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HomeMy WebLinkAboutEHPR-04-2016-23651.TIF ,g,A •G THIS IS NOT A PERMIT Case # EHPR-04-2016-23651 Qr' CATAWBA COUNTY HEALTH DEPARTMENT U •• �,o•• 0 v "p PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES �7 ' /842 sM Environmental Health Plan Review - OSWP `ro, �o I T IMPROVEMENT o M E ,iA j se-A MainfflWr Ai TA Applicant YER YANG, P.O. BOX 1398, CONOVER NC 28613 C:8282448402 Owner HAZEL BURGESS, 673 OLD HARON RD, DALLAS NC 28034 NAME TO APPEAR ON PERMIT YER YANG SITE ADDRESS: 3241 LEDFORD RD, VALE NC 28168 PIN # 269701293889 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 710,028.00 Acres 16.3 DIRECTIONS: Hwy 127 North, Plateau Rd, Left onto Lefford Rd, Property is on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY. 360 WATER SUPPLY: Private Well DESCRIBE WOR : Revised 5/11/16- Received New Plat of Proposed change in prop- r • -s. Has not been recorded*) IP for Purchase* There was an old septic on the property. Wanting to install a complete new system. No Old Wells on the property. 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40x60 #OF NEW BEDROOMS:: 3 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: LE)-eh:pplication 05/11/2016 11:34 Page 1 of4 vF�A \ CATAWBA COUNTY Case# EHPR-04-20 1 6-2365 1 _¢' ni Public Health Department Subdivision Q t 4 Environmental Health Division PIN# 269701293889 'DPI PO Box 389. 100-A Southwest Blvd,Newton, NC 28658 18�2� NAME ON PERMIT: (YER YANG), P.O. BOX 1398, CONOVER NC 28613 ( YER YANG) Site Address: 3241 LEDFORD RD, VALE NC 28168 Property Size: Square Feet 710,028.00 Acres 16.3 Directions: Hwy 127 North, Plateau Rd, Left onto Lefford Rd, Property is on the Left. 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. Date: 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 I I 1� E I' ' ldy ∎ i r ii E OMFEENAME1 ig1+ �'nra , il. l ill pii 0DAT iiiliyE UNT Improvement Permit Fee 04/14/2016 $150.00 Hrrliti 111TOTAL FS i, T I1�11 Ill1 li IIi 1Ilii lili lhi 11 r u!1l1i8li 111 4 u$lso oo m I) 4 .I �- ' IWL iiip-;: 1, ia11L ldil. il11311 1W16_, wdII ai 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 05/11/2016 11:34 Page 2 of 4 y o ` tKrill tl it ` s3 i • ° p o Fo 6"-�8 1 0' ,j 1� s'e ' a: - Q 0, 4 4a`m'I 1„ 1.7 °�i 9i u4.n. ..ii. ♦ .A ° .r ✓ \�• i' �. 0Om U \ t,i NZ F c h C y C V 2 03 _ mI �/ 09 Boa =�e 6 �r_ °" _�9d0y a N '&_ 61 09 J59 p91190 l ' 99U 971 P h 3 Sem 1946 V t 2 3 �� _ ,_ Cl CO N OLD o ° 1 ;J ° O z s 9S } a va .,..-:”...0, � Yk'� Cc r 2 c n� o� col Y a 5 b frl to 10 N O 8 o c., N' Z ¢ � Yd ,),".4 S 00•¢'45'E 265A9'� 3 S 0➢'12'a5'[ 227.73' z 1 V:. / 0 m q, 'p ` = o c,,ON °.u,.,, ym Y V m�4,II Y 0 el b p "u , � a ::::6 � o^ y�}� C� ' 02oV °I e m= h CIN o ^ 0 � n b �V1 ' O vry N VQrc 0ry w ;ry. 0° y m o°2 O : g 3 m mt= �` mo� oh I" me m' M Cio - G ° qh ,~ � . � Nh z""° o 1 pQ ¢Q Ue4 Qb o4 ° V 1 S CO b o ° 4 N h o n ``Cr v N° 4$ ^ ~ p�bp at; ■ i`,mm No'O �' ery _ �hMaQ g• crn 1V9.1 ", tp oa Nh ccmQ4 t r^ ¢ 1 iry am° m4°^r� omm ■ 2a k a^ 1 ch c yR m0 2 b 226.98' 2 104 97' 6 ur a h N N 00.23'531W N 00n5'2211./ 121 " y 81 ss e 7P J ryry 9 �-,,Y o}' E0 n nnxm `03.85' 95629 3.80,82.E0 N E�3 9 N I r 85' 41 4 p Occa 9'ci �" 2m E m 6 e El mm .3i J F n gy 7 1 X03 S /5' a t1'E _ € 5 4 cs^ B g a �`c5 g x 9 I 1g r $ 23 e.a""'� � s a fr'rE i E a sg x 9 E a tEEE �N i o 3 fuEs one t It-r... 5 4 F 6i y 9z " p y� E a il _° t c � y�y j _9 p,N. fil 7h s c flh1!�Id3t d�2 t rut 911 ,ib�i3.�Lh��. r`.�#'tea` / Ai ` ' ::- ,tom, '■∎ 2 cplz v 33o3 wycli A VC; q� c mo IRE. ro N N Q q 0 Or 111 ET • tn U �ii' °4mi mhg 40j D9 369 09 1190 0 ` co 0. 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H a i= 813 11/d3 it ''SON 1 d �„„ 0, 5 c :Y 1. ,a 88k3§ o�� ,CLO s� : THIS IS NOT A PERMIT Case # EHPR-04-20 1 6-23 65 1 Q15: y CATAWBA COUNTY HEALTH DEPARTMENT � '• �o v D C r f PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ,s 1842 5m Environmental Health Plan Review - OSWP ro �o IMPROVEMENT 0,� •ik• Applicant YER YANG, P.O. BOX 1398, CONOVER NC 28613 C:8282448402 Owner HAZEL BURGESS, 673 OLD BARON RD, DALLAS NC 28034 NAME TO APPEAR ON PERMIT YER YANG SITE ADDRESS: 3241 LEDFORD RD, VALE NC 28168 PIN # 269701293889 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 710,028.00 Acres 16.3 DIRECTIONS: Hwy 127 North, Plateau Rd, Left onto Lefford Rd, Property is on the Left. PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: IP for Purchase" There was an old septic on the property. Wanting to install a complete new system. No Old Wells on the property. 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: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF Vacant Lot EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 40x60 #OF NEW BEDROOMS:: 3 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: 19-ehappl Icatlnn 04/14/2016 11:38 Page 1 o14 ,viA •• CATAWBA COUNTY Case a EI-IPR-04-2016-2.1651 :-I n ,y Public Health Department Subdivision Igot 4 Environmental Health Division PIN# 269701293889 \-.., I PO Box 389, 100-A Southwest Blvd,Newton, NC 28658 1g42 ,w NAME ON PERMIT: (YER YANG), P.O. BOX 1398, CONOVER NC 28613 ( YER YANG) Site Address: 3241 LEDFORD RD, VALE NC 28168 Property Size: Square Feet 710,028.00 Acres 16.3 Directions: Hwy 127 North, Plateau Rd, Left onto Lefford Rd, Property is on the Left. 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 an labeling( n (2 of II property lines and corners and making the site accessible so that a co plete site valuation can be performed. Date: / (4 �,- Signature of Applicant or Agent 6 s An Environmental Health Specialist will contact you within 5 work ng days application date. If you need further information or assistance please call 828-466-7291 AREA2 **************44444**44***44****************44***************4***4444****************4*****4*************44* IR miniip1Ik lj�llj1 1 llii�liT'1iit?, r1H1111li r I1�rip1irtiq ,lam !''Hirt', jP. AMOUNT �J .'1 t ae V;gi kid�hli l{d���.r� �SIV> I Improvement Permit Fee 04/14/2016 $150.00 I, 10111'1I Ij,fTOTAL'EEESrII�ll!if�lliii�i!L�i'lilliii�7.1 !I�il1 l hn '11!16 !If 11111S150 00 "'' lI I ! �I��I{i�l i�� 1�. of ii I ii 1 1, II s�i ik,�lu ICL4nA aliathi illthi11 W1WuLJtillintit '4 hlild;.huJi• 6111.;.16M-JIIIIIIIII ,6 tiatl 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) 1:9-ehapplication 04/14/2016 11:38 Page 2 of 4 rrA\VBA THIS IS NOT A PERMIT COUNTY � aL CATAWBA COUNTY HEALTH DEPARTMENT .,� .—� Application for Environmental Services Page 1 Improvement Permi Authorization to Construct n Septic Repair n Septic Malfunction ❑ Septic Expan ion n New Well Permit ❑ Replacement Well n Well Abandonment n Well Repair ❑ Existing System Inspectiion ((Pre-Approval Required) n 2 Application is for ONew Construction Existing Facility n Property Address 3 I /;e) f OrOI �✓ Subdivision VMQ1 NC° 3-k /to k Lot# Acres /(p. '3 Section/Block/Phase } Driving Directions to Property u [ ) 7 n0 V'ln "CU 7�+ owy ) 1(Ar✓1 /mil LP'1-I NAME TO APPEAR ON PERMIT? n Owner )pplicant n Contractor Applicant Contact Information Name Nje{ \I ct.,4c Address 70 p� 13*c( 0,,&tOV`€rl NL �(9t3 Phone j Cell Phone Ces� -_ a-4 L(— 6)_ Owner Contact Information y Name ttdrt PLh � � GC""Z� t( 5t \ \k nm` tr"(- Address .•3, 4{31 j_ccii-U`rc1 vrv�P NuL r h l coK Phone 1 Cell Phone Contractor Contact Information Name License # Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? ❑ Owner Applicant n Contractor Description of Existing Structures on Site V O LO,., _ 0 SA-3 ifeer 1C,t # of Bedrooms *t Structure Dimensions of OccuVpaann Is_l Basement ❑ Yes No Basement Fixtures ❑ Yes No The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in in question. If the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes ( io Does the site contain any jurisdictional wetlands? Yes No Does the site contain any existing wastewater systems? ❑ Yes FINo Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes VNo Is the site subject to approval by any other public agency? ❑ Yes Igq No Are there any easements or right of ways on this property? Describe Existing water supply in use n Individual Well –1 Community Well n 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) J ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative 111 Other Kr Any cATAkx m A THIS IS NOT A PERMIT COUNTY . 1":1--f-z4,1- CATAWBA COUNTY HEALTH DEPARTMENT „a„b�,,,,-,, Application for Environmental Services Page 2 Proposed Facility Type Primary, Residence ❑ New Residence n Addition to Residence # of New Bedrooms *t 3 Project Description 6;it 4: Z I[ b vu t, /fir{/4e G.�uuT I GU' /h)0 5 fl ; 3/0c() ;18474. Structure Dimensions ; ??%;oG:;; e; !� iQ #of Occupants Basement ❑ Yes A] No Basement Fixtures ❑ Yes No Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling ❑ Yes n No Plumbing n Yes ❑ No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t 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.) ❑ 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 IT Individual Well n Semi-Public Well Community Well Abandonment Type n Drilled ❑ 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. 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. W. Signature of Owner or Agent f �� Date 4- 1 ,0 it d l uo Printed Name of Owner or Agent e r tot Iq Catawba County Environmental Health V i ) • 53 42 (3p3�300 C:"./ C:7:3 ..:, ss \ lb e A1,,` \ ■,,,,,* ¶4? 1 \4 ° CC X675 0 in 0 1080 .. . . .__ 085 W a (775 Parcel: 269701293889, 3241 LEDFORD RD 1in=80ft VALE, 28168 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 04/14/2016 Catawba County Environmental Health .._, E 1 \ I lig 201.a t 200.00 195.16 Mei g.k. Is .. .t�` 390.t e , `201, (t 351 sfi/ 726.81 _ .‘141111 3IN is 346'1 • 1111 s 4, 159.99 '12000 o vl r 11—s 8 m\\/ is 0 Q N M . rQ 873 r. Q rr.1 73 N �7� PoJ ss O 19800 196.7J' O 7060 h & \ rrQ B f3 'I 70, la‘ al 8 1 T075 o i v-,� Parcel: 269701293889, 3241 LEDFORD RD 1in=150ft VALE, 28168 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 04/14/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 269701293889 Owner: BURGESS HAZEL SETTLEMYRE VAP Parcel Address: 3241 LEDFORD RD TRUST U/A/D City: VALE, 28168 Owner2: COOK DELORES BURGESS LRK(REID): 8632 TRUSTEE Deed Book/Page: 3276/1501 Address: 673 OLD HARDIN RD Subdivision: null Address2: null Lots/Block: null/ null City: DALLAS Last Sale: State/Zip: NC 28034-7568 Plat Book/Page: School Information: Legal: null School District: COUNTY Calculated Acreage: 16.300 Tax Map: 009 B 05029 Elementary School: BANOAK Middle School: JACOBS FORK Township: BANDYS State Road #: 2041 High School: FRED T FOARD School Map TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: PROPST Zoningl: R-40 Building(s) Value: $0 Zoning2: null Land Value: $63,800 Zoning3: null Assessed Total Value: $63,800 Zoning Overlay: DWMH-O Year Built/Remodeled: null/null Small Area: PLATEAU Current Tax Bill Split Zoning Districts: null/null Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: null Building Details 2010 Census Block: 3015 WaterShed: null 2010 Census Tract: 011802 Voter Precinct: P2 Agricultural District: PROXIMITY Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise tram this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All r 2& 4 s reserved. 3 Jfl (O` or\ n *- -kPurkolier IkTd- NCO cn l'ir\a (\i)R-Perjul _ http://gis.catawbacountync.gov/nomap/parcel_report.php?key=269701293889&typ=P 4/14/2016 gA C CATAWBA COUNTY I-77 a )2s, IOOA SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT jra PHONE: 828.465.8399 Thursday, April 14, 2016 V .e.,gdp� � 1$[}2 sm www.catawbacountync.gov PAYOR: YANG, YER PAYMENTS TRANSACTION NUMBER: TRC-655099-14-04-2016 PAYMENT DATE : 04/14/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 04-16-327222 Improvement Permit Fee $150.00 TOTAL PAYMENTS : $150.00 EHPR-04-20 1 6-23 65 1 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 3241 LEDFORD RD, VALE NC 28168 Applicant YER YANG, P.O. BOX 1398, CONOVER NC 28613 C:8282448402 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Owner HAZEL BURGESS, 673 OLD BARON RD, DALLAS NC 28034 receipt 04/14/2016 11137 Page l of 1