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HomeMy WebLinkAboutEHPR-05-2016-23951 (2).TIF qA • THIS IS NOT A PERMIT Case # EHPR-05-201 6-2395 1 d � r CATAWBA COUNTY HEALTH DEPARTMENT D d.J 0 139,v '"°. PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES fT ti. /842 sM Environmental Health Plan Review - Septic Malfunction AUTH_CONSt- ABANDONMENT - SEPTIC MALFUNCTION Applicant CHUE XIONG, 5311 BIRCHLEAF LN, CLAREMONT NC 28610 C:8282347704 Owner PACHI XIONG, 1939 E NC 10 HWY,NEWTON NC 28658 C:8284482093 NAME TO APPEAR ON PERMIT Pachi Xiong SITE ADDRESS: 1939 E NC 10 HWY,NEWTON NC 28658 PIN # 374016932160 NAME of SUBDIVISION: Lot II Section/Block PROPERTY SIZE: Square Feet 14,374.80 Acres 0.33 DIRECTIONS: Hwy 10 East, House is on the corner of Hwy 10 East & Caleb Selzer Road, Once you turn on Caleb Selzer Rd the driveway is on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY : Private Well DESCRIBE WORK: Sewage surfacing over septic tank. Open Violation: EH-04-2016-5972. 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, Chicken House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 40x45 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 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: APPLICATION FOR WELL ABANDONMENT ABANDONMENT TYPE: Dug IN-ehapplication 06/14/2016 11:31 Page 1 of 12 CATAWBA COUNTY Case# EHPR-05-2016-23951 .F gin; Public Health Department Subdivision • Q\^7#'—� '�1 Environmental Health Division \ 1 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 PIN# 374016932160 1842 ,w NAME ON PERMIT: ( PACHI XIONG), 1939 E NC 10 HWY, NEWTON NC 28658 ( Pachi Xiong) Site Address: 1939 E NC 10 HWY,NEWTON NC 28658 Property Size: Square Feet 14,374.80 Acres 0.33 Directions: Hwy 10 East, House is on the corner of Hwy 10 East& Caleb Setzer Road, Once you turn on Caleb Setzer Rd the driveway is on the Right. 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 identificatio and labeling of all property lines and corners and making the site accessAii so that a co • =1e site evaluation can be performed. Date: ep —1 .— /1„b Signature of Applicant or Agent /t,.• ., ` An Environmental Health Specialist will contact you within 5 working days of,i. cation date. If you need further information or assistance please call 828-466-7 '1 AREA1 rL NNIAIM'F` r llilll��id6 tg i1 .Cliil.I 1I�IIGIIII[I1 'I., .., �; Liu LI l DATE j, k FEEiAMOUNT LL Authorization to Construct (Repair) Fee 05/25/2016 $300.00 Well Abaandonment Fee 06/14/2016 $100.00 �t, ����III�dIO� 111,0IIlIit1 �I111.-.. FS �� J,���fIII�Wlo1lrl @iu`, IdII1!'ll���«il��lijlt mJIiIIlE. tm6l1l114. ,mnit�i�������$400 00:",t. I,Iq,. it ii 1� , I I�', ,i4i ii o w It' WI J 1 1 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) NY-ehapplicut inn 06/14/2016 11:31 Page 2 of 12 y,A • CATAWBA COUNTY •ci 100A SOUTHWEST BLVD ���ill y NEWTON,NORTH CAROLINA 28658 RECEIPT d r rir W H PHONE: 828.465.8399 _/_,8 jv9/ C Thursday, June 16, 2016 w. 42 sM www.catawbacountync.gov PAYOR: Xiong, Chue PAYMENTS TRANSACTION NUMBER: TRC-692919-16-06-2016 PAYMENT DATE : 06/16/2016 PAYMENT TYPE: Check 3069 INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329504 Well Abandonment Fee $100.00 TOTAL PAYMENTS : S100.00 EHPR-05-2016-23951 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1939 E NC 10 HWY,NEWTON NC 28658 Applicant CHUE XIONG, 5311 BIRCHLEAF LN, CLAREMONT NC 28610 C:8282347704 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner PACHI XIONG, 1939 E NC 10 HWY,NEWTON NC 28658 C:8284482093 receipt 06/16/2016 09:41 Page 1 of 1 YA O THIS IS NOT APERMIT Case # EHPR-05-2016-23951 < cnnr GI CATAWBA COUNTY HEALTH DEPARTMENT rI v u� jo j PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 1842 sM Environmental Health Plan Review - Septic Malfunction tioo + P AUTH_CONST- SEPTIC_MALFUNCTION '• o n• D o w Applicant CHUE XIONG, 5311 BIRCI-ILEAF LN, CLAREMONT NC 28610 C:8282347704 Owner PACHI XIONG, 1939 E NC 10 HWY, NEWTON NC 28658 C:8284482093 NAME TO APPEAR ON PERMIT Pachi Xiong SITE ADDRESS: 1939 E NC 10 HWY,NEWTON NC 28658 PIN # 374016932160 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 14,374.80 Acres 0.33 DIRECTIONS: Hwy 10 East, House is on the corner of Hwy 10 East& Caleb Setzer Road, Once you turn on Caleb Setzer Rd the driveway is on the Right. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage surfacing over septic tank. Open Violation: EH-04-2016-5972. 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, Chicken House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 40x45 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 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: I`)-ehappl ical ion 05/25/2016 13:44 Page 1 of 7 p CATAWBA COUNTY Case# EHPR-05-2016-23951 (e vim '2 Public Health Department Subdivision !CJ K.\:::::-.0-.Z : �w ,H�, Environmental Health Division PIN# 374016932160 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 842 m NAME ON PERMIT: ( PACHI XIONG), 1939 E NC 10 HWY, NEWTON NC 28658 ( Pachi Xiong) Site Address: 1939 E NC 10 HWY,NEWTON NC 28658 Property Size: Square Feet 14,374.80 Acres 0.33 Directions: Hwy 10 East, House is on the corner of Hwy 10 East& Caleb Setzer Road, Once you turn on Caleb Setzer Rd the driveway is on the Right. 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 accessi le so that a complete site evaluation can be performed. Date: 5—?S— 1. Signature of Applicant or Agent �/�,t,t,ut ' An Environmental Health Specialist will contact you within 5 working days of application date. If you need further information or assistance please call 828-466-7291 AREA1 "Jr�IFEC�NAME 1� �llul ` .i,l; ' Ili i I�iiLlil�ISiLlt'J.1 w} I�� 'ti DIATE'i ���FEE�MOUNwT�IL Authorization to Construct(Repair) Fee 05/25/2016 $300.00 6tg.I1I II' yliCl IT •j�'TOTA"LFE_ESI;����d�l{1r��IIIIii(11111�i�Glli����ITIl �l�lll���1111111111nt�l : 4g11111III1 ' ii1111ttlti �lti������t�F;t ;.S30000. Vii; tiim' i ill sum.-}=-NtvitaNnutuNa',SNOT&NHf NNWk`JmaJlLIDiIIIIIIWIIG•' • 11411tH UUilI...J.ltIWY R.Mi1y5J,IiIP11If11 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-ehapplication 05/25/2016 13:44 Page 2 of 7 CAMV ' IA THIS IS NOT A PERMIT COUNTY ...--- •C�. CATAWBA COUNTY HEALTH DEPARTMENT "°° Application for Environmental Services Page 1 Improvement Permit n Authorization to Construct❑ Septic Repair in Septic Malfunction' Septic Expansion Li New Well Permit L Replacement Well ❑ Well Abandonment I I / ` Well Repair E Existing System Inspection (Pre-Approval Required) n Application is for New Construction ❑ Existing Facility Property Address i°1 3ct E f\6- l D \W `( Subdivision 4 (\JeiAr-pYl O XL,5j8 Lot Pi Acres Section/Block/Phase Driving Directions to Property a -e_ N c _ w• eGk_ k- -jam I\ c r '/1.5 Qn V • - _ ( WC. u. r -c 0a_• _ E NAME TO APPEAR ON PERMIT? ErOwner ❑ Applicant I I Contractor Applicant Contact Information Name C,In u e X j o in Gmf Address t 311 1'S€6,2kLrat r- Lvt Phone I Cell Phone $ ?S - - _1- g7De-1 Owner Contact Information L Name 6)Gh Li. (` \ )ne) j��W�r� 1�C `�� t Address (G� �c( E N G. 1 o 'I�wc_i I Phone I Cell Phone S 2 - 4/4 8 - -2 O r9 .3 Contractor Contact Information Name Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT?'C- owner "Applicant ❑ Contractor Description of Existing Structures on Site # of Bedrooms *j' '3 Structure Dimensions #of Occupants 4 Basement n Yes E/No Basement Fixtures ® Yes 9A No 'ice 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. 0 Yes I Does the site contain any jurisdictional wetlands? Yes �!! Does the site contain any existing wastewater systems? O Yes C8 N Is any wastewater going to be generated on the site other than domestic sewage? fa Yes 'f o Is the site subject to approval by any other public agency? O Yes o Are there any easements or right of ways on this property? Describe Existing water supply in use Individual Well ❑ Community Well ❑ Semi-Public ell n 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) V ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other y Any CATA \ t, I ,Q THIS IS NOT A PERMIT cx s i L�1 �.Cll_ CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type Primary Residence n New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement Yes ❑ No Basement Fixtures 10 Yes D No I I Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling n Yes ❑ No } Plumbing ❑ Yes ❑ No Describe Plumbing Needed I Multi-Family Residence#Units #Bedrooms per Unit*t Total# Bedrooms *1. Structure Dimensions F I Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) # Employees per Shift #of Shifts Dining Area(Sq. Ft.) U Business Specific Type of Business- Retail Floor Space # of Employees per Shift # of Shifts ❑ Other Facility Type Specify If Church# of Seats Kitchen ❑ Yes n No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type n Individual Well n Semi-Public Well ❑ Community Well Abandonment Type n Drilled n Bored ❑ Dug n 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. 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. 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 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 corners and making the site accessible so that a complete site evaluation can be performed. Signature of Owner or Agent Date 5- Printed Name of Owner or Agent S , _ _ , rA Catawba County Environmental Health rzef 1 1, 4 ct151 226 E,NC•16'N 60 • I—� •1939 • N LV co t • • (4.5) Parcel: 374016932160, 1939 E NC 10 HWY 1in=50ft NEWTON, 28658 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 05/25/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 374016932160 Owner: XIONG PACHI Parcel Address: 1939 E NC 10 HWY Owner2: null City: NEWTON, 28658 Address: 5311 BIRCH LEAF LANE LRK(REID): 21912 Address2: null Deed Book/Page: 3213/1492 City: CLAREMONT Subdivision: null State/Zip: NC 28610-8051 Lots/Block: null/ null School Information: Last Sale: School District: COUNTY Plat Book/Page: Legal: null Elementary School: BALLS CREEK Middle School: MILL CREEK Calculated Acreage: .330 High School: BANDYS Tax Map: 021N 01022 School Map Township: NEWTON State Road #: 10 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: NEWTON County Fire District: NEWTON RURAL Zoningl: R-20 Building(s) Value: $60,200 Zoning2: null Land Value: $8,300 Zoning3: null Assessed Total Value: $68,500 Zoning Overlay: null Year Built/Remodeled: 1950/null 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 #: 3710374000J Building Details 2010 Census Block: 3059 WaterShed: null 2010 Census Tract: 011300 Voter Precinct: P22 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 an 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. ci S S - Si S1 http://gis.catawbacountync.gov/nomap/parcel_report.php?key=374016932160&typ=P 5/25/2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH COMPLAINT FORM �9lgov EH-04-2016-5972 /g42 sM SEPTIC COMPLAINT Complainant ANONYMOUS COMPLAINT, 100 SOUTHWEST BLVD A,NEWTON NC 28658 Violator XIONG PACHI, 5311 BIRCHLEAF LN, CLAREMONT NC 28610 SANITARIAN: Megen McBride PROPERTY ID#: 374016932160 STATUS : Sent to Legal CALLBACK: NO MEDICAL CONFIDENTIAL: NO STREET ADDRESS: 1939 E NC 10 HWY, NEWTON NC 28658 DIRECTIONS: Hwy 10 East, House is on the corner of Hwy 10 East&Caleb Setzer Road, Once you turn on Caleb Setzer Rd the driveway is on the Right. Septic Complaint Septic Complaint COMPLAINT: 1 VIOLATIONS: VIOLATION DESC: Caller stated that their septic tank is uncovered&has been for a few months. Turning in off Hwy 10 the tank is by the road before the driveway on the Right. DUEDATE VIOLATION DATE ENDDATE DATE RECEIVED: 04/07/2016 PRELIMINARY DATE : 04/08/2016 CLOSED DATE: EXTENSION DATE: ACTIVITY DATE NAME COMMENTS Code Activities 04/11/2016 Notice of Violation letter MM INSPECTION# STATUS TYPE COMPLETED Septic Complaint EHINSP-321917 Failed EH First Inspection Megen McBride 04/08/2016 04/11/2016 No one was at home to talk to. Could clearly see sewage on ground over tank from driveway or road. Will send NOV. EHINSP-325293 Failed EH Complaint Investigation Megen McBride 05/13/2016 05/16/2016 Made site visit. Sewage still surfacing over septic tank. To date have not received application for repair or any correspondence from owner. Will refer to legal rehcomplaintform 05/25/2016 13:27 Page I of I 4'A --c--- ) CATAWBA COUNTY : a $ �a ION, SOUTFIWEST BLVD RECEIPT NEWTON, NORTH CAROLINA 28658 Q' pn cr v , eaPm� PHONE: 828.465.8399 C3 ea "',;°WY C Wednesday, May 25, 2016 -1842 SM www.catawbacountync.gov PAYOR: Xiong, Chue PAYMENTS TRANSACTION NUMBER: TRC-679126-25-05-2016 PAYMENT DATE : 05/25/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328732 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : 5300.00 EHPR-05-2016-23951 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1939 E NC 10 HWY, NEWTON NC 28658 Applicant CHUE XIONG, 5311 BIRCI-ILEAF LN,CLAREMONT NC 28610 C:8282347704 **NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner PACHI XIONG, 1939 E NC 10 HWY, NEWTON NC 28658 0:8284482093 receipt 05/25/2016 13:44 Page 1 of I