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HomeMy WebLinkAboutEHPR-03-2016-23514 (2).TIF BA •G THIS IS NOT A PERMIT Case # EHPR-03-2016-23514 (71 rfl Q H CATAWBA COUNTY HEALTH DEPARTMENT 0 v £0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES '/841' sM Environmental Health Plan Review - Septic Malfunction 0 o AUTH CONST - SEPTIC_MALFUNCTION •1:1} `'�' gr, - �If�7n �� rL Arrim Owner CHUE CHOR XIONG,2680 HWY 70, CONNELLY SPRINGS NC 28612 C:8282288683 NAME TO APPEAR ON PERMIT CHUE CHOR XIONG SITE ADDRESS: 5731 ALAN D GOOD LN, CONOVER NC 28613 PIN # 374520802483 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Peet 79,279.20 Acres 1.82 DIRECTIONS: Hwy 16 North, Springs Rd, 3/4 miles, left onto Alan D. Good Ln, about 1000 feet Property is on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GA LONS PER DAY: 360 WATER SUPPLY: Private Well SCRIBE WORK: Revised 4/7/16 - Per MC changing gallons per day to 3 BdRm 360 gal/day. & changing the occupants to 6 people. `sewage on the ground & backing up in home. Changed gallons per day to 540. (9 ppl x 60 gal/day) 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Doublewide EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 65x57 NUMBER OF EXISTING BEDROOMS: 3 F OCCUPANTS: 6 PROPOSED CONST UCTTO-N BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 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 accessibp t at a complete site evaluation can be performed. Date: /2- / Signature of Applicant or Agent An Environmental Health Specialist will contact you within 5 work' days of application date. If you need further information or assistance please c 828-466-7291 AREA2 89-chappllcation 04/07/2016 13:28 Page 1 of 7 yse•A • CATAWBA COUNTY Case It EHPR-03-2016-23514 T c' Public Health Department Subdivision < e c Environmental Health Division PIN# 374520802483/no PO Box 389. 100-A Southwest Blvd,Newton, NC 28658 /80 9 NAME ON PERMIT: (CHUE CHOR XIONG), 2680 HWY 70, CONNELLY SPRINGS NC 28612 ( CHUE CHOR XIONG) Site Address: 5731 ALAN D GOOD LN, CONOVER NC 28613 Property Size: Square Feet 79,279.20 Acres 1.82 Directions: Hwy 16 North, Springs Rd, 3/4 miles, left onto Alan D. Good Ln, about 1000 feet Property is on the Right. t E11f r3 if it;4, - Y �3 L ,7 Ys. r if I a fir1 51 stn 01 i-1 x r , `FEENAME +t� 1 " 1" 41111 r DATE i ' FEEAMOUNT=1 Authorization to Construct (Repair) Fee 03/30/2016 $300.00 I t TOTAL FEES �P ho ' e' ' $300004,**y FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) P9-61166666,u ion 04/07/2016 13'28 Page 2 of 7 s��1' � THIS IS NOT A PERMIT Case# EHPR-03-2016-23514 e � CATAWBA COUNTY HEALTH DEPARTMENT `Q 4r, PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 184'1 w Environmental Health Plan Review - Septic Malfunction �° 0f. AUTH CONST - SEPTIC_MALFUNCTION 1, Aft -Wall rile, : Owner CHUE CHOR XIONG, 26 H WY 70, CONNELLY SPRINGS NC 28612 C:8282288683 NAME TO APPEAR ON PERMIT CHUE CHOR XIONG SITE ADDRESS: 5731 ALAN D GOOD LN,CONOVER NC 28613 PIN # 374520802483 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 79,279.20 Acres 1.82 DIRECTIONS: Hwy 16 North, Springs Rd, 3/4 miles, left onto Alan D. Good Ln, about 1000 feet Property is on the Right. PRIMARY CONTACT: • • .-r SEWER TYPE: Septic Tank ALLONS PER DAY: 540 WATER SUPPLY: Private Well -IBE WORK: 'Sewage on the ground & backing up in home. Changed gallons per day to 540. (9 ppl x 60 gal/day) 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: — PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Doublewide EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 65x57 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 9 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 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 Ivill contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 ###*##R***Vi♦Wkt******W**+**kPk*YM4#•*******%**#%*Y****d*+M*i YY#k#Y##*******######M+#+#*4**################+ 1:9-ehapplii■a[ion 03/30/2016 16:25 Page 1 or 7 _14 • CATAWBA COUNTY Case# EHPR-03-2016-23514 Ca G Public Health Department Subdivision 4 R Environmental Iiealth Division PIN# 374520802483 PO Box 389. 100-A Southwest Blvd. Newton.NC 28658 842 :. NAME ON PERMIT: (CHUE CHOR XIONG), 2680 HWY 70, CONNELLY SPRINGS NC 28612 ( CHUE CHOR XIONG) Site Address: 5731 ALAN D GOOD LN, CONOVER NC 28613 Property Size: Square Feet 79,279.20 Acres 1.82 Directions: Hwy 16 North, Springs Rd, 3/4 miles, left onto Alan D. Good Ln, about 1000 feet Property is on the Right. R � t -, '� �FFNAME°4. y ,, DATE FEE AMOUNT) Authorization to Construct (Repair) Fee 03/30/2016 $300.00 * ti 1 j t4I�TOTALFEES 1 t, 1�( ��ll�III#5e a a�'i t r? 1 '., MI FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) L9-chapplication 03/30/2016 16:25 Page 2 of 7 G THIS IS NOT A PERMIT Case # EHPR-03-2016-23514 rft Qn CATAWBA COUNTY HEALTH DEPARTMENT D `. , S 0 V ` 79 7 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES fl , 1842 SM Environmental Health Plan Review - Septic Malfunction • _ 1 h. J• + AUTH_CONST- SEPTIC MALFUNCTION 'yy;;s Owner CHUE CHOR XIONG, 2680 HWY 70, CONNELLY SPRINGS NC 28612 C:8282288683 NAME TO APPEAR ON PERMIT CHUE CHOR XIONG SITE ADDRESS: 5731 ALAN D GOOD LN, CONOVER NC 28613 PIN # 374520802483 NAME of SUBDIVISION: Lot 6 Section/Block PROPERTY SIZE: Square Feet 79,279.20 Acres 1.82 DIRECTIONS: Hwy 16 North, Springs Rd, 3/4 miles, left onto Alan D. Good Ln, about 1000 feet Property is on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: `Sewage on the ground. 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? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Mobile Home OTHER DESCRIPTION: DESCRIPTION OF Doublewide EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 65x57 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 9 PROPOSED CONSTRUCTION BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED? Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: 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 identifica ion :nd labeling of all pro•erty lines and corners and making the site accessible��ee sible (hate complete site evaluation can be performed. Date / / ' • Signature of Applicant or Agent ( . j An Environmental Health Specialist will contact you within 5 rk' wo g days of application date. If you need further information or assistance please call 828-466-7291 AREA2 IN-ehapplicaiion 03/30/2016 11:57 Page I of 7 ivsA • CATAWBACOUNTY Case II EHPR-03-2016-23514 Public Health Department Subdivision ®t" Environmental Health Division �r Y PIN# 374520802483 PO Box 389. 100-A Southwest Blvd.Newton, NC 28658 Igo sM NAME ON PERMIT: (CHUE CHOR XIONG),2680 HWY 70,CONNELLY SPRINGS NC 28612 ( CHUE CHOR XIONG) Site Address: 5731 ALAN D GOOD LN, CONOVER NC 28613 Property Size: Square Feet 79,27920 Acres 1.82 Directions: Hwy 16 North, Springs Rd, 3/4 miles, left onto Alan D. Good Ln, about 1000 feet Property is on the Right. is 1 `1r 1.1✓ -+ n n. .. ` 11 n s;^1 u a 1 ¢ sg r :"' r A e 81: r ..,, I = FEENAME =z °�?,iy,5s =. t` FEErAMOUN7 k Authorization to Construct (Repair) Fee 03/30/2016 $300.00 t Y2 A n1 .`1 x `x-TOTAL FEES . -� e i j ..._.�., .__. v s , t wN•161,: 15 ~7., 1:rG's11111 ..m,, FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) F9-ehapplftatian 03/30/2016 11 57 Page 2 of 7 CATAWR /� THIS IS NOT A PERMIT �/3 201�2Zq ICOUUNNTTY V- CATAWBA COUNTY HEALTH DEPARTMENT „o„„c z— Application for Environmental Services Page 1 Improvement Permit E Authorization to Construct❑ Septic Repair n Septic Malfunction Septic Expansion ❑ New Well Permit❑ Replacement Well ❑ Well Abandonment ❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction H Existing Facility Property Address 5731 ilia0 () Good I_A.; Subdivision Lot# Acres Section/Block/Phase Driving Directions to Property )-f79 i,huc.ty /6 iv' T Z (Prints go 3// /ii/es YL '4Lo tGood ht `g ctok-F /000 4 ee-1` PraPe✓+v 0 (21 GA G, NAME TO APPEAR ON PERMIT? Owner H Applicant ❑ Contractor Applicant Contact Information !ll��� ' Name Address Phone Cell Phone mOwner Contact Information , Name Li)vtC (Thor X \o' o Address 'Z ws V V S F{-c56\-\_ c, 7n CO n n P ll S�r t r r�s /�( C 2 2(, ( Z Phone klb 2Z d? s�(o 7s 3 CL Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? $Owner ❑ Applicant n Contractor - Description of Existing Structures on Site t O-tA c '-1/4_)Zc-tC #of Bedrooms *it 3 Structure Dimensions la0( #of Occupants_q Basement ❑ Yes 0 No Basement Fixtures ❑ Yes [v'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 lallo Does the site contain any jurisdictional wetlands? 711/4Yes 0-No Does the site contain any existing wastewater systems? ❑ Yes CI-No Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes .Ed-No Is the site subject to approval by any other public agency? ❑ Yes .G-No Are there any easements or right of ways on this property? Describe Existing water supply in use (2—Individual Well H Community Well I I Semi-Public Well n County/City/Township Water Line Is a public water supply available? ** n Yes No 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) y�,,� �❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other t� Any CATAWBA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures ❑ Yes ❑ No H Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes n No Plumbing E. Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence 14 Units #Bedrooms per Unit*t Total # Bedrooms *t Structure Dimensions U 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 n 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 lithe 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. r Signature of Owner or Agent ) i Date J O -/ (o Printed Name of Owner or Agent /l/G� u e CA p r �� • Catawba County Environmental Health -------- / (230) AUGUST ST i 14415 pir , ___---- / - - }J) / i - �.a 7 f Q C ' di AI IK.,e-HN • Cif Z t„, Q R (.30) N, o 0 Parcel: 374520802483, 5731 ALAN D GOOD LN 1 in=60ft CONOVER, 28613 This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 03/30/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374520802483 Owner: XIONG TONG Parcel Address: 5731 ALAN D GOOD LN Owner2: null City: CONOVER, 28613 Address: 2680 US HIGHWAY 70 LRK(REID): 42649 Address2: null Deed Book/Page: 2604/0225 City: CONNELLYS SPRINGS Subdivision: null State/Zip: NC 28612-7519 Lots/Block: null/ null Last Sale: School Information: School District: COUNTY Plat Book/Page: Legal: 5731 ALAN D GOOD LN Elementary School: OXFORD Middle School: RIVER BEND Calculated Acreage: 1.820 Tax Map: 0900 00102B High School: BUNKER HILL Township: CLINES School Map State Road #: 1656 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoningl: R-20 Building(s) Value: $55,500 Zoning2: null Land Value: $22,600 Zoning3: null Assessed Total Value: $78,100 Zoning Overlay: null Year Built/Remodeled: 1988/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-12-18 Building Permits for this parcel. Firm Panel #: 3710374500K Building Details 2010 Census Block: 2005 WaterShed: null 2010 Census Tract: 010201 Voter Precinct: P33 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report 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/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=374520802483&typ=P 3/30/2016 CPD U CATAWBA COUNTY HEALTH DEPARTMENT NEWTON, NORTH CAROLINA COMPLETION PERMIT FOR SEPTIC TANKS PERMIT N_ 0468 /p� / DATE : f7 / O`e -5 OWNER �i�-."iC.e , �5-c.<-,4y nqy, ADDRESS ft city p6 Z ejn,�r,,.ao.�, BUILDING CONTRACTOR ll� SUBDIVISION LOCATION *Zw,„/ +,. _�r5 4s �� yo Aura ODt� # LOT SIZE BLOCK OR SECTION HOUSE ( ) MOBILE HOME (Y,) BUSINESS ( ) OTHER . ( ) , FHA-VA LOAN ( ) , SEPTIC TANK: (SIZE -J�'0 GALS) WATER SUPPLY : NO. BEDROOMS NO IXTURES INDIVIDUAL 1------- PUBLIC GARBAGE DISPOSAL UNIT:YES C ) NO ( )(l . IF WELL , TYPE : BOREDt/DRILLED DUG . AUTO WASHING MACHINE : YES (') NO ( ) DISTANCE FROM SEPTIC TANK OR NEAREST NITRIFICATION FIELD: ' j SQ.FT . POLLUTION : 0 FT. 1) NUMBER OF LINES m SEPTIC TANK INST LLE .BY: 2) LENGTH AND WIDT' • : N E'_LevCe - /1,1 T 7S' PERMIT FEE $ 1' a) BE SYSTEM ( CERTIFICATE OF COMPLE ,I N BY : .- _- ..,-_b=) __TRENCH _SYSTEt( _) • - —v- -��—°Tiletz-c-> �t=lJi1L-_ —;m_----- ,---- - 3) DEPTH OF STONE IN LINES /'L.7 REMARKS : ADEQUATE FALL (GRADE) ON: 1.) BUILDING, (HOUSE) SEWER LINE : YES (LI NO ( ) 2) NITRI�F}CATION LINES : DATE INSTALLED : d I ( YES 1,") NO ( ) • SEPTIC TANK LAYOUT I E, x O \--\,j U 6 C °� w F O- O a ni ill HEALTH DEPARTMENT COPY . p / . !l1 (JA 1.✓ .. 11�//A/ CCHINIKY HEALTH DEPARTMENT ,q , ' a24�Y� ` IMPROVEMEN�e PERMIT FOR SEPTIC TANKS Permit No 111111_6 n WWW ,, /MVP .I 0 OWNER iii _� •`„`a • DATE / ADDRESS OF OWNER • t-2-4-1-'. IL, ) Lg v 'rthA4Dtca.. PHONE NAME OF CONTRACTOR./ r / ADDRESS / ' LOCATIbN /JS /6 �c� , .4.7n. rzn., ii.c.4� .....1-752.. .y SUBDIVISION • . LOT NO. ;SECTION OR, BLOCK• • LOT SIZE .2-61-1-4-1-c FHQ,'VA LOAN HOUSE.( ) MOBILE HOME (, `BUSINESS O OTHER ( ) SEPTIC TANK LAYOUT NO. BEDROOMS: ('L) NO.. FIXTURES ( ) _ GARBAGE DISPOSAL UNIT: YES ( ) NO ( A) PLUMBING UNDER .BASEMENT: FLOOR: YES (' ) NO ( • Imo/-.,.� - SIZE OF TANK /FIELD: - LIQUID GALLONS L� NITRdFICAT30N FIELD: 1:. Number of lines --7.. Length and width of lines: S. Bed System /.a,- ' )( 2r ft. - b. Trench system ft. 3 3; Total Depth of stone 7 •,� inches # . GROUNDWATER INTERCEPTOR DRAIN: St WAT(IF REQUIRED) . ' OWNER. NOTIFIED TO CHECK ZONING: YES (.Y) NO ( ) 1M-- p OWNER AGREES WITH 'LAYOUT': YES (x) N(T+ ( ) W p- 4 4w r OWNER AGREES WITH SPECIAL INSTRUCTIONS: YES ( ) NO ( ) (J C/ pU , P OWNER OR CONTRACTOR SIGNATURE . • PERMIT- FEE $ { d. °9- " ft,-ptp PERMIT VOID AFTER 36 MONTHS r 74' IMPROVEMENT PERMIT ISSUED BY SEPTIC TANK CONTRACTOR MUST. UOLLOW ALL • (LAYOUT) DETAILS OF THIS PERMIT (LAYOUT) SANITARIAN =u!e, a•4-u n."-> _. HEALTH DEPARTMENT COPY SOLL. CLASSLFICATION:, SUITABLE ( ) PROVISIONALLY SUITABLE ( ) UNSUIT:4BLE.. ( ) SITE. FACTORSc 1.. SLOPE ( ,) Si- PS - U 7. SOIL PERMEABILITY S - PS - U 2. SOIL TEXTURE (12-48 IN.). S - PS - U UNDER 60 M1N.. 7 OVER 60 MIN. SANDY, LOAMY, CLAYEY 8. OTHER • S -. PS - U 3. SOIL STRUCTURE (12 748 IN.) S. - PS' - L' (SPECIFY) 4.. SOIL DEPTH (IN.) . . S - PS - U 9: • SOIL SERIES: 5. RESTRICTI/E HORIZONS (IN,) S:- PS - U A. CECIL ( ). B. HIWASSEE ( ).- (IMPERVIOUS STRATA, ROCK) C.. MADISON ( )- D. APPLING •( )- 6. SOIL ,DRAINAGE' - GROUNDWATER S - PS - U . E. PACOLET ( ) F. FLOOD- PLAIN ( ) (EXTERNAL - INTERNAL) C. 2-1 CLAY :SOIL H. OTHER-SPECIFY • 1. ' • y� Cp CATAWBA COUNTY � IOOA SOUTHWEST BLVD f57 •__ J NEWTON, NORTH CAROLINA 28658 RECEIPT r=-7 p PHONE: 828.465.8399 tIC' it Wednesday, March 30, 2016 /842 sh, www.catawbacountync.gov PAYOR: XIONG.CHUE CHOR PAYMENTS TRANSACTION NUMBER: TRC-646469-30-03-2016 PAYMENT DATE : 03/30/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-326634 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : S300.00 EHPR-03-2016-23514 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5731 ALAN D GOOD LN, CONOVER NC 28613 Owner CHUE CHOR XIONG,2680 HWY 70, CONNELLY SPRINGS NC 28612 0:8282288683 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/30/2016 11:56 Page I of 1