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Home My WebLink AboutRBPR-07-2012-16023.TIFTHIS IS NOT A PERMIT Case # RBPR-07-2012-16023 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Accessory Structure IMPROVEMENT Applicant MICHAEL TOWNSEND, 1704 ADAM ST, CONOVER NC 28613 Owner FLO TOWNSEND, 1704 ADAM ST, CONOVER NC 28613-8605 NAME TO APPEAR ON PERMIT Flo Townsend SITE ADDRESS: 1704 ADAM ST, CONOVER NC 28613 PIN # 373206289680 NAME of SUBDIVISION: GROVER HERMAN 3732 Lot # 57-59 PT 56 Section/Block PROPERTY SIZE: Square Feet Acres 0.37 DIRECTIONS: Section House Road to Adam Street 2nd house on right PRIMARY CONTACT: Applicant GALLONS PER DAY: DESCRIBE WORK: 12 x 24 storage building no electrical SEWER TYPE: Septic Tank WATER SUPPLY: Private Well Public water is **NOT** available for this property. APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF Single family dwelling EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 30 x 50 NUMBER OF EXISTING BEDROOMS: 2 PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 12 x 24 BASEMENT? No # OF OCCUPANTS PROPOSED CONSTRUCTION BASEMENT FIXTURES? No 2 PLUMBING REQUIRED? No 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 tr ble. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. . Any representation by you of hous or structure location should conform to applicable setbacks. �Iication Date, ��,� -/� Signature of Applicant or Agent/ iAn Environmental Health Specialist will contact you within 2 working days of date. If you need further information or assistance please call 828-466-7291 AREA2 MINIMUM SETBACKS FRONT: 30 SIDE: 10 REAR: 5 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/23/2012 $150.00 $150.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) I �Q - chapplication 07/23/2012 15:19 Page I of 3 x SpA THIS IS NOT A PERMIT C % CATAWBA COUNTY HEALTH DEPARTMENT C;y c Application for Environmental Services 1842 s� Page I 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( 701 kg_ , Subdivision 0-oMOWR fU C 09,E -Ln ( Lot # Acres Section/Block/Phase Driving Directions to Property ,�� /� •}`per -TZ {�' j cWl LAD(MiE ilk) qe NAME TO APPEAR ON PERMIT? [� Owner Applicant Contact Information Name j 1 C! &EL (A). 17"kYN2 tljll) Address f?(34 In Phone few- Owner Contact Information Name (.� l j N C60> Address (764 K'ZoA ��- Phone E jA_ 9SG -1��& Contractor Contact Information Name Address Phone J Applicant ❑ Contractor ki r 4 l / --� -Cell Phone Cell Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑Owned Applicant ❑ Contractor Description of Existing Structures on Site "pu�_ # of Bedrooms *'I �( 9Structw-e Dimensions � J )0 5-6 # of Occupants o1 Basement ❑ Yes 0 No Basement Fixtures ❑ Yes 'RNo Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe Proposed Future Structure Dimensions # of Bedrooms *'I if applicable Are there easements or right-of-ways recorded on this property ❑ Yes M No Describe Is a public water supply available on or adjacent to the above property ** l&7 Yes < FNo Check type available ❑ Comnumity Well ❑ Semi -Public Well ❑ County/City/Township Water Line A Existing water supply in use A 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) ^t i '3A G THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 1842 w Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms * j Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No C) LWW J CL Z 0 V W m ❑ Accessory Structure(s) Describe U (Nlyt_ �S /�//U� _ , AA(W 6 /tel DIP /*j//.1 M/ # of New Bedrooms *'i if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes E[iNo Plumbing ❑ Yes 10No 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 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 b tl ' de artment is valid for (5) five years from the date issued and is nota f abl Signature of Owner or Agent Printed Name of Owner or Agent/1/(1(02 IEL /,C , 7 smart l r� Date %,;,�'— /,2 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 N 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 I 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: 3732-06-28-9680 1 inch = 40 feet Prepared for: t i CP \ t \ , 1 1617 NG ` t \ \ r R-20 I n \ •.c� � \,ra��" t \ t 9680 1 \f, t 1 541 1 1 t, • ` ,` R-20 Date: 7/23/2012; \ 'Timei_3i15:01 PM'; THIS IS NOT A LEGAL DOCUMENT \ `\ \� , --z — - \ - \— M' \ 1 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3732-06-28-9680 Name: TOWNSEND FLO T Name2: Address: 1704 ADAM ST Address2: City: CONOVER State: NC Zip: 28613-8605 Account: 116024 Calc Acreage: 0.37 Tax Map: 166H 04003 LRK: 56811 Deed Book: 1134 Deed Page: 0905 Subdivision Name: GROVER HERMAN 3732 Subdivision Block: Lots: 57-59 PT 56 Plat Book: 8 Plat Page: 27 Building Number: 1704 Street Name: ADAM ST Site Zip: 28613 Township: HICKORY Fire Code: ST. STEPHENS City Code: COUNTY State Road: 1544 Total Bldgs Value: $64,300 Land Value: $12,700 Total Value: $77,000 Year Built: 1955 Year Remodeled: Last Sale Date: 6/1/1977 Last Sale Amount: $19,500 Neighborhood: 58 Watershed: Watershed Split: Voter Precinct: P28 E911 District: COUNTY Zoning: R-20 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: WEBB A MURRAY Middle School: ARNDT High School: ST STEPHENS School Split: NO P&Z Case Number: Census Tract 2010: 010303 Census Block 2010: 2052 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Monday, July 23, 2012 03:15 PM CATAWBA COUNTY HEALTH DEPARTMENT 0- 5590 telephone: (828) 465-827 D: (828�)4� Imp. Prmt.� Auth. to Const. Rpr. Prmt. � Opr. Prmt. Sys. TWell Prmt. Well Rpr. Prmt. Owner/Age it/� n'�>1 S�✓tr� 3i32-Ois'24i`[G� Phone .2s— 7i�,Ff `�► Address 14) y Subdivision V Section/Block/Phase Lot# Lot Size Directions: c. rv, S 7— 2 "v ?J e o:x e_r_ Facility: House Mobile Home Business Multi -family . Other: Tax Map or Pin Number Other . Zoning Approval # # Bedrooms # Seats # Employees . Application Rate ? S— GPD Flow 2k,4 [; Hot Tub or Spa yes/i&pecial Fixtures Basement yes/(Q) . 100% Repair Area yes/no Basement Plumbing yes/rb--� Water Supply: Private Well (' Public Semi -Public ************************************************************************************************************************* Type of System: Trench Bed Pump Pump/Panel Panel LPP Other Septic Tank Size fXK't`i..., Pump Tank Size -- Bed Size ' Trench Width Nitrification Field: Total Square Feet—�-Ot7 0 Cbepth of Stone A N \ Total Length of All Trenches Number of Trenches Trench Length _/_/ / / ! Feet on Center Maximum Trench Depth �4 " Distance of Nearest Well ";—e *DO NOT INSTALL SEPTIC WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo % Slope Texture[ )�. N� Structure I / ' Clay Min. = / Soil Wetness Soil Depth I (� Restric. Hoz. at _ (� Available space no Overall Class S U .� Comments: I >� c cid I y 7 i_ c hCAC_✓YN ST **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** *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 S 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 portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of water is guaranteed at any site by the Health Department. -S Permit Date EHS Owner/Ag�> , Septic Tank Installed By r Date_ y— Z q EHS "�� r_ Well Installed By * W 1 Grotj Approval Date Well Head Approval Date Date Sample Collected _ Date of Results Results EHS White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Inspection Authorization to Construct