # OF STRUCTURE OCCUPANTS: 0 I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a norrexpiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applieable set�backs. t Date: _�•-�s' u Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 wor �ng days of application date. If you need further information or assistance pleas c II 828-466-7291 AREA1 ***************************************************�***�*�*********************�*****�***�**�*�******************�**** 03/2�/I I 13:25 ��,A CAT.AWBA COUNTY Case # EHPR-3-1 1-10034 � G Public Health Department 2 Subdivision Q .: Environmental Health Division - Plan Revie�v � :'�' PO Box 389, 100-A Southwest Blvd, Newton, NC 286�8 Lot# Ig 2 sM PIN# 36370�292887 Applicant/Owner ROY SIGMON, 3610 NE 9TH STREET DR, HICKORY NC 28601 Site Address: 3425 SIGMON DAIRY RD, Newton, NC Property Size: SF 4.73 ACRES Directions: 321 SOUTH, LGFT AT ROME JONES RD,LEFT ON S[GMON DAIRY, 1 MILE TO MOB[LE HOME ON RIGHT Minimum Setbaeks Front: Side: Rear: Side St: Max Height: FEE NAME DATE AMOUNT BALANCE DUE Improvement Permit Fee 03/25/20ll $150.00 $0.00 TOTAL FEES $150.00 $0.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 03/25/I 1 13:25 1 ��A � J THIS IS NOT A PERMIT � CATAWBA COUNTY HEALTH DEPARTMENT � � Application for Environmental Services Page 1 J , � t 1 84`Z �M Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit � Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ E�sting System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility �� Property Address� ��Z,� .St c�NH i/` �1 Subdivision ��_,��, � � �. g � (3 Lot # Acres / % Sectio IocWP�iase � i Driving Directions to Property � 2 � m a�l� w OLCY I o � I a� f v � h-� �"'L a- � � � Q � . , ' -.�-,-�-.-� �-�. �' � W a NAME TO APPEAR ON PERNIIT? Owner ❑ Applicant ❑ Contractor O Applicant Contact Information U Name , W Address �y � �- ^ �/G-� �Q m � Phone 2_ Cell Phone � Z�-.� —� 8"D = Owner Contact Information � Name Z Address � Phone Cell Phone � Contractor Contact Information W Name � Address � = Phone Cell Phone F� Z WHO WILL BE THE PRIMARY CONTACT? �wner ❑ Applicant ❑ Contractor Description of E�sting Structures on Site � Q # of Bedrooms *�' � Structure Dimensions � cr �? c� # of Occupants .�S I� Basement ❑ Yes �o Basement Fixtures ❑ Yes �� Planned Future Additions or Improvements (Building Permit NOT requested at this time) OC Describe i,/� � Proposed Future Structure Dimensions # of Bedrooms *�' if applicable ? Are there easements or right-of-ways recorded on this property ❑ Yes o Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes ❑ No Check type available ❑ Communi Well ❑ Semi-Public Well ❑ County/City/Township Water Line Existing water supply in use dividual Well ❑ Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATI PROCEDUES) ��` G THIS IS NOT A PERMIT � � CATAWBA COUNTY HEALTH DEPARTMENT � J, °� � Application for Environmental Services Page 2 1 842 u� Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *�' Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe v:- u,v # of New Bedrooms *�' if applicable (� Structure Dimensions y 7 p # of Occupants � Accessory Dwelling ❑ Yes (��" Plumbing ❑ Yes �� Describe Plumbing Needed ❑ Multi-Family Residence # Units #Bedrooms per Unit* j' To tal # Bedrooms *�' 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 # o f 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 Rep air Requested ❑ Yes ❑ No Describe Calculated Design Flow, Commercial �' Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on- s ite st *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 tune of building pemut 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. Note: You must obtain Zoning approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. W CHANGE WORK ORDER REQUIltING REDESIGN AND/OR RETRIP WILL INCU AN � ADDITIONAL CHARGE (SEE FEE SCHEDULE) a I understand that this is a formal application for Environmental Services and authorize Catawba County Environmental � Health employees to go on this property for evaluation purposes. I certify the above information to be correct and understand � that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain V specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site W plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for m � (5) five years from the date issued and is not tr a�e � Signature of Owner or Agent � Printed Name of Owner or Agent Date — Catawba County, North Carolina N Phis map produc� irns prepnred fi�om the Ca�airba Counq�, NC, Geographic Lafornrntion Svstem. Cataiv6a County lrns made subs[aniinl ejjorrs !o ensm�e lhe accuracy oflocntion nnd labeling informa�ron contained on diis mnp. Ca�mvbn Cormq� promotes and recommends the independent verifrcntion ofnny datn contarned on lhis mnp product 6�� !he aser. The Cotmry ofCatmvbn, its emplovees, agents nnd personnel disclnim, and shall no� be held /iable for nny nnd nA damages, /oss w/iability, whether direc�, rndmect or conseqa�entia/ irhich arrses or niay arise fi�om diis mnp prodi�ct or lhe use �hereojby nny person or entity. L egen d Selected Parcel Number: 3637-OS-29-2887 l inch = 100 feet Prepared for: � i �;,� �, r -, \ ! �'' �"\ i S �?o o � ' � - � � \ \� s � � ; ,�,�� ' �o . \ \� t ;��,,.r,,..�.-."".°'�'" . N \ ` � / J � (,?� � ; ( ,., -- _ ,.��rv �J� � ! �y/ � 4.73A �� ,�,, � / 2$87 �.. i' < f / ,; �2� ; / � �� (r � � � -� ; �. � �� .` , � � � �. � � � � �. . � p �� o• ,�,. � * � / ; � �� o0 � � � �,�°� �. s' ��. � `,�.,�.�--�""`. � �ti `� � ��'� ! /� ' / / � ,�""'� ; .- � ,/ i / � � �, ,� TffiS IS NOT A LEGAL DOCUMENT Friday, March 25, 2011 Ol:l4 PM �� ]� / � � / � 1.15P g ��'' / .t� /�� _�-..,"" i CATAWBA COUIVTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel I D: 3637-05-29-2887 Name: SIGMON ROY STEVE Name2: Address: 3610 9TH STREET DR NE Address2: City: HICKORY State: NC Zi p: 28601-9625 Account: 63382990 Calc Acreage: 4.73 Tax Map: 069N 01004A LRK: 36469 Deed Book: 1128 Deed Page: 0721 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 3425 Street Name: SIGMON DAIRY RD Site Zip: 28658 Township: NEWTON Fire Code: MAIDEN RURAL City Code: COUNTY State Road: 2012 Total Bldgs Value: Land Value: $35,600 Total Value: $35,600 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 113 Watershed: Watershed Split: Voter Precinct: P34 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED-O,RP-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: STARTOWN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011702 Census Block 2010: 2028 Small Area Plan: STARTOWN Agricultural District: PROXIMITY Printed: Friday, March 25, 2011 01:14 PM I .� C�� CATAWBA COUNTY, NC � �, ]00-A South West Blvd PLAN RECEIPT �-; Newton, NC 28658- U �� ' (828)465-8399 Friday, March 25, 2011 < �► 1842 sM www.catawbacountync.gov P�an �ase: EHPR-3-11-10034 �nvoice ►vumber: INV-3-11-273422 Environmental Health Plan Review Invoice Date: 03/25/2011 Site Address: 3425 SIGMON DAIRY RD, Newton, NC APPLICANT OWNER CONTRACTOR ROY SIGMON ROY SIGMON 3610 NE 9TH STREET DR 3610 NE 9TH STREET DR HICKORY NC 28601 HICKORY NC 28601 828-327-3129 828-327-3129 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS PAYER: ROY SIGMON Date Pay Type Check Number Amount Paid Change 03/25/2011 Cash -1 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 I plan reccipt 03/25/201 I 1324