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HomeMy WebLinkAboutEHPR-08-2016-24551 (2).TIF at3A or, THIS IS NOT A PERMIT Case # EHPR-08-2016-24551 CATAWBA COUNTY HEALTH DEPARTMENT . ' D v -'11 'C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES , ` F /842 Shy' Environmental Health Plan Review - OSWPD ad; t • IN 4 • REPLACE WELL 0.:, ' ti• . Applicant XIA VUE, 3630 ROCKY FORD RD, NEWTON NC 28658 C:828-217-9971 NAME TO APPEAR ON PERMIT Xia Vue SITE ADDRESS: 3630 ROCKY FORD RD, NEWTON NC 28658 PIN # 361812756216 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 212,137.20 Acres 4.870 DIRECTIONS: W NC 10, left Hickory Lincolnton Rd, left Rocky Ford Rd, approx 1/2 mile lot on left PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: "EMERGENGYAPP"current completely well dry 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 residence EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 60 x73 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 7 PROPOSED CONSTRUCTION Desired system types (Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: YES 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 ay�d labeli g of all property lines and corners and making the site accessible that a c m lete site evaluation can be performed. Date: ,� f��",��(�j Signature of Applicant or Agent / I- - An Environmental Health Specialist will contact you within working days of application date. If you need further information or assistance please call 828-466-7291 AREA2 hl-ehnpplint inn 08/22/2016 10:14 Page 1 of 4 r° CATH\VBA COUNTY Case a EHPR-08-2016-24551 ;Q' Ri: t G Public Health Department Subdivision < .11, Environmental Health Division PIN# �' �" t' 361812756216 f:7 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 r84%�� NAME ON PERMIT: ( XIA VUE), 3630 ROCKY FORD RD,NEWTON NC 28658 ( Xia Vue) Site Address: 3630 ROCKY FORD RD, NEWTON NC 28658 Property Size: Square Feet 212,137.20 Acres 4.870 Directions: W NC 10, left Hickory Lincolnton Rd, left Rocky Ford Rd, approx� 1/2 mile lot on left ' Il�iiW1I lll11G1 114116 h y+1V"yi,�1i��i111,1d l$'07v , 7 oit Ii i{���111{�i11 ti�� !. YliUT" IMPI PU1111 ,4 imI�P9 %FEENAMEl, 4�,,,,y0116,1lI ,, 14:� ;1,;II��,a;ihI��lililig DATEW�yth .EE EAMOUNT Well Permit& Inspection Fee 08/22/2016 $300.00 r m . 1 1!t IIr tTOTA LFEESt1: " Jnt+d , 1,I!,11;Ii m1gur 6.iri1nfItl$300 00��IIyiLi - ..Y".,.. ..,t'ut':,y(;9y ilialI! '",,i21211,:7., ,J no 1,I .,,, IF 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) 19-ehapplicatinn 08/22/2016 10:14 Page 2 of 4 CATAWBA THIS IS NOT A PERMIT conte tm CATAWBA COUNTY HEALTH DEPARTMENT Ne „o Application for Environmental Services61 Page 1 Improvement Permit E Authorization to Co�nnstr�J'ct 111 Septic Repair U Septic Malfunction E Septic Expansion ❑ New Well Permit P'Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility LJ Property Address 3(030 co C,kcj FO Od Subdivision N eU bV\) 1 r'3C a 2(D R Lot# Acres 5 S ectiol/BlocklPhase Driving Directions to Property NAME TO APPEAR ON PERMIT? ❑ Owner ❑ Applicant ❑ Contractor Applicant Contact Information Name Xl n \if Address 3(030 npoq Food �d NaDvuri ` C 9S (05x Phone Cell Phone 44 ' 7_4l W L?-- Owner Contact Information 9`17-1 Name XI/A V(AA Address R 0.sO p_OCk'y ReCL1261 e wlV�”, N( (..)Tp<X Phone Cell Phonet 32R ' (914— 99'1 Contractor Contact Information Name l-IC'Ory Lu-P11 DV( (. 9 an t teigiah ) Address Phone Cell Phone( ) _ — 0033_ WHO WILL BE THE PRIMARY CONTACT? 1./Owner ❑ Applicant ❑ Contractor Description of Existing Structuresl� on Site # of Bedrooms *j' 3 Structure Dimensions 6 14 7 3 # of Occupants 11 Basement ❑ Yes No Basement Fixtures a Yes RNo The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property irluestion. If the answer to any question is "yes", applicant must attach supporting documentation. ® xiso Does the site contain any jurisdictional wetlands? Yes Does the site contain any existing wastewater systems? C Yes :TrIs any wastewater going to be generated on the site other than domestic sewage? CI YesIs the site subject to approval by any other public agency? �! 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 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) 0 Accepted 0 Alternative ❑ Conventional 0 Innovative ❑ Other 0 Any C A STWA -BA THIS IS NOT A PERMIT coo vl 11� CATAWBA COUNTY HEALTH DEPARTMENT for or Environmental Services Page 2 Proposed Facility Type ❑ Primary Residence ❑ New Residence ❑ Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement ❑ Yes No Basement Fixtures n Yes a 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*j Total #Bedrooms *t Structure Dimensions —1 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 Cons action/Abandonment/Repair Proposed Well Type Individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored I I Dug ❑ Unknown Well Repair Requested ❑ Yes n 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. p Signature of Owner or Agent /GCS �� Date. 3/ / I Printed Name of Owner or Agent ./ Catawba County Environmental Health 40000por. -401 b \v 0 J ����L F"' 391.96 g9 Hrn A6� / 31) Parcel: 361812756216, 3630 ROCKY FORD RD 1 in=80ft 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 08/22/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 361812756216 Owner: YANG VANG Parcel Address: 3630 ROCKY FORD RD Owner2: VUE XIA City: NEWTON, 28658 Address: 3630 ROCKY FORD RD LRK(REID): 700542 Address2: Deed Book/Page: 2793/1206 City: NEWTON Subdivision: State/Zip: NC 28658-8855 Lots/Block: / Last Sale: $99,000 on 2006-11-09 School Information: Plat Book/Page: 48/142 School District: COUNTY Legal: PL 48-142 PL 48-142 Elementary School: BLACKBURN Middle School: JACOBS FORK Calculated Acreage: 4.870 Tax Map: High School: FRED T FOARD School Map Township: JACOBS FORK State Road #: 2019 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: 321-ED(I) Building(s) Value: $86,000 Zoning2: Land Value: $51,000 Zoning3: Assessed Total Value: $137,000 Zoning Overlay: ED-O Year Built/Remodeled: 1995/ Small Area: STARTOWN Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710361800J Building Details 2010 Census Block: 1011 WaterShed: 2010 Census Tract: 011702 Voter Precinct: P3 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=361812756216&typ=P 8/22/2016 8C ***Op. •Permit- and/or Cert. Op. Required_ (Must $e completed prior to final) • IVs - -- /{ ' ` t .CATAA COUNTY rHEALTH ,DEPARTMENT [( (704) 465-6270 y� - Lot -Eval. 11 Improve. Permit )(Repair Permit Cert. of Comp. Permit A Oper. Permit, Owner/Agent .(0�j L Phone 9 i t{ - ,3q�i Co Address :- ^Qp.3• . .jQvv.){i„cc.l u (-top Subdivision - - • iae1 • *ra1. I • !_ U Section/Block/Phase Lot# i - Lot Size -• . ^ . ` .•io rec ' ns:-. h- (0 ., Ar Y . C., 0 flak, ;(Prrl CETT . Si-sr Vie • the{t_ Facility: House Mobile Home )c Business . Other: Tax Map # 'f i' 3s ---I' -/ Multi-family . ' other . Zoning Approval # =.?-4Sn.396, Bedrooms 4e "Seats' Employees . Application Rate .c9'- n GPD;';Flow 'N O HotaTubor Spa yes/•s Special Fixtures 100% Repair Area..yes/no' “- REPAIR: NOTICE: Basement yes/re Basement Plumbing yes/no . REPAIRS MUST BE WITHIN 30 DAYS OR ' . Water Supply: Private k Public . DAYS FROM DATE OF PERMIT. Type of System: -Trench X Bed Pump / Pump/Panel Panel LPP_ Other A/ .Tank Size: Septic Tank tea° 4 Pump Tank Nitrification Field: Total Square Feet /ZOO Depth of Stone / L Bed Size rTrench�Width 3& ' Total Length of All Trenches yea Number of -Trendhes- ',Y ' n ' M 'InInt °'.„-,s t dy 5.1'!cg njf,)rIil S. i' ,4:11,-,.;',” � 'i ,;;;Indlvi�55dual Trenchi.Lngth/AO //00//et) /-/8./ Feet on Center MaxiMUI.Trench,4�Depth s i ,F nr +�-,al ruy iL Hi', 141 yir ' 't: wt i " S,is e' . . - b�y�'O''��,lt SrYi iSilv(f'(ii�f b�s'rn +iiC ntf, t " ,'Distance[of4Nerest i�Wel r '- V'o .'-•A4 Lot Evaluation 'Approved,/no (VoidreAfter')24fmonths) Pp nv� f, .n * ma r**rirww"sir,{ , F ei`11. tTopo'z °adrl tHiS1"ops Sketch of clot Evaluate on Site _ System Design Flnal� . +i1�ia a ''ij''4 .rrrrrwrraarrrra+rrrrrar+rrra+rrw*agerrwrar**+wrr+wwarawwwrararrr+*wa+wrrr+ter++arrrar 1, f, na r^ a,3w K � ! fi 0il:.0 e_s r ' ie Al�;, ,", . t r v p .3 d � xftf i t d 'i.7Texture �(4;1,f:y:98ili V. ;xl'+,T.rrai 'kv., p•,-. -„ cS. - . . ,e . Aetig-DO NOT.:-. � . .marc.= Cs - - INSTALL ` -Structure`t edv - (> WHEN WET i1r,4l1 , A ".1' :!..1-,-1,X.:^ iLi . M- IT; , j `Clay Mln.' • itI141,1 .-v!� • — 1,-., t s� ' ',(W� t' SoilWetness �.S " e '{,,,,,,m4„,..„,,,,,,,„:„,.,:...,,,, f4i;4• 3' lhG ih' ;,1 Soil Depth >Qk7 " `r'; 7,0 ' It 7iyi* r ,, V 1' 2 ((, p f • ,{�� ,Restrlc Hoz at �.-� L .: let e 7� lrw >ig? • ell, h r Available, space`at/ho to N" S I - Oderall:Class? catII Comments: -�`_,.e �' QM1 l�c1G i Tt�vt C C '4- \ `J V <� a\ • • Septic Tank Contractors MUST contact the Sanitarian BEFORE changing permit. 1 @a Fcit.e (ZC( y ' `• **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN THROUGH THh-ISSUANL. Oe ra b..,rSrt1°mi** , •• Permit Date Cat-, 7 a.- TS (Improvemen Permit v of - 0 montEs) Owner/Agent 1\ Q� !Irian ( / .--;/) . . Installed;By ,n•t�bcf r t ti.f'(.�(LN G-rt Date 7. /�'S Sanl tar n � ,-_Ai s'• 5• (Note any changes/information -in red or by sketch on back) , •, • IF A'PERMIT HAS TO BE REDESIGNED-AND/ORfRET;IPS MADE TOfrTHE PROPERTY,• THERE..IS AN*•.**•'* ADDITIONALf.$25 CHARGE. - - - While Office ;..,Blue-Building Inspection Completion Yellow-Owner/Agent Green-Building lnspecuon IP,,,"!,a t iac. f„• C p' CATAWBA COUNTY �-1 100A SOUTHWEST BLVD �������1� NEWTON,NORTH CAROLINA 28658 V►e PHONE: 828.465.8399 vaso Monday, August 22, 2016 +y'�4..842 SA1 WWW.CatawlJacount)'I1C.aOV PAYOR: Vue, Xia PAYMENTS TRANSACTION NUMBER: TRC-794506-22-08-2016 PAYMENT DATE : 08/22/2016 PAYMENT TYPE: Credit Card 170768869 INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331838 Well Permit& Inspection Fee $300.00 TOTAL PAYMENTS : 5300.00 EHPR-08-2016-24551 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3630 ROCKY FORD RD, NEWTON NC 28658 Applicant XIA VUE, 3630 ROCKY FORD RD, NEWTON NC 28658 C:828-217-9971 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/22/2016 10:10 Page 1 of 1