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HomeMy WebLinkAboutEHPR-03-2016-23299.TIF -St$A • THIS IS NOT A PERMIT Case # EHPR-03-2016-23299 F d_ y - CATAWBA COUNTY HEALTH DEPARTMENT 0 Y io•1•% • 1 0 PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES rir 1n era 842 s+ Environmental Health Plan Review - Septic Malfunction 4oy o r AUTH CONST- SEPTIC_MALFUNCTION . o�a Owner KIATHAO, 1484 WIIITEOAK DR,NEWTON NC28658 �` C:9805857523 NAME TO APPEAR ON PERMIT Kia Thao SITE ADDRESS: 1484 WHITE OAK DR, NEWTON NC 28658 PIN # 373005172854 NAME of SUBDIVISION: 3 OAKS DEVELOPMENT Lot 1-9&ADJ Section/Block A PROPERTY SIZE: Square Feet 39,204.00 Acres 0.9 DIRECTIONS: Old Conover Startown Rd, Left onto Settlemyre Bridge Rd, Left onto White Oak Dr, Brick house on the corner PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage is 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: House OTHER DESCRIPTION: DESCRIPTION OF House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: 79x46 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 identification and labeling of all property lines and corners and making the site accessible sot at a com lete site evaluation can be performed. Date: :5-3—Ilo Signature of Applicant or Agent • 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 AREA2 E9-ehapplication 03/02/2016 09:48 Page 1 of 7 ,1e • CATAWBA COUNTY Case n EHPR-03-2016-23299 R'4.�.� a Public Health Department Subdivision 3 OAKS DEVELOPMENT =- * ,�, Environmental Health Division PIN# 373005172854 sr®; PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 6842 x‘i NAME ON PERMIT: (KIA THAO), 1484 WHITE OAK DR, NEWTON NC 28658 ( Kia Thao) Site Address: 1484 WHITE OAK DR, NEWTON NC 28658 Property Size: Square Feet 39,204.00 Acres 0.9 Directions: Old Conover Startown Rd, Left onto Settlemyre Bridge Rd, Left onto White Oak Dr, Brick house on the corner Prrate a= _"`z.:c a v n�w P a rara nt:-ian g r`d9vis :c v xNA1G.y,_ m1 r ,c i uFFFNAMEZ' n�� M r .t a,le=r��.�..,L��e r ,5r°_ttuf&t DATE .wso-FEE AMOUNT 4M Authorization to Construct(Repair) Fee 03/02/2016 $300.00 1111 . .TOTAEFEES ''i�.1gi1'1�€ `'y . 8'',v '' c 0;.�% LJ ".,$300 001 ��t"AW, v: j8 fit i + 3� cis St�ri'� :3 a� �h`� ti tt ; ..5 .g... 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EZNIi MEs,w7„c ,h11..1£0,v{..a: 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 03/02/2016 09:48 Page 2 of 7 C4TAVT THIS IS NOT A PERMIT cou NT Y' _ CATAWBA CO❑®TTY HEALTH DEPARTMENT �wr. ,,,,,;;o 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 (Pit-Approval Required) ❑ A Application is for New Construction ❑ Existing Facility DroPer j' d // Address / 7n y sill ie0a e v v 1✓- - Subdivision ,Ul.a40/ti Lot# ` Acres i Section/Block/Phase j Driving Directions to Property �A ale w UzX 1nJ� Q � D� Coro �, Dick S ''f 6/0 V �o '-- ` by ti.l l i v�oeck_ ID r l s Just- r o' S<--I 1- o h,✓Je r n etoc Rc7cd NAME TO APPEAR ON PERMIT?XOwner ❑ Applicant ❑ Contractor 1 Applicant Contact Information Name /ILL L I k to Address 1'-+-S4 1A611 i 1c D&k 13nV-4.# Phone Cell Phone el St - St j- / 5 a 7) 4 Owner Contact Information /1` Name 4/AA- L MAW Address 1'-{g'-j 1111,1}e- (7at k 7)n v e— Phone I Celt Phone cl St- 5 S--7 J a Contractor Contact Information Name Address Phone I Cell Phone WHO WILL BE THE PRIMARY CON ACT? gatmer ❑Applicant ❑ Contractor\ (w x( _Descrpt on of Existing Structures on Site of Bedrooms *j 5 Structure Dimensions' # of Occupants 5 Basement E. Yes No Basement Fixtures 0 Yes i�! 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_ i Yes P"'o Does the site contain any jurisdictional wetlands? Ayes To Does the site contain any existing wastewater systems? TJ Yes I No Is any wastewater going to be generated on the site other than domestic sewage? 0 Yes ' No Is the site subject to approval by any other public agency? D Yes Ni To Are there any easements or right of ways on this property? Describe Existing water supply in use V Individual Well Li Community Well ❑ Semi-Public Well ❑ County/City/Township Water Line Is a public water supply available? „s. [ 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) X/ 0 Accepted 0 Alternative 0 Conventional 0 Innovative 0 Other ■ Any r-°'� THIS IS NOT A PERMIT • a.-�t�;tir3 CATA�YBA COUNTY HEALTH DEPARTII'IEi�TT — 4t13 �n , Application for Environmental Services Page 2 • Proposed Facility Type E Primary Residence ❑ New Residence n Addition to Residence #of New Bedrooms *t Project Description Structure Dimensions #of Occupants Basement ❑ Yes ❑ No Basement Fixtures 0 Yes a No Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling Yes _ No Plumbing ❑ Yes 0 N Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*j' Total#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.) 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 ❑ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well 7 Semi-Public Well ❑ Community Well Abandonment Type ❑ Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested n Yes ❑No Describe Calculated Design Flow, Commercial j 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 applicafions.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 maybe revoked if the information on this application, site plans dr 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 rates. I understand that I am solely responsible for the proper identification and labeling of all propertylines and comers and making the site accessible so that a complete site evaluation can be performed. Sic mature of Owner or Agen. Date .5-9-- I La Printed Name of Owner or Agent `&- LLD Catawba County Environmental Health 306.92 Se1T M . ° L� YI{F ie ftroG R 1 1 26... I I I (179) --._ 4. .,I (176) ' I I 1 v I I I I • a I I I 1- I i f 441 L iit \--I's-\1/4\4 -2 . _ T \\\150.•e ir 9 N-%,,- - - - - - \ Parcel: 373005172854, 1484 WHITE OAK DR 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 03/02/2016 Parcel Report Page I of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373005172854 Owner: THAO KIA Parcel Address: 1484 WHITE OAK DR Owner2: City: NEWTON, 28658 Address: 1484 WHITE OAK DR LRK(REID): 25616 Address2: Deed Book/Page: 3172/1515 City: NEWTON Subdivision: 3 OAKS DEVELOPMENT State/Zip: NC 28658-8360 Lots/Block: 1-9 & ADJ/A Last Sale: School Information: Plat Book/Page: 10/86 School District: COUNTY Legal: LOT 1-9 & ADJ THREE OAKS PL 10-86 Elementary School: STARTOWN Calculated Acreage: .900 Middle School: MAIDEN Tax Map: 027N 01021 High School: MAIDEN Township: NEWTON School Map State Road #: 1243 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: NEWTON County Fire District: NEWTON RURAL Zoningl: R-20A Building(s) Value: $98,400 Zoning2: Land Value: $13,900 Zoning3: Assessed Total Value: $112,300 Zoning Overlay: Year Built/Remodeled: 1960/ Small Area: Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710373000J Building Details 2010 Census Block: 2001 WaterShed: 2010 Census Tract: 011701 Voter Precinct: P40 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages.loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2015, Catawba County Government, North Carolina. All rights reserved. L. )\N kr S 1 S1lli� l l j auk. wo\kot:(7 RH tion Lan [Tc http://gis.cata countync.gov/nomap/parcel_report.php?key=3730051728548ayp—P 3/2/2016 / n r , 4 :lam` DI Q . Z i A ~ v 2,do ri V C• W v C u22 k r b 3F1 O O G W r tl a .� a c en ev Q c O o �} Ct 1 O . G g F+ .0 ct3 z ° 50 a 0 u—; ` o a M Q o W r z c O \_ a ;� a hi X j z W .� 4 •u C"' 4. = Z a V A r] frk v c0. F. y ts, d F Vl t/7 V2 V +a i p w tr 22 m O '.�. a u cES �' d ¢ Q � ; x of Z a �" '� 0 r y -y X V \ J H O Q 2 0:1 0 V \ d \An ZO O 6. h V ' V = �. . 1 t‘� .I V w \ 27.1 1 v �\ Y ' CZ ? d. h1 `�Y vim, N �' .�.- —....-....t�- Z •■ w 3 d''� i w r'' 'M E a t\:\c-s? - y <a4 C.) E U, 0 . \ x -co x O w cp z4 w a, cp o ct [t. m 4+ -44 ti g c o of " "711 ce5 ff, p$ v F_ . _ . • . , • CATAWBA COUNTY HEALTH DEPARTMEN7�'JOwi vz—a613u ' Telephone: (828)465-8270 TDD: (828)465-8200 �/ IP AC Rpr. Pr'i. Opr. Prmt. Sys Type Well Prmt. Replacement Well A Well Rpr. Prmt. Owneant' Phone Address Subdivision . •degL{bet, . Section/B o Ph.se •t# /-7 . e P' ect.ens: .fl a SS WelitesaIN7-// .t6O* Lv•* Property Ad.Eess of/ i w' Oq4 Dr- Facility: House X Mobile Home Business Multi-family . Other: Pin Number . I — —_a Other .0 . Zoning Approval# ' M Bedrooms 3 k Seats k Employees . Application Rate _GPD Flow Hot Tub or Spa yes/no Special Fixtures Basement yes/no . 100% Repair Area yes/no Basement Plumbing yes/no Water Supply: Private Well Public Semi-Public Type of Syst:, : Trenc. Bed • • . Pump/Pan- Panel LPP _ Other Septic Tank ize i Pump T. : ize trifica• on Field: Total S... e Fe-t - D••th f Stone Bed Size _Trench W +t 'otal Length of All Trenc. Numb of Trem es . SS IIIII Trench -th_/_ / / / enter . . um Trench Depth Distance of Nearest Well *DO NOT INSTALL SE• WHEN WET* *WELL RECORD REQUIRED AT COMPLETION* *************************************************************************************************************************** Topo % Slope Texture �( Structure I i\ ,q to Clay Min. LJ �y Soil Wetness .. • C 11 Soil Depth 54' ,� OC\ Restric. Hoz. at - • - Available space yes/no IZb Overall Class S PS U I1 / Comments: ���^� / t 0[t ( e . , . , ...,, , . . . . . . ,, ,oti sr\ A �,ftt 75 C J • :71 . 4.2.7), . q.,_., ....0/ Filter Required I _L- Riser required when (AuVt' "✓ tank is more than 6 9 1/Z C r inches deep. V . "NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM (1.1.y WILL FUNCTION** *************************************************************************************************************************** *Improvement Permit has.no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for(5) five years froth date issued and is not transferable. Well Permit valid for 5 years provided site conditions do not change. Well location, installation, and protection must meet state and local regulations, and must be `� inspected and approved by a representative of the Catawba County Health Department before any portion of the installation is put into use. The siting of the well by the Health Department staff is to provide protection from known possible sources of contamination. No volume of g+ water is guaranteed a%agY ite by the Health Department. �� T Permit Date , ( "5 'OZ EHS ate. I- _ /� r Owner/Agent ��. u - Septic { .dig . ri al Date EHS :�' 'Well Installed By ;A�j tr r/ . . 9 Well Grout Approval Date Cc/0-02f Well Head Approval Date Date Sample Collected r, Date of Results Results EHS White-Office Yellow-Owner/Agent Pink-Building Inspection Authorization to Construct ys�'A CATAWBA COUNTY i�"if. 4 �� 100A SOUTHWEST BLVD _ _ NEWTON,NORTH CAROLINA 28658 RECEIPT ►. PHONE: 828.465.8399 v T tea►;' Wednesday, March 2, 2016 184'1 sM www.catawbacountync.gov PAYOR: Thao, Kia PAYMENTS TRANSACTION NUMBER: TRC-630253-02-03-2016 PAYMENT DATE : 03/02/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 03-16-325756 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-03-2016-23299 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 1484 WHITE OAK DR, NEWTON NC 28658 Owner KIATHAO. 1484 WHITE OAK DR. NEWTON NC 28658 C:9805857523 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 03/02/2016 09:48 Page 1 of 1