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Home My WebLink AboutEHPR-9-10-7256 (2).TIF � 0 � THIS IS NOT A PERMIT Case # EHPR -9 -10 -7256 (; t i CATAWBA COUNTY HEALTH DEPARTMENT 0 ' 'C Plan Review Application for Environmental Services \ 1842 sM Environmental Health Plan Review - OSWP IMPROVEMENT NAME TO APPEAR ON PERMIT RITA SIGMON SITE ADDRESS: 3981 LANEY RD, Maiden, NC Pin#: 366704734127 NAME of SUBDIVISION: Lot 4 PT 2 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 0.46 DIRECTIONS: HWY 16 S/ RT ON BUFFALO SHOALS RD/ 1.5 MI LT ON LANEY/ 2ND HOUSE ON RT APPLICANT OWNER CONTRACTOR RITA SIGMON RITA SIGMON TIM HEFNER 3981 LANEY RD 3981 LANEY RD 2942 ELBOW RDNEWTON NC 28658 - MAIDEN NC 28650 MAIDEN NC 28650 (828)244 -1532 PRIMARY CONTACT: Contractor APPLICATION FOR: Existing Structure DIM EXISTING STRUCTURE: 28 X 54 EXISTING FACILITY TYPE: House NUMBER OF EXISTING BEDROOMS: 1 SEWER TYPE: Septic Tank EXISTING WATER SUPPLY IN USE: Private Well CALCULATED DESIGN FLOW: WELL TYPE: Public water is * *NOT ** available for this property. PUBLIC WATER TYPE AVAILABLE: DESCRIBE WORK: 9X22 SUNROOM ADDITION * *Setback approved by Chris Timberlake /Planning Ofc DESCRIPTION OF HOUSE EXISTING STRUCTURES ON SITE (IF ANY) PROPERTY EASEMENTS: NO PROPOSED CONSTRUCTION • PRIMARY RESIDENCE NEW RESIDENCE? Add /Alt to Residence # OF NEW BEDROOMS: 0 # OF STRUCTURE OCCUPANTS: 1 PROJECT DESC: 9X22' SUNROOM ADDITION ON EXISTING PATIO PROJECT DIMENSION: 9 X 22 BASEMENT? No BASEMENT FIXTURES? 0 1 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 non - expiring 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 repres ntation by you of house or structure location should conform to applicable setbacks. ,,�' / Date: 9 — Ib ID Signature of Applicant or Agent W An Environmental Health Specialist will contact you within 2 workin days of application date. If you need further information or assistance please call 828 - 466 -7291 AREA1 09/10/10 09:50 CATAWBA COUNTY Case # �a�� EHPR -9 -10 -7256 G Public Health Department �e Subdivision Enviromnental Health Division - Plan Review PO Box 389, 100 -A Southwest Blvd, Newton, NC 28658 Lot# PT 2 8 '1 M PIN# 366704734127 Applicant/Owner RITA SIGMON, 3981 LANEY RD, MAIDEN NC 28650 Site Address: 3981 LANEY RD, Maiden, NC Property Size: SF 0.46 ACRES Directions: HWY 16 S/ RT ON BUFFALO SHOALS RD/ 1.5 MI LT ON LANEY/ 2ND HOUSE ON RT Minimum Setbacks FEE NAME DATE AMOUNT BALANCE DUE Front 50 Side 15 Improvement Permit Fee 09/10/2010 $150.00 Rear 30 TOTAL FEES $150.00 Side St 30 Max Hght CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 09/10/10 09:50 THIS IS NOT A PERMIT � CATAWBA COUNTY HEALTH DEPARTMENT Q "0 -c Application for Environmental Services Page 1 /842 s, Improvement Permit Authorization to Construct ❑ Septic Repair ❑ Septic Malfunction ❑ Septic Expansion ❑ New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre- Approval Required) ❑ Application is for New Construction ❑ Existing Facility ❑ Property Address 37g/ A.A /t Subdivision / id 0W675 o Lot # Acres / Section/Block/Phase Driving Directions to Property /lv. y lb sk 4 �" D� f // o Sip 4 Jg oksc Q, NAME TO APPEAR ON PERMIT? Owner Applicant Contractor Applicant Contact Information U Name //✓h � e ,fvuevL,, m Address ,,59 q E) o u) 4d v€,'- h v c ..Z sf �oS5 1, Phone 'lair 5 Cell Phone 2'/ / /5 -3 2 Owner Contact Information Name l + A- 31 1 , 0 z Address g i _ _ e L ey Q Phone Cell Phone E Contractor Contact Information j Name 5, eZe, Address = Phone Cell Phone • WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant Lontractor • Description of Existing Structures on Site rflm Q # of Bedrooms *1 / Structure Dimensions # of Occupants 1► Basement n Yes No Basement Fixtures ❑ Yes ® No Planned Future Additions or Improvements (Building Permit NOT requested at this time) CC Describe kby4�P O Proposed Future Structure Dimensions # of Bedrooms *t if applicable Are there easeme is or rigl t -of -ways recorded on this property .A Yes ❑ No Describe ' — f(; . .Aims Is a public water supply available on or adjacent to the above property ** ❑ Yes Al No Check type available ❑ Community Well ❑ Semi - Public Well ❑ County /City /Township Water Line Existing water supply in use [i Individual Well 1 1 Community Well ❑ Semi - Public Well ❑ County /City /Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) `,� �� THIS IS NOT A PERMIT ,F3� CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 /41. 5� Proposed Facility Type ❑ Primary Residence ❑ New Residence [Addition to Residence # of New Bedrooms *t_ Project Description ._5 i Structure Dimensions 9 ' � X 22 # of Occupants / Basement ❑ Yes 11 Basement Fixtures n Yes ❑ No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes n 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.) ❑ Business Specific Type of Business Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Daycare Specify Occupancy Application for Well Construction /Abandonment/Repair Proposed Well Type ❑ Individual Well ❑ Semi- Public Well n Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug [ 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. tlf 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. CHANGE WORK ORDER REQUIRING REDESIGN AND /OR RETRIP WILL INCURE AN W ADDITIONAL CHARGE (SEE FEE SCHEDULE) 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 CO • (5) five years from the date issued and is not transferab e Signature of Owner or Agent Printed Name of Owner or Agent / /, J�'e e✓L Date 4 7--10- I'O Catawba County, North Carolina N This map product was prepared from the Catawba County, NC, Geographic Information System. Catawba County has made substantial efforts to ensure the accurary of location and labeling information A contained on this map. Catawba County promotes and recommends the independent verification of-any data contained on this tnap product by the user. The Connor of Catawba. its employees, agents and personnel disclaim, and .shall not be held liable fin' any and all damages, loss or liability, whether direct. indirect or consequential which arises or may muse from this map produce or the use thereof by any person or (miry Legend Selected Parcel Number: 3667 -04 -73 -4127 1 inch = 40 feet Prepared for: 1—U19 , 3352 2 2 . A A ) .. , •, ,,,,;,,,( ; . . . •, ,,,:, • ---- : � ,,, • 222 . v r „. 1 1.0 . 8 ,, • 8 1 � .. , .. h .„,.. . . 4 1 27 , o,, N co • O „ . . . . . . . . . . . . O 2A 3 • ,--- . cy) 3. 3 a� 2.1i . • ___ „„._ __ „ 0) tlOA O I 'I (7) 9 R ^,, 3 a . THIS IS NOT A LEGAL DOCUMEN 1 • Friday, September 10, 2010 08:40 AM CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3667 -04 -73 -4127 Name: SIGMON RITA CHARLOTTE Name2: Address: 3981 LANEY RD Address2: City: MAIDEN State: NC Zip: 28650 -9151 Account: 63307500 Calc Acreage: 0.46 �0 Tax Map: 008 K 03034K LRK: 7928 a' Deed Book: 1530 \-Y) '( Deed Page: 0717 Subdivision Name: Oh" Minor Subdivision: MINNIE A CALDWELL Subdivision Block: Lots: PT 2 Plat Book: UNRE Plat Page: UNRE Building Number: 3981 Street Name: LANEY RD Site Zip: 28650 Township: CALDWELL Fire Code: BANDYS City Code: COUNTY State Road: 1860 Total Bldgs Value: $84,400 Land Value: $8,600 Total Value: $93,000 Year Built: 1986 Year Remodeled: Last Sale Date: 10/1/1987 Last Sale Amount: $44,000 Neighborhood: 113 Watershed: Watershed Split: Voter Precinct: P9 E911 District: COUNTY Zoning: R -40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: TUTTLE Middle School: MAIDEN High School: MAIDEN School Split: NO P &Z Case Number: Census Tract 2010: 011600 Census Block 2010: 4002 Small Area Plan: BALLS CREEK Agricultural District: Printed: Friday, September 10, 2010 08:32 AM ( 0 I\ —C O CATAWBA COUNTY, NC 100 -A South West Blvd PLAN RECEIPT t--] Newton, NC 28658- 0 i o (828)465 - 8399 Friday, September 10, 2010 j 8 4 2 sM www.catawbacountync.gov Plan Case: EHPR -9 -10 -7256 Invoice Number: INV -9 -10- 266843 Environmental Health Plan Review Invoice Date: 09/10/2010 Site Address: 3981 LANEY RD, Maiden, NC APPLICANT OWNER CONTRACTOR RITA SIGMON RITA SIGMON TIM HEFNER 3981 LANEY RD 3981 LANEY RD 2942 MAIDEN NC 28650 MAIDEN NC 28650 ELBOW NEWTON NC 28658- (828)244 -1532 Fee Name Fee Amount Improvement Permit Fee Fixed $150.00 Total Fees Due: $150.00 PAYMENTS PAYER: TIM HEFNER TIM HEFNER BUILDING Date Pay Type Check Number Amount Paid Chang( 09/10/2010 Check 4007 $150.00 $0.00 Total Paid: $150.00 Total Due: $0.00 plan receipt 09/10/2010 10:00