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HomeMy WebLinkAboutEHPR-04-2016-23727 (2).TIF �yy A THIS IS NOT A PERMIT Case # EHPR-04-2016-23727 icT .W -1-, CATAWBA COUNTY HEALTH DEPARTMENT O`I' . f O � ` voc,, PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES \842 5M1i Environmental Health Plan Review - Septic Malfunction f 0 0 X II 't r AUTH_CONST- SEPTIC MALFUNCTION _ 0 0 Owner VANG PENG, 1511 2l ST ST NE, HICKORY NC 28601 C:8284468002 NAME TO APPEAR ON PERMIT Vang Peng SITE ADDRESS: 151 1 21ST ST NE, HICKORY NC 28601 PIN # 371312858761 NAME of SUBDIVISION: Lot# 6-11 PT 5 Section/Block _ PROPERTY SIZE: Square Feet 39,639.60 Acres 0.91 DIRECTIONS: 140 Exit 146, McDonald Parkway, Follow to Springs Road &take a Left, About 1/2 mile down on Right 15th Ave NE, 2nd Road on the Right, 2nd house on the Left. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Tank Only Replacement* Tank Collapsed. Open hole in 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: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) 'DIM EXISTING STRUCTURE: 83x39 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION BASEMENT? Yes 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 identificati n and I beling of all property lines and corners and making the site accessible s°'4thAt a complete site evaluation can be performed. Date: it‘9,- 1 Signature of Applicant or Agent \1�---' V �� An Environmental Health Specialist will contact you within 5 working days o of cation date. If you need further information or assistance please call 828-466-7291 AREA2 E9-ehapplicatinn 04/25/2016 14:58 Page I of8 a' CATAWBA COUNTY Case a EHPR-04-2016-23727 itin J Public Health Department Subdivision woo "- Environmental Health Division PIN# 371312858761 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 g.2 ,M NAME ON PERMIT: (YANG PENG), 1511 21ST ST NE, HICKORY NC 28601 ( Vang Peng) Site Address: 1511 21ST ST NE, HICKORY NC 28601 Property Size: Square Feet 39,639.60 Acres 0.91 Directions: 140 Exit 146, McDonald Parkway, Follow to Springs Road &take a Left, About 1/2 mile down on Right 15th Ave NE, 2nd Road on the Right, 2nd house on the Left. F'EE{NAGME• l l 'I n i ' i �sG, ll'liilly,! 1;' �llili`��1FroATEgi!,HI .FEEAMOU�NTi,;. _ 1 ���I ii wn9 nixr, l iu���,.u' x tlh _ �1V� Authorization to Construct (Repair) Fee 04/25/2016 $150.00 111�� TN! � I ��i 111!1!, ' = w#i� ,'.��I�I ' �1 it 1 ToTA�F> ESI�hIVIhI'�!Ill ' �, 71 h��,�« 1,{�ululnP� .MaI,V�l�l�l, $1s0 001�,1 rl�l� p, „ a1q11� Ip... d1 �l�{� !11 h u,uri ; :¢Ily1 tU1811uwl IIH7qEm: M pIWILIUWp+ur�_�NLJ'-": .,�ii.111iIj,iL` 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) E9-cheppli cation 04/25/2016 14:58 Page 2 of 8 cArrA« 7� ® THIS IS NOT A PERMIT COUNTY -4 Jam[ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 1 Improvement Permit❑ Authorization to Construct ❑ Septic Repair ] Septic Malfunction`s Septic Expansion n New Well Permit L Replacement Well n Well Abandonment n Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction n Existing Facility Property Address i - (\ cIr 5T N 12-' Subdivision 1-t■C.kt-o-9 1 lot- .9-8 60 I Lot# Acres Section/Block/Phase Driving Directions to Property bFc or. 59c J go c--.4 NAME TO APPEAR ON PERMIT? U2' wner n Applicant n Contractor Applicant Contact Information Name •-pc r r\reA Address tSt d.ta%- NS Phone (f5zM cj L (, _ boo 2- Cell Phone Owner Contact information Name Address Phone Cell Phone Contractor Contact Information Name Address Phone ell Phone WHO WILL BE THE PRIMARY CONTACT? 0-Owner n Applicant (-1 Contractor Description of Existing Structures on Site 5,f,4,-L. Mc,v< Pe:\Ikr. :0,,,. #of Bedrooms 41 3 Structure Dimensions #of Occupants Basement [y Yes ❑ No Basement Fixtures Q Yes ®'co 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 0-11-o Does the site contain any jurisdictional wetlands? )(Yes ' 'So Does the site contain any existing wastewater systems? ❑ Yes 04 Is any wastewater going to be generated on the site other than domestic sewage? ® Yes G1 Is the site subject to approval by any other public agency? ❑Yes 19-< Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well n Community Well n Semi-Public Well 0 County/City/Township Water Line Is a public water supply available? ** g 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) ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Any CATAWBA THIS IS NOT A PERMIT aiunrv„ CATAWBA COUNTY HEALTH DEPARTMENT �—� Application for Environmental Services Page 2 Propo ed Facility Type Primary Residence n New Residence ❑ Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement n Yes ❑ No Basement Fixtures ® Yes C2 No El Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes ❑ No Plumbing n Yes ❑ No Describe Plumbing Needed I I Multi-Family Residence# Units #Bedrooms per Unit*t Total ft 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.) E 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 in Unknown Well Repair Requested ❑ Yes Li 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. t If structure is plumbed but no bedrooms, calculated design flow is required. ** IfNo,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 transferable. Permits maybe 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 comers and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agen Date 14 I a 5 1 Printed Name of Owner or Agent Katherine Harris From: Shawn Pennell [spennell @hickorync.gov] Sent: Monday, April 25, 2016 2:57 PM To: Katherine Harris Subject: 1511 21st ST NE This address may do a tank only replacement at this time. In the future they would be required to connect to City sewer if repairs or replacements are necessary. M. Shawn Pennell Utilities Environmental Manager spennellna hickorync.gov City of Hickory, NC (828) 323-7427 www.hickor nc.qov Pursuant to North Carolina General Statutes Chapter 132, Public Records, this electronic mail message and any attachments hereto, as well as any electronic mail message(s) that may be sent in response to it may be considered public record and as such are subject to request and review. 1 Catawba County Environmental Health■ 0) w - ` - _ _ N Pr — - 252.99 - _ _ w _ - - J 8 -- - ` - _ Y - _ N — ` --_ -- — _ _ rn •• 1. . 04 il_ __ 7' ; _ 4 32• t 1 1, I 1 Parcel: 371312858761 , 1511 21ST ST NE 1 in=50ft HICKORY, 28601 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 04/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 371312858761 Owner: VANG PENG Parcel Address: 1511 21ST ST NE Owner2: null City: HICKORY, 28601 Address: 1511 21ST ST NE LRK(REID): 46669 Address2: null Deed Book/Page: 3246/0065 City: HICKORY Subdivision: null State/Zip: NC 28601-2953 Lots/Block: 6-11 PT 5/ null Last Sale: $130,000 on 2007-04-27 School Information: Plat Book/Page: School District: COUNTY Legal: LOT 6-11 PT 5 Elementary School: ST STEPHENS Calculated Acreage: .910 Middle School: ARNDT Tax Map: 118H 01038 High School: ST STEPHENS Township: HICKORY School Map State Road #: null Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: HICKORY Zoning District: HICKORY County Fire District: All in City Zoning1: R-3 Building(s) Value: $96,700 Zoning2: null Land Value: $17,500 Zoning3: null Assessed Total Value: $114,200 Zoning Overlay: null Year Built/Remodeled: 1962/1984 Small Area: null Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710371300J Building Details 2010 Census Block: 3023 WaterShed: null 2010 Census Tract: 010401 Voter Precinct: P30 Agricultural District: 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=371312858761&typ=P 4/25/2016 A CATAWBA COUNTY „}a! 0 IOOA SORTH CAROLI VD RECEIPT , NEWTON, NORTH CAROLINA 28658 ; cmaxmn�g ,..—., �, C.� ' ���- PHONE: 828.465.8399 Monday, April 25, 2016 �`up 1� 1842 sn+ www.catawbacountync.gov PAYOR: Peng, Vang PAYMENTS TRANSACTION NUMBER: TRC-661705-25-04-2016 PAYMENT DATE : 04/25/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327593 Authorization to Construct(Repair) $150.00 Fee TOTAL PAYMENTS : $150.00 EHPR-04-2016-23727 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1511 21ST ST NE, HICKORY NC 28601 Owner VANG PENG, 1511 21ST ST NE, HICKORY NC 28601 C:8284468002 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 04/25/2016 14:58 Page 1 of 1