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Home My WebLink AboutRBPR-07-2012-15941.TIFA 1842 sM THIS IS NOT A PERMIT Case # RBPR-07-2012-15941 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT Contractor CLAYTON HOMES #81 /CMH INC, 1230 CONOVER BLVD, CONOVER NC 28613 B:828 -465 -3450C:828 -217-2104F:828-464-0261 R081@CLAYTON.NET Owner CLINTON SIGMON, 3260 PONDS RD, MAIDEN NC 28650-8420 NAME TO APPEAR ON PERMIT Clinton Sigmon SITE ADDRESS: 3260 POND RD, MAIDEN NC 28650 PIN # 365803335935 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square I-eet Acres 14.08 DIRECTIONS: Hwy 16 South / Right Providence Mill Rd / Approx 3 miles / Right Pond Road PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well Public water is **NOT** available for this property. DESCRIBE WORK: Change out Class B Single Wide Mobile Home / Must be masonry Underpinned / Must screen or remove towing tongue / must have min 36 sf deck on front / mobile home to be placed in same location as previous mobile home which has already been removed APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF 12 x 60 MOH already removed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 12 x 60 NUMBER OF EXISTING BEDROOMS: 2 # OF OCCUPANTS: 1 PROPERTY EASEMENTS: none PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30 x 56 # OF NEW BEDROOMS:: 2 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 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 thi42rking representation by you of house or structure location should conform to applicable setbacks. Date: 7 .5-/ z— Signature of Applicant or Agent An Environmental Health Specialist will contact you widays of 4application date. If you need further information or assistance please call 828-466-7291 AREA1 ************************************************************************************************************ MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/05/2012 $150.00 $150.00 1.9-Owpplication 07/05/2012 10:12 Page I of � n THIS IS NOT A PERMIT , 5ggJ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 1 42 SM 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 3„2( io /,,d Subdivision /VC Lot # Acres / Section/Block hase Driving Directions to Property �(� S�,u �p% //� �,✓ ro U1,(V4 �`S o �r� i�rG� 3 vim• /e NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant NC Contractor Applicant Contact Information Name �'�a,�L p,,� /torte eS Address./2 p CaryOa er ��vc0 W Phone 1?02? - S"— �7/SD - - Ow er[Cont/act Information � S u e j �4�i'� )-i oo rJ Address Phone Contractor Contact Information Name / � 4,,/ f 4.," eS Address ��Z/U r,,,,ou.e� Phone -J0 veo— AIC 21 Cell Phone d'ia,'�De•� , sv c ��s6 Cell Phone CvNOU e.-- NC ;2- FG/ 3 Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant M Contractor Description of Existing Structures on Site /,:?— X 6 0 CR # of Bedrooms * j Structure Dimensions # of Occupants Basement ❑ Yes ® No Basement Fixtures ❑ Yes M No Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe Proposed Future Structure Dimensions # of Bedrooms *t if applicable Are there easements or right-of-ways recorded on this property ❑ Yes W No Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes [ZNo Check type available ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Existing water supply in use M Individual Well ❑ 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) W a 0 U W m H THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 84 ski Proposed Facility Type r'-" Primary Residence P New Residence ❑ Addition to Residence # of New Bedrooms 'i Project Description s,'N9!� (,QlI�L /"IdNw�aca��✓�cl /76wr C Structure Dimensions30� �' SG # of Occupants Basement ❑ Yes ® No Basement Fixtures ❑ Yes ® No ❑ Accessory Structure(s) Describe # of New Bedrooms *f if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi -Family Residence # Units Total # Bedrooms *"I' ❑ Food Service Specify Type #Bedrooms per Unit* j Structure Dimensions # 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 I 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. I 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. CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN 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 specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site plans or intended use changes for the proposed facili An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not tra/f- Signature of Owner or Agent Printed Name of Owner or Agent,, ? Date %-S =/Z N 1 inch = 120 feet Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba County promotes and recommends the independent verification of any data contained on this map 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 product or the use thereof by any person or entity. Selected Parcel Number: 3658-03-33-5935 Prepared for: Plat 63-134 14.08A 593-5-\ I 54A 02 00 '//-\1.06A \//0693 461 'o �C 11001 7 , \ \ THIS IS NOT A LEGAL DOCUMENT \ 833b 128.7! Time:9:56:10AM - -- II N Plat E M 0 1 Plat 69-18< 1.92Ak, `\85 - CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel,ID:' 3658-03-33-5935 Name: SIGMON CLINTON STEVEN Name2: Address: 3260 POND RD Address2: City: MAIDEN State: NC Zip: 28650-8420 Account: 62137000 Calc Acreage: 14.08 Tax Map: 004 K 03009 LRK: 3543 Deed Book: 1058 Deed Page: 0013 Subdivision Name: Subdivision Block: Lots: Plat Book: 63 Plat Page: 134 Building Number: 3260 Street Name: POND RD Site Zip: 28650 Township: CALDWELL Fire Code: MAIDEN RURAL City Code: COUNTY State Road: 1810 Total Bldgs Value: $6,000 Land Value: $68,300 Total Value: $74,300 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 113 Watershed: Watershed Split: Voter Precinct: P20 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: 1000 Small Area Plan: BALLS CREEK Agricultural District: Proximity Printed: Thursday, July 05, 2012 09:56 AM -To Pb. -al. 101�tL Std CATAWBA COUNTY Case # Subdivision Z Public Health Department Section/Bl/Ph/Lot# eaPe Environmental Health Division v odDw PO Box 389, 100A Southwest Blvd, Newton NC 28658 PIN# 18 42 sal (828) 465-8270 Fax (828) 465-8276 TDD(828)465-8200 W LS2009-00659 365803335935 Applicant/Owner Clinton Sigmon Site Address: 3260 Pond DR, Maiden NC Property Size: 14.08 acres Directions: HWY 16S, RT Providence Mill RD, RT on Pond RD, I" Big Mailbox on RT, To top of hill EXISTING SYSTEM INSPECTION REPORT Site/System Diagram J c r I , l3� C 10^P's�� Z° Ari V, r Type of Facility : House x Mobile Home #Bedrooms 3 Business F-1 Specify Other n Specify Proposed Additions/Accessory Structure: •22'x26' detached carport Approved x Not Approved Reason Evidence of System Malfunction : YES ❑ NO ® System Type/Description // gravel 9I AUTHOR_ED STATE AGENT APPROVAL DATE NOT FOR LOAN APPROVAL, CX)omments and Settings\jenglish\Local Settingffemporary wernet Piles\Content.Outlook\PP83W906\WLS 2009-00659EXISTING TANK CHECK.docx