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Home My WebLink AboutRBPR-07-2012-15976.tifTHIS IS NOT A PERMIT Case # RBPR-07-2012-15976 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New �i.� ►�CC'� _(t I � IJP_ 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 MARK SIGMON, 5511 REST HOME RD, CLAREMONT NC 28610 0:8284464277 NAME TO APPEAR ON PERMIT CLAYTON HOMES #81 /CMH INC ) SITE ADDRESS: 5533 REST HOME RD, CLAREMONT NC 28610 PIN # 375407784326 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 1.73 DIRECTIONS: HWY 16 N/ RT ON OXFORD SCHOOL RD/ LT ON REST HOME RD/ HOUSE ON LT PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well Public water is **NOT** available for this property. DESCRIBE WORK: 1 STORY MODULAR DWELLING APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Sinqle Family Residence ` OTHER DESCRIPTION: DESCRIPTION OF SW MOBILE HOME EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 14 X 60 NUMBER OF EXISTING BEDROOMS: PROPERTY EASEMENTS: NONE NEW STRUCTURE DIM:: t2 X 48 Modula BASEMENT? No # OF OCCUPANTS: 3 PROPOSED CONSTRUCTION BASEMENT FIXTURES? PLUMBING REQUIRED? Yes 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 this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further informatio as ' tance please call 828-466-7291 Area 2 - ********************************************************************************************************* MINIMUM SETBACKS FRONT: 80 SIDE: 15 FEENAME Improvement Permit Fee TOTAL FEES REAR: 30 MAX HEIGHT: DATE FEE AMOUNT 07/13/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9 - ehapplicatinn 07/13/2012 16:36 Page 1 of 3 THIS IS NOT A PERMIT Case # RBPR-07-2012-15976 CATAWBA COUNY Y HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Building New 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 MARK SIGMON, 5511 REST HOME RD, CLAREMONT NC 28610 C:8284464277 NAME TO APPEAR ON PERMIT SITE ADDRESS: 5533 REST HOME RD, CLAREMONT NC 28610 PIN # 375407784326 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 1.73 DIRECTIONS: HWY 16 N/ RT ON OXFORD SCHOOL RD/ LT ON REST HOME RD/ HOUSE ON LT PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well Public water is **NOT"" available for this property. DESCRIBE WORK: 1 STORY MODULAR DWELLING APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE DESCRIPTION OF SW MOBILE HOME EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 14 X 60 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 3 PROPERTY EASEMENTS: NONE PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 52 X 48 BASEMENT? No BASEMENT FIXTURES? PLUMBING REQUIRED? Yes 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 this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: �� Ij `� Z Signature of Applicant or Agent z r An Environmental Health Specialist will contact you within 2 working days of applicat on ate. If you need further information or assistance please call 828-466-7291 2 MINIMUM SETBACKS FRONT: 80 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/13/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) C9 - chapplication 07/13/2012 09:24 Page 1 of 3 THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page I 134 sm ptic Repair [I Septic Malfunction F-1 Improvement Permit F-1 Authorization to Construct El Se Septic Expansion M New Well Permit n Replacement Well E] Well Abandonment ❑ Well Repair F1 Existing System Inspection (Pre-Approval Required)*,� Application is for New Construction E] Existing Facility Property Address_ 55a&,,41� 1 -f Subdivision 4- Lot # Acres 7 7 Section[Block/Phase Driving Directions to Property NLI- �Xle 14v 7e N1 N /V 6 -/lv - 71-,f , / tqX )C6,_ W _57c /,0, 71_1Z__ it e C, 0,0J le C Lai LIJ CL NAME TO APPEAR ON PERMIT? El Owner M Applicant El Contractor ZApplicant Contact Information 0 U I Name e .5- U-1 Address ca o Phone Cell Phone f2f_,21 2- Owner Contact Information Name Address NC Q Phone Z:' Cell Phone -4�Z 77 Contractor Contact Information Name UJ (J) Address tn (Cell Phone 7 -2 1654 X Phone -3 4��C> WHO WILL BE THE PRIMARY CONTACT? [:]Owner DApplicant nContractor Description of Existing Structures on Site /44 X 0 # of Bedrooms *'1 3 Structure Dimensions 9 of Occupants Basement n Yes [:1 No Basement Fixtures F] Yes F1 No Planned Future Additions or Improvements (Building Pen-nit NOT requested at this time) cc Describe 0 Proposed Future Structure Dimensions 9 of Bedrooms *-j if applicable Are there casements or right-of-ways recorded on this property El Yes K No Describe Is a public water supply available on or adjacent to the above property ** El Yes K No Check type available F1 Community Well El Semi-Public Well E] County/City/Township Water Line Existing water supply in use Individual Well F] Community Well E] Semi-Public Well ❑ County/City/Township Water Line ❑ I WOULD LIKE TO SCHEDULE A COMBINED FLAGGING AND SOIL EVALUATION (SEE COMBINED EVALUATION PROCEDUES) sti' A THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 84 u, Proposed Facility Type C] Primary Residence ❑ New Residence� ❑ Addition to Residence # of New Bedrooms *f Project Description /'IOeo �`7rST'► �' Structure Dimensions SZ X q -fl # of Occupants 3 Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No ❑ Accessory Structure(s) Describe # of New Bedrooms 'I if applicable Structure Dimensions ## of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ElNo Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit* j Total # Bedrooms * j 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 # of Employees per Shift ❑ Other Facility Type Specify # of Shifts Retail Floor Space 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 1* 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. 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 CL 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 ki specified conditions. Improvement Permits and Well Permits are transferrable, but may be revoked if this information, site WA 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 t - erab Signature of Owner or Agent Printed Name of Owner or Agents Date '7 -1? -1-z- I inch = 60 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: 3754-07-78-4326 Prepared for: 4537 (600) 331-05 1 LID M Plat 71 - co 2'1.52 K ',` ,. 1.73A 4326 00 —4 j CEI 320.04 , (,per ' A ", A THIS IS NOT A LEGAL DOCUMENT —'~I Date: 7/13/2012 CU Time: 9:6239 AM I 60 vL CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3754-07-78-4326 Name: SIGMON MARK O Name2: Address: 5511 REST HOME RD Address2: City: CLAREMONT State: NC Zip: 28610-8120 Account: 159781137 Calc Acreage: 1.73 Tax Map: 1000 00072A LRK: 44700 Deed Book: 3126 Deed Page: 0192 Subdivision Name: JOHNNY RAY + PAULA T SIGMON Subdivision Block: Lots: 1 Plat Book: Plat Page: Building Number: 5533 Street Name: REST HOME RD Site Zip: 28610 Township: CLINES Fire Code: OXFORD City Code: COUNTY State Road: 1702 Total Bldgs Value: Land Value: $26,400 Total Value: $26,400 Year Built: Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 67 Watershed: WS -IV Protected Area Watershed Split: NO Voter Precinct: P27 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: WP -O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010101 Census Block 2010: 1015 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Proximity Printed: Friday, July 13, 2012 09:02 AM G�c20� �,C r-IcL SGS S�l�Ci1V Iced �� 1 4-4, 1 rP��nrcj c �aen t —t o 'r rn b O� S�P�i✓ -1 k � I -a- 1--o - O CATAWBA COUNTY HEALTH DEPARTMENT Telephone (828) 465;8270 DD (828) 465-8200 WLS # Q� O`�Z 7 Improvement Permit AC R_e rmit. enation Permit. System Type2-Je11 Permit Replacement Well Owner/Agent `Jo /111711/ /�►�OAJ Phone Address 'Tj Subdivision l r ect' n/B o k/PhaseLo Lt Lot Size CS Directions /9 " OX V GIA- �AV n - �-ii 11 V Property Address551I Facility- House Mobile Home X Business Multi -family Other: Pin Number 375 f D119' -+-:3z6 Other Zoning Approvall # # Bedrooms 3 // Seats # Employees Application Rate! O 35 GPD Flow 36..0 Hot Tub or Spa yes�pecial Fixtures Basement yeso 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public *********************************************************************************************************************** Type of System: Trench_ Bed Pump Pump/Panel Panel LPP I Other Septic Tank Size ' �� Pump Tank Size. ll Nitrification Field. Total Square Feet �� Z� Depth of Stone IZ/nC& Bed Size Trench Width t3 `f4 Total Length of All Trenches Number of Trenches -.3 Trench Len th / ( / / / / Feet on Center g . q Maximum Trench Depth,3� Distance of Nearest Well -t-6*b ' *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* Topo % Slope` Texture T "- Z- 1- o5 / "k- Structure Clay Min. I �r —�`�1 X L°�1llICX. �� Soil Wetness Soil Depth S IGUUG� Q Restric Hoz. at—" I nl Available space yes/no 67 P1 a ((p' Overall Class SPS U Comments. bid Wkl?4 Z7 loo i Filter Required Riser required when tank is more than 6 L �� inches deep. -- — — — — ---A' **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN WILL FUNCTION** TOT P.ERFO`�. CE OR LENGTH OF TIME THIS SYSTEM - � w *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 po ion of the installation is put into use. The siting of the well by the Health Department staff is torovide protecti from no ossible s roes of contamination. No volume of water is guaranteedt any to by the Health Department. Permit Date ) / �2 7- SL EH ; ix 6t Owner/Age �� /,_ Septic Tank Installed y Date /Z1�0/YJ� EHS (, �Well Installed By Well G ort p oval Date Well Heid Approval a Date Sample Collected Date of R ults Results EHS White - Office Yellow Owner/Agent Pink - Building Inspection Authorization to Construct