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HomeMy WebLinkAboutEHPR-05-2016-23896.TIF y�$A •� THIS IS NOT A PERMIT Case # EHPR-05-2016-23896 4 ,. a CATAWBA COUNTY HEALTH DEPARTMENT 0 TRIO. U "f ��pr C PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES ¢ ''r t J842 sM Environmental Health Plan Review - Septic Malfunction o o o AUTH CONST - SEPTIC MALFUNCTION ch ox Owner YOUA YANG, 1842 29TH ST NE, HICKORY NC 28601 H:8282563254 C:8283207781 HOME:8282563254 NAME TO APPEAR ON PERMIT Youa Vang SITE ADDRESS: 2774 E US 70 HWY, CONOVER NC 28613 PIN # 375220709202 NAME of SUBDIVISION: Lot# Section/Block_ PROPERTY SIZE: Square Feet 21,780.00 Acres 0.5 DIRECTIONS: From 1-40 Exit 135, Right onto North Oxford St, Right onto US Hwy 70, House is on the Right. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: Sewage is on the ground* This is a rental house. Open Violation - EH-02-2016-5908 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, Well House, Shed EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 62x32, Wel House 5x5, Shed 12x12 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 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: 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 1 am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a.�omplete site evaluation can be performed. Date: 5— 17— / Signature of Applicant or Agent c' -6 '� ,� Y An Environmental Health Specialist will contact you within 5 working days o-application date. If you need further information or assistance please call 828-466-7291 AREA2 E)-ehapplication 05/17/2016 16:51 Page 1 of 7 CATAWBA COUNTY Case# EHPR-05-2016-23896 t L Public Health Department Subdivision d n Z9 Environmental Health Division PIN# 375220709202 PO Box 389. 100-A Southwest Blvd,Newton.NC 28658 NAME ON PERMIT: (YOUA YANG), 1842 29TH ST NE, HICKORY NC 28601 ( Youa Vang) Site Address: 2774 E US 70 HWY, CONOVER NC 28613 Property Size: Square Feet 21,780.00 Acres 0.5 Directions: From 1-40 Exit 135, Right onto North Oxford St, Right onto US Hwy 70, House is on the Right. lorrp1>aa<, LEM1E i �I���� 9ir.._ 11�Ii i41±hllhilUij f I�i I ii�hll�l hR(�h, DATatRip. t�Ii�FIIEE^AMOUNT, IIIFEENAME 6u,11, flue y,11L,6V��1 I�ihu uilirul L.a, p iS`i Authorization to Construct (Repair) Fee 05/17/2016 5300.00 ! ii m �I�Tolmu PI FEES u�I:rIiii8II g.tf INII r':i� i lllgI iI�Iltlltml!lltm1f_ ,f'111�Hiuir �illllu llllu . 'IJi�'IVY I , 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) F9-ehapplication 05/17/2016 16:51 Page 2 o17 CATA\ ]BA THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT 19fCY� Noah C.volinn4' Application for Environmental Services Page 1/ Improvement Permit 111 Authorization to Construct❑ Septic Repair Septic Malfunction IXI Septic Expansion El New Well Permit n Replacement Well n Well Abandonment E \ Well Repair n Existing System Inspection (Pre-Approval Required) Application is for New Construction _ Existing Facility Property Address &')1 r 05110 Iu Subdivision eutArafrt r i N e Lot# Acres Section/Block/Phase NC Driving Directions to Property \ c e,: - y C ✓, >>f; I r r X111 C�� t, a1 OA- n" 4krIs \ 15 \\W't lU \uws.t c•.r • Vic t\V�'c NAME TO APPEAR ON PERMIT? Owner [ Applicant Contractor Applicant Contact Information Name Address Phone Cell Phone Owner Contact Information Name /,a XL. &"eL Va d\ Address /cLL2_ 7j �JJ, __42' ' e Phone (fl ) - 2`b_ 375' Cell Phone IF yv_ 51 Contractor Contact Information Name License# Address Phone Cell Phone WHO WILL BE THE PRIMARY CONTACT? Owner E Applicant ❑ Contractor yDescription of Existing Structures on Site `t;\ #of Bedrooms *j' Structure Dimensions .1.�)( 7 2 /t`ix 71# of Occupants y. �^ ^� Basement ❑ Yes ' No Basement Fixtures ❑ Yes ❑ No �IP,I I p"1 i w, � `lY � 1 '1 0(17- T 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 DiNo Does the site contain any jurisdictional wetlands? )(Yes ❑ No Does the site contain any existing wastewater systems? ❑ Yes To Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes 'No Is 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-Publt Well ❑ County/City/Township Water Line Is a public water supply available? ** AYes ❑ 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) 1/ ❑ Accepted ❑ Alternative ❑ Conventional ❑ Innovative ❑ Other Any cATAv BA THIS IS NOT A PERMIT COUNTY .+E tom` CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Page 2 Proposed Facility Type I I Primary Residence I I New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement Yes [ No Basement Fixtures I I Yes No ❑ Accessory Structure(s) Describe # of New Bedrooms *1- if applicable Structure Dimensions # of Occupants Accessory Dwelling n Yes n No Plumbing n Yes , No Describe Plumbing Needed ❑ Multi-Family Residence#Units #Bedrooms per Unit*t Total#Bedrooms *j 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 ❑ Yes _ No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type I Individual Well ❑ Semi-Public Well Community Well Abandonment Type n Drilled Bored ❑ Dug ❑ Unknown Well Repair Requested Li Yes IT 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 perforrmmeed. *Signature of Owner or Agent � 5 ^ Date 5- ( `7- 14 Printed Name of Owner or Agent T 0 t-. ��C VA-N C`1 Catawba County Environmental Health \\IIC‘i ..› N 129.08 m > 95 48.22 39 w l 8� � N • doi cc-, 1 1 1 1 I iq I 1 �� X I I D 1 N l N 1 a I 1 . 1 1 1 1 •27 I I I l 1 .03 no 10812 (110) EUS1° - - • Parcel: 375220709202, 2774 E US 70 HWY 1 in=50ft 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 05/17/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375220709202 Owner: VANG YOUA B Parcel Address: 2774 E US 70 HWY Owner2: VANG MEE X City: CONOVER, 28613 Address: 1842 29TH ST NE LRK(REID): 68484 Address2: null Deed Book/Page: 2922/1518 City: HICKORY Subdivision: null State/Zip: NC 28601-3263 Lots/Block: null/ null School Information: Last Sale: School District: COUNTY Plat Book/Page: Elementary School: CLAREMONT Legal: HWY 64-70 Middle School: RIVER BEND Calculated Acreage: .500 Tax Map: 4200 00010A High School: BUNKER HILL School Map Township: CLINES State Road #: null Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: CLAREMONT County Fire District: CLAREMONT RURAL Zoningl: R-2 Building(s) Value: $83,400 Zoning2: null Land Value: $11,200 Zoning3: null Assessed Total Value: $94,600 Zoning Overlay: null Year Built/Remodeled: 1960/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 #: 3710375200J Building Details 2010 Census Block: 3042 WaterShed: WS-IV Protected Area 2010 Census Tract: 010102 Voter Precinct: P6 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. Crlit CGOat Yial t • � http://gis.catawbacountync.gov/nomap/parcel_report.php?key=375220709202&typ=P 5/17/2016 141?:11,A CATAWBA COUNTY �tz I00A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT '�NeaPe PHONE: 828.465.8399 v 1)'�ludana. J Tuesday, May 17, 2016 1842 SM www.catawbacountync.gov PAYOR: Vang, Youa PAYMENTS TRANSACTION NUMBER: TRC-674616-17-05-2016 PAYMENT DATE : 05/17/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328464 Authorization to Construct (Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-05-2016-23896 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 2774 E US 70 HWY, CONOVER NC 28613 Owner YOUA YANG, 1842 29TI-I ST NE, HICKORY NC 28601 H:8282563254C:8283207781 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 05/17/2016 16:51 Page 1 of 1