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HomeMy WebLinkAboutEHPR-05-2016-23943.TIF yy13A THIS IS NOT A PERMIT Case # EHPR-05-2016-23943 mGi CATAWBA COUNTY HEALTH DEPARTMENT 0 0 t 0 ra U ►i C 'r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES /842 sm Environmental Health Plan Review - Septic Malfunction ' uel.'G ` o 1 r? AUTH CONST- SEPTIC MALFUNCTION • - s ;x Contractor BRANDON MARTIN, 6499 GEORGE HILDEBRAND SCHOOL RD, HICKORY NC 28602 C:8282174138 Owner ZOUA VUE YANG, 4117 HERMAN SIPE RD, CONOVERQ NC 28613 H:8282342634 C:8282344206 HOME:8282342634 NAME TO APPEAR ON PERMIT ZOUA VUE YANG SITE ADDRESS: 4117 HERMAN SIPE RD, CONOVER NC 28613 PIN # 373315535950 NAME of SUBDIVISION: Lot# Section/Block PROPERTY SIZE: Square Feet 0.00 Acres DIRECTIONS: 140, Exit 130, Right onto 1st St W, Right onto 10th Ave NW, Left onto County Home Rd, Left onto Herman Sipe Rd, Go about a 1/2 mile& house will be on the Right, Brick house &#on the house. PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Public Water DESCRIBE WORK: Water 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, Bldg, Chicken House EXISTING STRUCTURES ON SITE (IF ANY) DIM EXISTING STRUCTURE: House 58x42, Bldg 60x24 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 6 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 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: ' -3-ti —( 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 Ii_9-ehappli cat ion 05/24/2016 16:51 Page 1 of 7 ,,�3A CATAWBA COUNTY Case# EHPR-05-2016-23943 Q * -�\ Public Health Department Subdivision „tip Environmental Health Division PIN# 373315535950 it PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 184 NAME ON PERMIT: (ZOUA VUE YANG),4117 HERMAN SIPE RD, CONOVERQ NC 28613 (ZOUA VUE YANG) Site Address: 4117 HERMAN SIPE RD, CONOVER NC 28613 Property Size: Square Feet 0.00 Acres Directions: 140, Exit 130, Right onto 1st St W, Right onto 10th Ave NW, Left onto County Home Rd, Left onto Herman Sipe Rd, Go about a 1/2 mile& house will be on the Right, Brick house&#, on the house. iAE n 1� 1 U hoI f ' lFE nI1 FEENM ' LIV Y�* Wj iliil ., DATE il E AMOUNT Authorization to Construct(Repair) Fee 05/24/2016 $300.00 1i(lt , t t w F t ug ri it r�k. it f: `t,'TOTA1aF,ENIIIIIftil iQ� iIAIIIIIIIIIIl��N4tt 11111119 �1�lI`�Id �� i -01 fills tS3 * Pt �.#,„,b v '�,t+- nn !Una aliMin' gilidaYaO .• #11111111:1I1121 t,WtW4._,.91f L 8i0d__ujt IltIl FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN ANDIOR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-eliapplication 05/24/2016 16:51 Page 2 of 7 \ ,t-A THIS IS NOT A PERMIT COUNTY CATAWBA COUNTY HEALTH DEPARTMENT � Application for Environmental Services Page 1 wrtn c�.or Improvement Permit❑ Authorization to Construct ❑ Septic Repair i Septic Malfunction Septic Expansion ❑ New Well Permit E Replacement Well ❑ Well Abandonment Well Repair ❑ Existing System Inspection (Pre-Approval Required) ❑ Application is for New Construction ❑ Existing Facility Nic Property Address _* • -, . C Subdivision �'C� c LA° YV Q E /� Lot# Acres /-ee Secc*;o n/R l o c h/P ha s e Driving Directions to Property Ce S P P61-7 t /J(O i77 i" r7 cf 7%47 • , e r ,Q w g C`-�"h!< _ _ NAME TO APPEAR ON PERMIT? X Owner ❑ Applicant ❑ Contractor Applicant Contact Informmaation /, . Address cjl/ 7 //e4K82 j �.-i/-�/r /2G e0/70✓Q-/ (t873 -Phone Cell Phone S.-Z.t....- 27, c/ —z--/Zo6aY2-ycp Owner Contact Information 7-6 35 Name /0c#t Va. (' /ea n �i . Address 4el/ 7- ,44,2,r,„..., C[ i-7 /Clf r Z/ (yiOr rye -Y*t/3 )��� Phone Cell Phone e7 -Zc c'-- 11-264 O r2- ctr24 Contractor Contact Information Name inndfl1 Tii�)-, . Address 6'4499" 9ed e- ,�///Jrcth Ao'o/ .ad Air/4&77 r'G 2-)ga - Phone gg .—,9/ 9 edge- ff Cell Phone WHO WILL BE THE PRIMARY CON ACT? II Owner ❑ Applicant ❑ Contractor Description of Existing Structures on Site I ! t,_ LA 1'4. J aL # of Bedrooms *j' `. Structure Dimensions # of Occupants C tBasement ❑ Yes X No Basement Fixtures Cl Yes A 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. 0 Yes No Does the site contain any jurisdictional wetlands? Yes No Does the site contain any existing wastewater systems? Yes o 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? 0 Yes No Are there any easements or right of ways on this property? Describe Existing water supply in use [ Individual Well In Community Well ❑ Semi-Public Well 4 County/Crity/Township Water Line Is a public water supply available? ** Yes n 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) ❑ Accepted 0 Alternative ❑ Conventional ❑ Innovative 0 Other 1% Any • C�rrA ]�➢A THIS IS NOT A PERMIT counrr ;IL—\ CATAWBA COUNTY HEALTH DEPARTMENT - Application for Environmental Services Page 2 Proposed Facility Type Fl Primary Residence ❑ New Residence n Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement I1 Yes n No Basement Fixtures ® Yes t] No n Accessory Structure(s) Describe # of New Bedrooms *t if applicable Structure Dimensions # of Occupants Accessory Dwelling Ti Yes Ti No Plumbing ❑ Yes n No Describe Plumbing Needed I Multi-Family Residence#Units #Bedrooms per Unit*' Total# Bedrooms *.j Structure Dimensions H Food Service Specify Type # Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area (Sq. Ft.) Ti 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—I Individual Well ❑ Semi-Public Well I I Community Well Abandonment Type Drilled ❑ Bored ❑ Dug ❑ Unknown Well Repair Requested n 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. 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 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. / _j,,� Signatwe of Owner or Agent �( � Date 5.—^ q ({ Printed Name of Owner or Agent 2d ❑ I/ y9/1/G- Catawba County Environmental Health 7/1/ , . 0,1/4,53ii cn I. rip I glir allitia: ( 05) ,Ite • „la) : . , ..... `i....... • -$1 . • . , . . Parcel: 373315535950, 4117 HERMAN SIPE RD tin=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 05/23/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 373315535950 Owner: YANG ZOUA V Parcel Address: 4117 HERMAN SIPE RD Owner2: null City: CONOVER, 28613 Address: 4117 HERMAN SIPE RD LRK(REID): 65009 Address2: null Deed Book/Page: 2625/1089 City: CONOVER Subdivision: null State/Zip: NC 28613-8909 Lots/Block: null/ null Last Sale: School Information: School District: NEWTON CONOVER Plat Book/Page: Legal: 4117 HERMAN SIPE RD Elementary School: SHUFORD Calculated Acreage: 1.410 Middle School: NEWTON CONOVER Tax Map: 2218 02003 High School: NEWTON CONOVER Township: CLINES School Map State Road #: 1490 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: CONOVER RURAL Zoningl: R-20 Building(s) Value: $67,800 Zoning2: null Land Value: $19,000 Zoning3: null Assessed Total Value: $86,800 Zoning Overlay: null Year Built/Remodeled: 1951/null Small Area: ST STEPHENS/OXFORD 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 #: 3710373300J Building Details 2010 Census Block: 2005 WaterShed: null 2010 Census Tract: 010202 Voter Precinct: P33 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. ©2016, Catawba County Government, North Carolina. All rights reserved. ?vr Pin Cl I wjdo fretic Olc soa, http://gis.catawbacountync.gov/nomap/parcel_report.php?key=373315535950&typ=P 5/23/2016 � A CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT Q r" t�-v►�' PHONE: 828.465.8399 /v �Ives� Tuesday, May 24, 2016 842 514 www.catawbacountync.gov PAYOR: YANG,ZOUA VUE PAYMENTS TRANSACTION NUMBER: TRC-678720-24-05-2016 PAYMENT DATE : 05/24/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 05-16-328701 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS : $300.00 EHPR-05-2016-23943 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 4117 HERMAN SIPE RD,CONOVER NC 28613 Owner ZOUA VUE YANG, 4117 HERMAN SIPE RD,CONOVERQ NC 28613 H:8282342634C:8282344206 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** Contractor BRANDON MARTIN, 6499 GEORGE HILDEBRAND SCHOOL RD, HICKORY NC 28602 C:8282174138 receipt 05/24/2016 16:50 Page 1 of I