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HomeMy WebLinkAboutRBPR-07-2012-16020.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2012-16020 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Manufactured Home IMPROVEMENT Applicant ETHEL MCINTOSH, 4162 OXFORD SCHOOL RD, CATAWBA NC 28609 H:828241250IC:82846t4370 Owner CLARENCE LANE, 4170 OXFORD SCHOOL RD, CATAWBA NC 28609 NAME TO APPEAR ON PERMIT Ethel McIntosh SITE ADDRESS: 4162 OXFORD SCHOOL RD, CATAWBA NC 28609 PIN # 377303412204 NAME of SUBDIVISION: Lot # 2 Section/Block PROPERTY SIZE: Square Feet Acres 0.46 DIRECTIONS: 1-40 exit 138 go left Oxford School Rd / lot on right PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 240 WATER SUPPLY: Private Well Public water is **NOT"* available for this property. DESCRIBE WORK: 1987 DW MOBILE HOME W/ 12 X 12 SCREEN PORCH ON REAR OF HOME/ MEETS APPEARANCE CRITERIA; MUST FACE FRONT OF PROPERTY; MUST BE MASONRY UNDERPINNED; MUST HAVE 36 SQ.FT. DECK ON FRONT; AND TONGUE MUST BE REMOVED OR SCREENED APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF SW MOBILE HOME 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::28x65 W/15X10 FRT PCH & 12X12 SCRN PCH ON REAR # 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 this property. Any representation by you of house or structure location should conform to applicable setbacks. ,����tI�..eX_``Iate:__, ture of Applicant or �Aent 7 - _-;_7 -3 An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 30 MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit (Existing) Fee 07/23/2012 $90.00 TOTAL FEES $90.00 45 1?1 - l:happlicaiwn 07/23/2012 10:07 Page I of3 141 `O W CLz O W m H �c C O U h Z O Cz ccC O THIS IS NOT A PERMIT r CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 1842 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 Address4///K1 OX f � Subdivision Lot # Acres Section/Block/Phase Driving Directions to Property _ L� /_. �� � , 15 G -n f v - NAME TO APPEAR ON PERMIT? ❑ Owner N Applicant ❑ Contractor Applicant Con/tact Information` f Name F 7-APi Address Phone Owner Contact Information Name o � k� --Z M d S Cell Phone 4/4 , (L 3 77) Address 5 1-M Phone I Cell Phone Contractor Contact Information Name AddressI Q Phone11—W— I Cell Phone WHO WILL BE THE PRIMARY CONTACT? 2_101�vner ❑ Applicant ❑ Contractor Description of Existing Structures on Site ) P # of Bedrooms * j Structure 6irnensions��� U # of Occupants Basement ❑ Yes [y No Basement Fixtures ❑ Yes No Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe 7)12 Z/4 (Ji M e) , ), n/1'1 4Z__ Proposed Future Structure Di►nensioni� &X of Bedrooms *i if applicable.7_� Are there easements or right-of-ways recorded on this property ❑ Yes ❑ No Describe Is a public water supply available on or adjacent to the above property ** ❑ Yes ❑ No Check type available ❑ Community Well [Semi -Public Well ❑ County/City/Township Water Line Existing water supply in use KrIndividLial 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) Q UJW J CL 0 V W m A 1842 std THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 71ppltimary osed Facility Type Residence ❑ New Residence �, Addition to Residence # of New edrooms Project Description Structure Dimensions # of OCCU ants / Basement El Yes Pp No Basement Fixtures ❑Yes] No ❑ Accessory Structure(s) Describe �%Z x =J U S # of New Bedrooms *'I if applicable Structure Dimensions _Z'?XV6S- # of Occupants ! Accessory Dwelling ❑ Yes ❑ No Plumbing ElYes [I No Describe Plumbing Needed ❑ Multi -Family Residence # Units #Bedrooms per Unit* f 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 j Additional information may be required to determine design flow from certain facilities. This value will be determined (luring 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 facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable l Signature of Owner or Agent D __ _r �C-,•� Printed Name of Owner or Agent r �/� �• %1/]� �.�, Date 7 — 3 - J ?- CATAWBA COUNTY PERMIT ZONING AUTHORIZATION (R) Manufabtured Home IVR PIN# PERMIT NO: ZONR-07-201-029781 P. O. Box 389 Phone: 828-465-8380 APPLIED: 07/23/2012 100A Southwest Blvd FAX: 828-465-8484 ISSUED: 07/23/2012 Newton, North Carolina 28658 EXPIRES: 04/05/2013 www.catawbacountync.gov Applicant ETHEL MCINTOSH, 4162 OXFORD SCHOOL RD, CATAWBA NC 28609 H: 8282412501 C: 82846143 70 **NO PEOPLESOFT ACCOUNT ASSIGNED Owner CLARENCE LANE, 4170 OXFORD SCHOOL RD, CATAWBA NC 28609 PROPERTYID#: 377303412204 CENSUS TRACT: 010101 STREET ADDRESS: 4162 OXFORD SCHOOL RD, CATAWBA NC 28609 LOT#: 2 PROJECT DESCRIPTION: 1987 DW MOBILE HOME W/ 12 X 12 SCREEN PORCH ON REAR OF HOME/ MEETS APPEARANC CRITERIA; MUST FACE FRONT OF PROPERTY; MUST BE MASONRY UNDERPINNED; MUST HAN 36 SQ.FT. DECK ON FRONT; AND TONGUE MUST BE REMOVED OR SCREENED FLOOD ZONE? No OWNER TYPE: 100 YEAR FLOOD ZONE PLAIN? LAND OWNER: FLOOD PLAIN, STRUCTURE? No REQUIRED SETBACKS FRONT: 30 REAR: 30 SIDE: 15 MAX HEIGHT: 45 INVOICE#: 07-12-288495 FEE DESCRIPTION DATE, FEE AMOUNT Residential Zoning Fee 07/23/2012 $25.00 TOTAL -FEES,, $25.00 The applicant hereby certifies that all information and attachments to this Certificate of Zoning Compiliance are true and correct, and acknowledges that this permit was issued on the basis of the information required herein. The applicant further acknowledges that any construction, alteration or addition which differs from this application shall be subject to removal or alteration so as to bring said structure into conformance with the specifications and standards of the Catawba County Zoning Ordinance. Such co action s I be at the c? 7Zz A_]�Af - xile I 9cp-liv APPLIC�AN'f NAME (PRINTED) APPLICANT SIGNATURE SIGNATURE Z6NING APPROVED BY ***** ZONING FEES ARE NON-REFUNDABLE ***** COMPANY NAME Fl) - permit 07/23/2012 10:09 ISSUED BY: Pat Queen Page I of I L 0 I inch = 40 feet C% C4 Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Infonnation 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 anv 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: 3773-03-41-2204 Prepared for: 1-1 V P\ �I THIS IS NOT A LEGAL DOCUMENT / t Date: 7/23/2012 -*�;� 14 Time: 9:20:16 AM CATAWBA COUNTY Public Health Department Environmental Health Division PO Box 389, 100-A Southwest Blvd, Newton; N1 25658 Applicant/Owner Clarence Jackson Lane Il Site Address: 4162 OXFORD SCHOOL RD, Catawba, NC Property Size: SF 0.46 ACRES Directions: 1-40 exit 138 go west .5 miles - grey mobile home on right Improvement Permit Case # IMPV-10-10-11903 Subdivision Lot # 2 PIN# 377303412204 'INITIAL SYSTEM EXISTING= IP FOR REPAIRSYSTEM ONLY Facility: Primary Residence Permit Category: Other Bedrooms 2 WATER SUPPLY: Public Water Type: County/City/Township Water Basement? No Basement Plumbing? No ------------------------------------------------------------------------------------------------------------------------------------------------------------ INITIAL SYSTEM SPECIFICATIONS ------------------------------------------------------------------------------------------------------------------------------------------------------------ Permit Valid: Expires In Five Years: _X_ No Expiration: Projected Daily Flow 240 g•p•d Proposed Wastewater System: CONVENTIONAL Type: I113 - CONV SYSTEM WITH <750 LINEAR FEET OF LINE Pump Required?: No Operator Required?: NO Permit Conditions: IP for as built for existing septic system for 14'X I T addition and a 8'X 10' deck. ---------------------------------------- ---------------------------------------- -------- ------------------------------------------------------- REPAIR ------------------------------------- REPAIR SYSTEM SPECIFICATIONS --------------------------------------------------------------------------------------------------------- -------------------------------- ------ Repair System Required? Required Proposed Wastewater System: 25% REDUCTION . Type: I1113 - SYSTEM W/SINGLE EFFLUENT PUMP Pump Required?: Yes Operator Required?: NO Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter Flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspensioNrevocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes, or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewaee Treatment and Disnosa/ Svstems' (15A NCAC ISA .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily Susan BUrngarner 10/12/2010 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 10/11/2015 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. 10/13/10 08:35 'ZgPR -1D- M- TD Aa, lf,tY) PV - 10-10- 1190 3 CS- r 4 1 5J 39 �XQ -7�kbw;w;ll.� Iykel Y. O C' �u� p -{v ,�,ZS°la rtpl. 0x-�Y-d &ha,I Rd 10. CATAVVBACOUNTY NC'Parcel Report Information Regarding Selected P |hV Parcel ID: 3773'03~41'2204 Name: LANE CLARENCEJACKSON U Name2: Address: 417OOXFORD SCHOOL RD Addmas2: City: C/QAVVBA S��� NC Zip: 28608-8321 Account: 159758591 Calc e: 0.46 Tax Map: LRm 301699 Deed Book: 3007 Deed Page: 1519 Subdivision Name: Subdivision Block-, Lots: 2 Plat Book: 61 Plat 13 Building Number: 4162 Street Name: OXFORD SCHOOL RD Site Zip: 28609 Township: CATAW8 Fire Code: CATAWV8ARURAL City Code: COUNTY State Road: 1717 'Total Bldgs Value: Land Value: $9.100 Total Value: $0.100 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'30 4uning2: Zoning Split: N Zoning Overlay: WP -O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(l): 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 2D1O:O1O1O1 Census Block 2O1O:3O1Q SmaVAem Ran: STSTEPHEMS/OXFORD Agricultural District: Printed: Monday July 23, 2012 09:05 AM