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HomeMy WebLinkAboutRBPR-07-2012-16028.TIF� BA 1842 sm Applicant THIS IS NOT A PERMIT Case # RBPR-07-2012-16028 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Accessory Structure IMPROVEMENT - AUTH CONST MICHAEL MARTIN, 4014 S OLIVERS CROSS RD, NEWTON NC 28658 C:8284469234 Owner NORMA POPE LFI, 4655 WINSLOW RD, CLAREMONT NC 28610-8273 NAME TO APPEAR ON PERMIT Norma Pope LFI SITE ADDRESS: 4655 WINSLOW RD, CLAREMONT NC 28610 PIN # 367902686201 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres 13.65 DIRECTIONS: Hwy 16 South / Left Balls Creek School Rd / Right Winslow Rd / Left at turn around to very end PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 100 WATER SUPPLY: Private Well Public water is `*NOT** available for this property. DESCRIBE WORK: 40 x 60 Accessory structure with Electrical and half bath (Sink and toilet only) APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Accessory Structure DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 38 x 50 NUMBER OF EXISTING BEDROOMS: PROPERTY EASEMENTS: none New Structure ACCESSORY STRUCTURE OTHER DESCRIPTION: # OF OCCUPANTS: PROPOSED CONSTRUCTION `NEW STRUCTURE DIM.. ) 80 x 80 Accessory Structure w half bath 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: Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further informat'n--1-assi nce please call 828-466-7291 Area 1 *************************************************** *********************************************************** MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 5 MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/24/2012 $150.00 Fee Improvement Permit Fee 07/24/2012 $150.00 TOTAL FEES 5300.00 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) EI - ehapphcation 07/24/2012 16:34 Page 1 of A Co naPn 1842 ski THIS IS NOT A PERMIT Case # RBPR-07-2012-16028 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Accessory Structure IMPROVEMENT - AUTH CONST Applicant MICHAEL MARTIN, 4014 S OLIVERS CROSS RD, NEWTON NC 28658 C:8284469234 Owner NORMA POPE LFI, 4655 WINSLOW RD, CLAREMONT NC 28610-8273 NAME TO APPEAR ON PERMIT Norma Pope LFI SITE ADDRESS: 4655 WINSLOW RD, CLAREMONT NC 28610 PIN # 367902686201 NAME of SUBDIVISION: Lot # Section/Block PROPERTY SIZE: Square Feet Acres DIRECTIONS: Hwy 16 South / Left Balls Creek School Rd / Right Winslow Rd / Left at turn around to very end PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 100 WATER SUPPLY: Private Well Public water is **NOT`* available for this property. DESCRIBE WORK: 40 x 60 Accessory structure with Electrical and half bath (Sink and toilet only) APPLICATION FOR: STRUCTURE TYPE: FACILITY TYPE: Accessory Structure DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 38 x 50 NUMBER OF EXISTING BEDROOMS: PROPERTY EASEMENTS: none NEW STRUCTURE DIM:: 80 x 80 BASEMENT? No New Structure ACCESSORY STRUCTURE OTHER DESCRIPTION: # OF OCCUPANTS: 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 1� An Environmental Health Specialist will contact you Athin 2 working days of application date. If you need further information or assistance please call 828-466-7291 MINIMUM SETBACKS FRONT: 30 SIDE: 15 REAR: 5 MAX HEIGHT: FEENAME DATE FEE AMOUNT Authorization to Construct Fee (New/Expansion) 07/24/2012 5150.00 Fee Improvement Permit Fee 07/24/2012 $150.00 TOTAL FEES $300.00 I.() - chapplicaU"xi 07/24/2012 16:13 Page I of 0 LWW J CLZ 0 U W Ca H Z V W H H Z I OC 0 Z �Bw THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT $ �c Application for Environmental Services Page 1 1842 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 i `�� ♦ ►mV��90p •.d ro Subdivision Cl"e p% y`r Lot # Acres Section/Block/Phase Driving Directions to Property gL.4v per/ Cruet- Ith;J 0 IV ow Zep 4Ae e_Q1%kf4Le_ *Ab Ll**4 40 eAw ®;� evt4- pv� NAME TO APPEAR ON PERMIT? 'EQ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name i�:G��d Pk&r4:14 Address L®®%►,� s• ®®iJe{ti Phone TZ e• eyyc. 9 Z 3' 7 Owner Contact Information Name N®r^&- "-r evfAf_ Address 4/4.fr (j;#S�W lip Phone ?24,- 7,qt- 3 q,7 Contractor Contact Information Name Address Cell Phone Cell Phone Phone I Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant ❑ Contractor Description of Existing Structures on Site //Iberbt- # of Bedrooms *-f 'L Structure Dimensions 3g* # of Occupants Basement ,}Yes ❑ No Basement Fixtures 'Yes ❑ No Planned Future Additions or Improvements (Building Permit NOT requested at this time) Describe Proposed Future Structure Dimensions # of Bedrooms *j if applicable Are there easements or right-of-ways recorded on this property ❑ Yes L'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 12 hldividual 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 PR(CEI�TE$. ,j,/1THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *'I Project Description Structure Dimensions # of Occupants Basement ❑ Yes ❑ No Basement Fixtureso ❑ Yes . ❑ No AccessoryStructures Describe O t�@ ' "'`��°` I �' # of New Bedrooms *t if applicable '�t►►ctur'e°�}t r�siis 1 y # of Occupants Accessory,Dwe4big ❑ Yes —®1N0 t�►�ibing%�- [ I) � DblAe PlurnAigAe9 deV0'.�, �� 2u1h41 amilq t$s e�tee' # Uwils ; 1-`%-4 # 13v'&Oolhgq ee"hiitll�j' '101t 4 Total # Bedrooms "i Structure Di►$,ions ❑ 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 _o 4A %v/'" b ❑ Other Facility Type Specify v%0 '°°Z3 C�4 r'� 1h 1 s'bo%OAQ 0t '.1' }® od If Church # of Seats Kitchen ❑ Yes ❑ No If Dyca►te Spe1'F5y O cupancy Application for Well Construction/Abandonment/Repair °©.o -a, t'Aica'A Proposed Well Type ❑ Individual Well [ .ri;e4 ► alic`"+Wellt ;- ] t ,i}►niky Wi=., Abandonment Type ❑ Drilled ❑ Bored �, ug °;� b D I-Mknown 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 during consultation with on- site staff. *Any room that will be intended for sleeping at the tim6xBfcgA*ruction or for future consideration should be noted as a bedroom and counted on all appitczpns,.,' number of bedrooms will be confir►ned1by 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. 0 CHANGE WORK ORDER REQUIRING REDESIGN AND/OR RETRIP WILL INCURE AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) CL 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 0 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 m I-.(5) five years from the date issued and is not transferable Signature of Owner or Agent Printed Name of Owner or Agent pmt A�®.a®ed Datel' dy". 't' 0 ®`p— Catawba County, North Carolina This map product was prepared from the Catawba County, NC, Geospatial Information System N Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map. Catawba Countypromotes 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 disclaun, 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. I 1 inch = 150 feet N N � I R-40 (215 ) 812 0 212.00 CD izco C? I- -- co CD 2066 r 212.00 N N N 76.40 155.50 81.60 0 O to 995.00 13.65A 6201 - Selected Parcel Number: 3679-02-68-6201 Prepared for: THIS IS NOT A LEGAL DOCUMENT Date: 7/24/2012 Time: 3:44:15 PM 1 )::...... ::: ::':. 0 oo' -' ......:::..................... . .. ::::::::.::::::::::::_ ..... ........................................... ... ........................... ...........:: .,�::::: tib` tx .. ..... ..... .. f r' :i•ii :f. 3. f` g THIS IS NOT A LEGAL DOCUMENT Date: 7/24/2012 Time: 3:44:15 PM 1 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3679-02-68-6201 Name: POPE NORMA GAY H LFI Name2: ' Address: 4655 WINSLOW RD Address2: City: CLAREMONT State: NC Zip: 28610-8273 Account: 198522 Calc Acreage: 13.65 Tax Map: 023 Y 02044 LRK: 23203 Deed Book: 3081 Deed Page: 0708 Subdivision Name: Subdivision Block: Lots: Plat Book: Plat Page: Building Number: 4655 Street Name: WINSLOW RD Site Zip: 28610 Township: CATAWBA Fire Code: BANDYS City Code: COUNTY State Road: Total Bldgs Value: $61,100 Land Value: $66,400 Total Value: $127,500 Year Built: 1955 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 122 Watershed: WS -IV Protected Area Watershed Split: NO Voter Precinct: P5 E911 District: COUNTY Zoning: R-40 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: DWMH-0,WP-0,FPM-0 Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: BALLS CREEK Middle School: MILL CREEK High School: BANDYS School Split: NO P&Z Case Number: Census Tract 2010: 011402 Census Block 2010: 4012 Small Area Plan: BALLS CREEK Agricultural District: Proximity Printed: Tuesday, July 24, 2012 03:44 PM CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N° 4 3 S 8 DATE: OWNER ADDRESS BUILDING CONTRACTOR J l. SU IVISI ���� IG �X-L'l.o 1. ✓ �%{t G�.1, r7�` L7 /�4.1d�'i..-.o ��y' :• fC.d, �d +. 1 � i LOCATION_�(,`Zr,<:<. �, /, � �%�c.:' � r �A .® ��tvu:Z.�:'_ �:-:'-�=;��.. �'i��T C LOT SIZE BLOCK OR SECTION HOUSE (U),-' MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) FHA -VA LOAN ( ) SEPTIC TANK: (SIZE " GALS) WATER SUPPLY: NO. BEDROOMS NO FIXTURES INDIVIDUAL PUBLIC GARBAGE DISPOSAL UNIT:YES ( NO ( ) IF WELL, TYPE: BORED DRILLED DUG AUTO WASHING MACHINE: YES NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: i5 SQ.FT. POLLUTION: FT. 1) NUMBER OF LINES "-; SEPTW TANK JNSTALLED BY: 2) LENGTH AND/WIDTH OF LINES /f/ �K y PERMIT I'EE -� a) BED SYSTEM ( ) CE T)FIATE OF,COMPL.TION BY: b) TRENCH SYSTEM 3) DEPTH OF STONE IN LINES k/ , RENIA=. KS ADEQUATE FALL (GRADE) ON: 1) BUILDING (HOUSE) SEWER LINE YESO 2) NITRI ICGATION LINES: DATE INSTALLED: YES (�� NO ( ) SEPTIC TANK LAYOUT HO W H 0 a HEALTH DEPARTMENT COPY (:ATAWBA COUNTY HEALTH DEPARTMENT � JO8 $MEROVEMENT PERMIT FOR SEPTIC TANKS Pe i't No. 1 34 NAME OF OWNER'-/~ �,�1 (', c�-1A--'' DATE ADDRESS OF OWNER PHONE NAME OF CONTRACTOR ADDRESS LOCATION% ,,'7- lC SUBDIVISION `LOT NO. SECTION OR BLOCK LOT SIZE FHA, VA LOAN HOUSE ( ) MOBILE HOME ( ) BUSINESS ( ) OTHER ( ) NO. BEDROOMS ( ) NO. FIXTURES ( ) GARBAGE DISPOSAL UNIT: YES ( ) NO ( ) PLUMBING UNDER BASEMENT FLOOR: YES ( ) NO ( ) SIZE OF TANK LIQUID GALLONS NITRIFICATION FIELD: 1. Number of :Lines 2, Length and width of lines: a. Bed System�� C%. ft. b. Trench system ft. 3. Total Depth of stoneinches =ROUNDWATER INTERCEPTOR DRAIN: (IF REQUIRED) DATER SUPPLY: PRIVATE ( ) PUBLIC ( ) )WNER NOTIFIED TO CHECK ZONING: YES ( ) NO ( ) )WNER AGREES WITH LAYOUT: YES ( ) NO ( ) )WNER AGREES WITH SPECIAL INSTRUCTIONS: YES ( ) NO ( ) )WNER OR CONTRACTOR SIGNATURE 'ERMIT FEE $ 'ERMIT VOID AFTER 36 MONTHS !h1PROVEMENT RMIT ISSUED) BY ;ANITARIAN SEPTIC TANK LAYOUT let /d r � a SEPTIC TANK CONTRACTOR MUST FOLLOW ALL DETAILS OF THIS PERMIT (LAYOUT) HEALTH DEPARTMENT COPY :OIL CLASSIFICATION: SUITABLE ( ) PROVISIONALLY SUITABLE ( ) UNSUITABLE ( ) LITE FACTORS: SLOPE (%) S.- PS - U SOIL TEXTURE (12-48 IN.) S - PS - U SANDY, LOAMY, CLAYEY SOIL STRUCTURE (12-48 IN.) S - PS - U SOIL DEPTH (IN.) S - PS - U RESTRICTIVE HORIZONS (IN.) S - PS - U (IMPERVIOUS STRATA, ROCK) SOIL DRAINAGE - GROUNDWATER S - PS - U (EXTERNAL - INTERNAL) 7. SOIL PERMEABILITY S - PS - U UNDER 60 MIN. - OVER 60 MIN. 8. OTHER S - PS - U (SPECIFY) 9. SOIL SERIES: A. CECIL ( ) B. HIWASSEE ( ) C. MADISON ( ) D. APPLING ( ) E. PACOLET ( ) F. FLOOD PLAIN ( ) G. 2-1 CLAY SOIL H. OTHER -SPECIFY