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Home My WebLink AboutRBPR-07-2013-17660.TIF1842 sM THIS IS NOT A PERMIT Case # RBPR-07-2013-17660 CATAWBA COUNTY HEALTH DEPARTMENT 0� •�� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES J i T Residential Building Plan Review - Accessory Structure • .� IMPROVEMENT- AUTH_CONS T - %I3l I13 )w k Po,A- J SEPTIC MALFUNCTION Applicant ANDREA IGNASIAK, 5843 SPRINGS RD, HICKORY NC 28601 H:8284554751 HOME:8284554751 Owner ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 H:8284554751 C:8284552644 HOME:8284554751 NAME TO APPEAR ON PERMIT 10 Andrea Sigmon SITE ADDRESS: 5843 SPRINGS RD, CONOVER NC 28613 PIN # 375517011505 NAME of SUBDIVISION: Lot # 5 Section/Block PROPERTY SIZE: Square Feet Acres 1.79 DIRECTIONS: Corner of Springs Rd & Edison Rd PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: REVISED 7/18/2013- RP went on-site for inspection and system was failing. Revised app for a Repair Permit. 30 x 30 detached garage SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: FACILITY TYP ingle Family Residence DESCRIPTIO F uoublewide EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 24 x 60 NUMBER OF EXISTING BEDROOMS: 3 NEW STRUCTURE DIM:: 30 x 30 ACCESSORY STRUCTURE OTHER DESCRIPTION: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: PLUMBING REQUIRED? No CONVENTIONAL: ANY: [`9 - ehapphcation 07/31/2013 09:48 Page 1 of 7 �yA CATAWBA COUNTY Case # RBPR-07-2013-17660 Public Health Department Subdivision Environmental Health Division PIN# 375517011505 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 I8 � SM NAME ON PERMIT: ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 Site Address: 5843 SPRINGS RD, CONOVER NC 28613 Property Size: Square Feet Acres 1.79 Directions: Corner of Springs Rd & Edison Rd Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Date: Signature of Applicant or Agent 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: 5 MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit Fee 07/12/2013 $150.00 Authorization to Construct (Repair) Fee 07/18/2013 $150.00 TOTAL FEES $300.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) L9 - ehophlicauon 07/31/2013 09:48 Page 2 of 7 Applicant Owner THIS IS NOT A PERMIT Case # RBPR-07-2013-17660 CATAWBA COUNTY HEALTH DEPARTMENT L!1J �Mv. f J PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES { r Residential Building Plan Review - Accessory Structure _ • T.# IMPROVEMENT -A UTH1-_ CONS T- SEPTIC—MALFUNCTION ANDREA IGNASIAK, 5843 SPRINGS RD, HICKORY NC 28601 H:8284554751 HOME:8284554751 ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 H:8284554751 C:8284552644 HOME:8284554751 NAME TO APPEAR ON PERMIT Andrea Sigmon SITE ADDRESS: 5843 SPRINGS RD, CONOVER NC 28613 NAME of SUBDIVISION: Lot # PROPERTY SIZE: Square Feet Acres 1.79 DIRECTIONS: Corner of Springs Rd & Edison Rd 0 12ev i SQ6 -1 13 l \ '�> - .--b- PIN # 375517011505 5 Section/Bloch PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK) REVISED 7/18/2013- RP went on-site for inspection and system was failing. Revised app for a Repair Permit. 30 x 30 detached garage SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: FACILITY TYPE: Accessory Structure DESCRIPTION OF Doublewide EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 24 x 60 NUMBER OF EXISTING BEDROOMS: 3 ACCESSORY STRUCTURE OTHER DESCRIPTION: # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30 x 30 BASEMENT? No BASEMENT FIXTURES? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: OTHER: INNOVATIVE: Other described: PLUMBING REQUIRED? No CONVENTIONAL: ANY: I:9 - ehapplicaticm 07/18/2013 09:32 Page I of 7 �A CATAWBA COUNTY Case# RBPR-07-2013-17660 Q Public Health Department Subdivision 4 .v- Environmental Health Division PIN# 375517011505 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 Ig 2 sv NAME ON PERMIT: ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 Site Address: 5843 SPRINGS RD, CONOVER NC 28613 Property Size: Square Feet Acres 1.79 Directions: Corner of Springs Rd & Edison Rd Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identificati n and labeling of all property lines and corners and making the site accessi so that a complete site evaluation can be performed. Date: Signature of Applicant or Agentj}7�jjo� 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: 5 MAX HEIGHT: FEENAME DATE FEE AMOUNT Improvement Permit Fee 07/12/2013 $150.00 Authorization to Construct (Repair) Fee 07/18/2013 $150.00 TOTAL FEES $300.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 1-9 - ellapplication 07/18/2013 0933 Page 2 of 7 PAYOR Ignasiak, Andrea PAYMENTS CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 PHONE: 828.465.8399 www.catawbacountync.gov TRANSACTION NUMBER: TRC -274803-18-07-2013 PAYMENT DATE: 07/18/2013 PAYMENT TYPE: Check 1458 NCDL-4727302 DOB -12/5/57 XP -12/5/15 RECEIPT Thursday, July 18, 2013 INVOICE NUMBER FEE NAME FEE AMOUNT 07-13-298629 Authorization to Construct (Repair) $ 150.00 Fee TOTAL PAYMENTS : $150.00 RBPR-07-2013-17660 CASE TYPE: Residential Building Plan Review WORK CLASS: SITE ADDRESS: 5843 SPRINGS RD, CONOVER NC 28613 Applicant ANDREA IGNASIAK, 5843 SPRINGS RD, HICKORY NC 28601 H:8284554751 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 H:8284554751C:8284552644 Accessory Structure E9 - receipt 07/18/2013 09:32 Page l of I THIS IS NOT A PERMIT Case # RBPR-07-2013-17660 CATAWBA COUNTY HEALTH DEPARTMENT ace PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review - Accessory Structure IMPROVEMENT Applicant ANDREA IGNASIAK, 5843 SPRINGS RD, HICKORY NC 28601 H:8284554751 HOME:8284554751 Owner ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 H:8284554751 C:8284552644 HOME:8284554751 NAME TO APPEAR ON PERMIT Andrea Sigmon D SITE ADDRESS: 5843 SPRINGS RD, CONOVER NC 28613 PIN # 375517011505 NAME of SUBDIVISION: Lot # 5 Section[Block PROPERTY SIZE: Square Feet Acres 179 DIRECTIONS: Corner of Springs Rd & Edison Rd PRIMARY CONTACT: SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: 30 x 30 detached garage SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is "YES", then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? APPLICATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACILITY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF Doublewide EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 24 x 60 NUMBER OF EXISTING BEDROOMS: 3 # OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 30 x 30 BASEMENT? No BASEMENT FIXTURES? PLUMBING REQUIRED? No Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: C4 - chappfcaforl 07/12/2013 11:10 Page I of 4 CATAWBA COUNTY Case # RBPR-07-2013-17660 �� 1r Public Health Department Subdivision Q� K Environmental Health Division PIN# 375517011505 PO Box 389, 100-A Southwest Blvd, Newton, NC 28658 184 SM NAME ON PERMIT: ANDREA SIGMON, PO BOX 855, CONOVER NC 28613 Site Address: 5843 SPRINGS RD, CONOVER NC 28613 Property Size: Square Feet Acres 1.79 Directions: Corner of Springs Rd & Edison Rd Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identificat n and labeling of all property lines and corners and making the site access e so that a complett�j site evaluation car�bbe `performed. Date: j 2 — i0 -- Signature of Applicant or Agent/)'% _ N;L/C✓Y)Q e J�J 67 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: 5 MAX HEIGHT: FEENAME Improvement Permit Fee TOTAL FEES DATE FEE AMOUNT 07/12/2013 $150.00 $150.00 SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) 111> - chapplicatxm 07/12/2013 11:10 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT COLI) CATAWBA COUNTY HEALTH DEPARTMENT North Cural(no Application for Environmental Services Page 1 Improvement Permit'd 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 C�S(q3 Sr i n S Rd Subdivision ('vn o VF-, r, Z& t 3 Lot # Acres A LQ-�f Section/Block/Phase Driving Directions to Property u l� /V ,(�p(l n s kc� — /� 511f_;,1/Yl i le �J c)/Y2 e n 1-11h-! b, -.:z P(O' O-eSt ScAOeCE+� e- I E4SCJ11 R(i, NAME TO APPEAR ON PERMIT? ® Owner ❑ Applicant ❑ Contractor Applicant Contact Information 1� -� Name -T i m _4 Afw� f ec, T —: G D CSS LQ I� / �/ �`,' Address 5q Ll 3 ':� pr )Flea S ✓�_ r� no it e( N -G, ` %Sf&'/i / Phone L4 S'�S i 7_S Cell Phone Owner Co tact Information Name d f i~ Address5q �n Phone lci42V Contractor Contact Information Name Address Phone !fix /1a/r►� / 1 S 1 rxl �'� ✓1 Con oueT NC` 2 Co ►3 Cell Phone �''?V L1 Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site U0 -b I e- W t C4,e # of Bedrooms *f 3 Structure Dimensions �2 U /_ lr U # of Occupants Basement ❑ Yes D -No Basement Fixtures ❑ Yes ❑ No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. If the answer to any question is "yes", applicant must attach supporting documentation. ❑ Yes ❑'1 o Does the site contain any jurisdictional wetlands? O`Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes -0 No Is any wastewater going to be generated on the site other than domestic sewage? Des ❑ No Is the site subject to approval by any other public agency? ❑ No Are there any easements or right of ways on this property? Describe 3U 4-1 Existing water supply in use 0--gidividual Well ❑ Community Well ❑ Semi -Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes [3 -50 - If applying for an Improvement Permit or Authorization to Construct, Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 13 Alternative ❑ Conventional 0 Innovative ❑ Other 0 Any -�� - CATAWBA THIS IS NOT A PERMIT CATAWBA COUNTY HEALTH DEPARTMENT No,w Application for Environmental Services Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions Basement ❑ Yes ❑ No # of Occupants Basement Fixtures ❑ Yes ❑ No Page 2 ❑ Accessory Structure(s) Describe( .r"'0_ # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes U40, Plumbing ❑ Yes ErNo Describe Plumbing Needed ❑„„ Multi -Family Residence # Units #Bedrooms per Unit*j' 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 t 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. f 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. SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non -expiring under certain specified conditions. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable; Improvement Permits and Well Permits are transferrable. Permits may be revoked if the information on this application, site plans or intended use changes for the proposed facility. I have read this application and certify that the information provided herein is true, complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Printed Name of Owner or Agent Date 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 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 1 inch = 60 feet Selected Parcel Number: 3755-17-01-1505 Prepared for: 1 1 '5843 (210) THIS IS NOT A LEGAL DOCUMEN D ifn ((1 Date: 7/12/2013 Time: 10:44:510 AM n n 3- 3 ID "4• r, W... w (210) THIS IS NOT A LEGAL DOCUMEN D ifn ((1 Date: 7/12/2013 Time: 10:44:510 AM n n 3- 3 ID CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3755-17-01-1505 Name: • SIGMON ANDREA K Name2: Address: PO BOX 855 Address2: City: CONOVER State: NC Zip: 28613-0855 Account: Calc Acreage: 1.79 Tax Map: 0915 02001 LRK: 43216 Deed Book: 2064 Deed Page: 1529 Subdivision Name: Subdivision Block: Lots: 5 Plat Book: UNRE Plat Page: UNRE Building Number: 5843 Street Name: SPRINGS RD Site Zip: 28613 Township: CLINES Fire Dist: OXFORD City/Tax: State Road: Total Bldgs Value: $48,300 Land Value: $25,000 Total Value: $73,300 Year Built: 1981 Year Remodeled: Last Sale Date: Last Sale Amount: Neighborhood: 67 Watershed: Watershed Split: NO Voter Precinct: P33 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: OXFORD Middle School: RIVER BEND High School: BUNKER HILL School Split: NO P&Z Case Number: Census Tract 2010: 010201 Census Block 2010: 1013 Small Area Plan: ST STEPHENS/OXFORD Agricultural District: Printed: Friday, July 12, 2013 10:44 AM CATH BA-LENCOLN-ALEXANDER DISTRM IT HEALTH DEPARTMENT HICKORY, N. C.—NEWTON, N. C.—LINCOLNTON, N. C: TAYLORSVILLE, N. C. Phones 328-2561 464-7680 735-3001 632-3101 TO ONSTALL SEPTM TANK . PERMIT NO ......... ................ PERMIT DATE..... 19 Owner .... f.:.l.q:..�_•.....(:.'.-..-r.C... ...... ........Address �} ,�. ..! ............ ............. .... ... ._... Tenant........ .......... ............. ......... . :....- .. r ...... .. f Address..... ... ................... .............. . Installed by .!... •. , .., _ ... `r% ... r...r� i °•'�'...r' .. Address .. .. ............... .......,... ...... {1i of Property.. ,r._. ._ :. ..../.r':r::Z.... -s °. '......' ...�. ....... .......:........::...A^....r,.........`ti�._z..a!ii .;R.a:'..�Z'. i..;;''�.......... _��..�'. _. .......... ..... .. ........ .. ...... ... ... ... ... Kind of tank. ... .... .r'4........ `. _......>.. .. Size .... .,.,--- Length of trench _ NOTIFY HEALTH DEPARTMENT AT LEAST EIGHT HOURS BEFORE TANK IS TO BE INSPECTED Final Inspection ...............• r:,..r.::'.`: .: -:.... f / ... 19.../ `,. Approved Disapproved ( ) , Remark.. ........................... _........................ . ........ ....................... ............. r .'....................:..................................................... i�E�• Firs five eet of line from outlet house should be of cost iron soil pipe. ....................... % Sanitarian. Sketch of tank and line showing distance !! r from dwelling and well on subject property r .i B�'.�l(� ± ___ ____._ _ and on adjoining property.