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HomeMy WebLinkAboutEHPR-05-2016-23831 (2).TIF „a$A C. THIS IS NOT A PERMIT Case # EHPR-05-2016-23831 Qr CATAWBA COUNTY HEALTH DEPARTMENT O 'i” O V "'� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ~ .*i Ig41 su Environmental Health Plan Review - Septic Malfunction ■o zo At7rol AUTH CONST- SEPTIC MALFUNCTION Owner MARTIA YANG, 5653 SWINGING BRIDGE RD, CONOVER NC 28613 H:828-781-9676 HOME:828-781-9676 NAME TO APPEAR ON PERMIT Martia Vang SITE ADDRESS: 5653 SWINGING BRIDGE RD, CONOVER NC 28613 PIN # 375409069511 NAME of SUBDIVISION: MARTIA J VANG Lot# 2 Section/Block PROPERTY SIZE: Square Feet 68389.20 Acres 1.57 DIRECTIONS: From Conover go Hwy 16 North towards Taylorsville, Left at the Exxon Gas Station onto Swinging Bridge Rd, abour a mile& a 1/2 down the road the house will be on the Left with a blue tractor under the carport. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 480 WATER SUPPLY: Private Well DESCRIBE WORK: sewage starting to surface on 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, Shed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 88x32, Shed 12x12 NUMBER OF EXISTING BEDROOMS: 4 #OF OCCUPANTS: 8 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 ales.-(.understand that I am solely responsible for the proper identification a f^d labeling of all property lines and corners and makin the site acce :-.le o hat - sterilise a site evaluation can be performed. Date: 5 ///ce, Signature of Applicant en diba nadliI- ... An Environmental Health Specialist will contact you within 5 WI rking days of app lion date. If you need further information or assistance please call 828-466-72' AREA2 E9-chapplication 1)5/11/2016 13:35 Page I of 7 av' CATAWBA COUNTY case a PHPR-05-2016-23831 �� Public Health Department Subdivision MARTIAJVANG �. � ;' Environmental Health Division PINK 375409069511 wf-� . PO Box 389, 100-A Southwest Blvd.Newton,NC 28658 )g42 :M NAME ON PERMIT: ( MARTIA YANG), 5653 SWINGING BRIDGE RD, CONOVER NC 28613 ( Martia Vang) Site Address: 5653 SWINGING BRIDGE RD, CONOVER NC 28613 Property Size: Square Feet 68,389.20 Acres 1.57 Directions: From Conover go Hwy 16 North towards Taylorsville, Left at the Exxon Gas Station onto Swinging Bridge Rd, abour a mile &a 1/2 down the road the house will be on the Left with a blue tractor under the carport. { ,1F F MEN � r 'L'lli� l'iI . , ~"Ftm of iIDATE I ,' l FEE'AMOIUNT��,. Authorization to Construct (Repair) Fee 05/11/2016 $450.00 f l�t I�fI�ITOTAL!F,E£SIYI lhr.11.14iT9t�rh 1i 1�1 �1, rlvll, 111 0 1 a l 1 ro u1.. rs i' (' � t�"1PlYlo `���;y. �. Yallligt �=,��llh� 1�f1iN{6 sas000� ?LI I l 1111-• 1thim11111 t J11III tlW11.71tIwN IBBI11li111 wIDWllitlatla1l@0lililliialilo` :11411 112—at81lhu t ma JI�m16 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) 119-ehnpplicaunn 05/11/2016 13:35 Page 2 of 7 CATAWBA THIS IS NOT A PERMIT cot�xry CATAWBA COUNTY HEALTH DEPARTMENT „o„a . Application for Environmental Services Page 1 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 5653 SWINGING BRIDGE RD Subdivision CONOVER, NC 28613 Lot# Acres Section/Block/Phase _ Driving Directions to Property From Conover going HWY 16 North towards Taylorsville,turn left at the Exxon gas station on Swinging Bridge RD.About a mile and a half, brick house will be on the left with a blue tractor under carport. NAME TO APPEAR ON PERMIT? U Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name Martia Vang Address 5653 Swinging Bridge RD, Conover, NC 28613 Phone 828-781-9676 Cell Phone Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ® Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site Single family home # of Bedrooms *t 4 Structure Dimensions E3 1Z #of Occupants 8 Basement ❑ Yes ❑ No Basement Fixtures Q Yes P 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 tD No Does the site contain any jurisdictional wetlands? n Yes ® No Does the site contain any existing wastewater systems? ® Yes P No Is any wastewater going to he generated on the site other than domestic sewage? O Yes 0 No Is the site subject to approval by any other public agency? ® Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use U Individual Well H Community Well H Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ 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 CArr AWBA 'lIlISIS NOT APERMIT t:ouxrr�„� 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 Fixtures ® Yes ® No ❑ Accessory'Structure(s) Describe #of New Bedrooms *T if applicable Structure Dimensions #of Occupants Accessory Dwelling ❑ Yes ❑ No Plumbing ❑ Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence(' Units #Bedrooms per Unit*t Total # Bedrooms *I' 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 n 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. t 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 Owne gent Pr Date 57l //(o Printed Name of Owner or Agent fan K— Ilk/6— Catawba County Environmental Health (175) �r • 2.8.73 '8.73 • • N VJo 0 0 cfs N N • (274 • rn 0 • 220) 280.42 { m I # Parcel: 375409069511 , 5653 SWINGING 1in=60ft BRIDGE RD 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 05/11/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375409069511 Owner: YANG MARTIA Parcel Address: 5653 SWINGING BRIDGE RD Owner2: null City: CONOVER, 28613 Address: 5653 SWINGING BRIDGE RD LRK(REID): 404364 Address2: null Deed Book/Page: 2992/0987 City: CONOVER Subdivision: MARTIA J VANG State/Zip: NC 28613-7416 Lots/Block: 2/ Last Sale: $165,000 on 2009-09-11 School Information: School District: COUNTY Plat Book/Page: 69/68 Legal: LOT 2 PL 69-68 Elementary School: OXFORD Calculated Acreage: 1.570 Middle School: RIVER BEND Tax Map: null High School: BUNKER HILL Township: CLINES School Map State Road #: 1515 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: $106,300 Zoning2: Land Value: $16,000 Zoning3: Assessed Total Value: $122,300 Zoning Overlay: DWMH-O Year Built/Remodeled: 1955/null Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: null Building Permits for this parcel. Firm Panel #: null 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. oftibrie Locale (Aria ( (kr/TM- http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375409069511&typ=P 5/11/2016 gA Case# W1s2009-00708 ^� �G CATAWBA COUNTY Subdivision t- .f a . Public Health Department Section BVPh Lot# Lot 2 d a, Environmental Health Division PIN# roz , PO Box 389, 100A Southwest Blvd,Newton NC 28658 ,�q 842 su (828)465-8270 Fax (828)465-8276 TDD(828)465-8200 iSY -II -041 -7b5 Applicant/Owner Martia Vang Site Address: 5653 Swinging Bridge Rd Property Size: Directions: el EXISTING SYSTEM INSPECTION REPORT Site/System Diagram F p Ili u - - `p N .-c - -4 V 1 J S.- 5 1 lic J / ✓ o , a 'o 2Ze)- Type of Facility : House ® Mobile Home n #Bedrooms 3 Business n Specify Other in Specify Proposed Additions/Accessory Structure: Property Division Approved ® Not Approved ❑ Reason Evidence of System Malfunctions: /Y//ES ❑ NO ® System Type/Description 2a Lis/'A tClitilk 11-",0-09 At1THORI7_ED STATE AGENT APPROVAL DATE NOT FOR LOAN APPROVAL e:\DOmments and Seeings yenglishLLocal Settings\Temporary Internet Files\Content.Outlook\P6CRMTUF\EXISTING TANK CHECK 2009-00708.docx $A C() CATAWBA COUNTY `y ,�°, 4 \rt 100A SOUTHWEST BLVD Q NEWTON, NORTH CAROLINA 28658 RECEIPT Peav"f, PHONE: 828.465.8399 c3� no, Wednesday, May 11, 2016 /842 SM www.catawbacountync.gov PAYOR: Vang, Mania PAYMENTS TRANSACTION NUMBER: TRC-670826-11-05-2016 PAYMENT DATE : 05/11/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328234 Authorization to Construct (Repair) $450.00 Fee TOTAL PAYMENTS : $450.00 EHPR-05-2016-23831 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5653 SWINGING BRIDGE RD, CONOVER NC 28613 Owner MARTIA VANG, 5653 SWINGING BRIDGE RD, CONOVER NC 28613 H:828-781-9676 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05/11/2016 13:35 Page 1 of 1