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HomeMy WebLinkAboutEHPR-04-2018-28958.tif �A /a'� �G THIS IS NOTA PERMIT Case# EHPR-04-20 1 8-28958 /LT Q -Ti CATAWBA COUNTY HEALTH DEPARTMENT �i 3 VS,q�, PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES :. . P' Scr7 \1842 su Environmental Health Plan Review- Septic Malfunction II G • l'r AUTH_CONST- SEPTIC_MALFUNCTION n r c II ❑.. .aA+ . Owner YANG VANCi,5497 CLOVER ST.HICKORY NC 28602 C:8284596073 NAME TO APPEAR ON PERMIT Vang Vang SITE ADDRESS: 5497 CLOVER ST,HICKORY NC 28602 PIN # 279115542940 NAME of SUBDIVISION: CLEARVIEW ACRES PL 14-28 Lot# 4 Section/Block G PROPERTY SIZE: Square Feet 23,958.00 Acres 0.55 DIRECTIONS: 127 turn right at Moss Farm Rd,tun right on Clover St,The house is on the right side of the intersection of Clover St and Pinoak Dr PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: 300 WATER SUPPLY: Community Well DESCRIBE WORK: System failing 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: 70x45 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: vhapplicaiion 04/202018 16:21 Page I of/ ri • CATAPBACOUNTY Case# EHPR-04-2018-28958 .g sn Public Health Department Subdivision CLEARVIEW ACRES PL 14-28 4 /�1f1� Environmental Health Division PIN# 279115542940 Lit, PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 /. a NAME ON PERMIT: (VANG VANG),5497 CLOVER ST,HICKORY NC 28602 (Vang Vang) Site Address: 5497 CLOVER ST, HICKORY NC 28602 Property Size: Square Feet 23,958.00 Acres 0.55 Directions: 127 turn right at Moss Farm Rd,tun right on Clover St,The house is on the right side of the intersection of Clover St and Pinoak Dr Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements 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. The undersigned is the owner of the property or legal agent of the owner. S7 / �' � p Date: / w Signature of Applicant or Agent If you need further information or assistance please call 828-466-7291 AREA2 44*****444}#44'/44444444t44444444444444444t*44 **4444444444**4*+*4*4*/2444444?4kt#44444444444444*4*4i 444444444 r,PLLN4�IL __ `i r, It' DAIL ILL ANIOUNI I Authorization to Construct(Repair) Fee 04/20/2018 $300.00_ I O AL FEES aH,. 'r S300.00 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) eirapplicmiun 04/202018 16:21 Page 2 o17 rt�,j1� �=T k' IS ii j ��_ TI-IIS IS NOT A PERMIT „cour Tx CATAWBA COUNTY HEALTH DEPARTMENT N �``_ ,„.,,, :, Application for Environmental Services Application is for: New Construction Existing Facility Improvement Permit Authorization to Construct New Septic . Septic Repair/Malfunction Septic Relocation Septic Expansion Existing System Inspection or Reconnection New Well Replacement Well Well Abandonment Well Repair Property Address _cifq 7 C/oi/e r$7 Subdivision 7/e GKo✓y .a/( 2-rSC,9 _ Lot# Acres . C Driving Directions to Property / 027 h {U'✓1 'kr 5�� e - MD`5St pc ,cn Rd ` D ft r1- %--t,-e 'IAte t! Se-e-i`,-.� ri\ f1ou j j Q (-- Applicant C� o�tact i nto •oration 1 Name j4?rn Address 5 17 7 7 /' 70 /A/ S/ , Phone ., , -0 ' Cell Phone fi-f- 4/5-5 - 4 p 7 3 Owner Contact Information Name Address Phone Cell Phone Contractor Contact Information Name License# Address Phone Cell Phone Name to Appear on Permit? -{ Owner Applicant I I Contractor Who will be the Primary Contact? Owner LI Applicant n Contractor Existing Structures on Site? • A Yes f I No If yes, describe_ ' _ , _ - — #of Bedrooms% # of Occupants Structure Dimensions_ Basement E Yes No Basement Plumbing Yes n No 1)/0 x CIS- .Existing Water Supply? n Individual Wellf Community Well I 1 County/City1Cownship Water Line Is a public water supply available? ** n Yes ❑No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well n Semi-Public Well A Community Well Abandonment Type 1 f Drilled Bored ' I-1 .Dug TH Unknown Well Repair Requested Yes [No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? Ye- ,No Ei THIS IS NOT A PERMIT Oun m CATAWBA COUNTY RE s LTD DEPARTMENT llEN T — —' „o,he;;a `, Application for Environmental Services Proposed New Construction - Residential Primary Residence I I New Residence Addition to Residence # of New Bedrooms *t Project Description Structure Dimensions # of Occupants Basement H Yes No Basement Plumbing ❑ Yes pI No Accessory Structure(s) Describe Structure Dimensions Plumbing Yes n No Describe Plumbing Needed Accessory Dwelling LJ Yes No # of New Bedrooms *t # of Occupants Proposed New Construction - Commercial Food Service Specify Type #Seats Floor Space -Entire Food Service Facility (Sq. Ft.) #Employees per Shift # of Shifts Dining Area(Sq. Ft.) Business/Other Specify Type Structure Dimensions Retail Floor Space # of Employees per Shift #of Shifts If Church #of Seats Commercial Kitchen ❑ Yes I I No If Daycare,#of Children If Multi-Family Residence,#of Apartments #Bedrooms per Apartment*t Total#Bedrooms *j Other Information Calculated Design Flow, Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property)n question. ff the answer to any question is"yes", applicant must attach supporting documentation. ❑ Yes ' do Does the site contain any jurisdictional wetlands? i1 Yes o Does the site contain any existing wastewater systems? ❑ Yes Is any wastewater going to be generated on the site other than domestic sewage? ❑ Yes ki:No Is the site subject to approval by any other public agency? ❑ Yes , l No Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): ems can be ranked in order of your preference) Accepted ❑ Alternative ❑ Conventional ❑ innovative ❑ Other ❑ Any *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 floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** If No,a well permit must be issued with the A uthorization to Construct. RETRIl'TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Completed applications are valid for a period of 2 years. Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct,issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed Facility changes.Permits may be revolted if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and conect. 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.� The undersigned is the owner of the propertt c gallegal anent towner. Signature of Owner or Legal Agent /7L / Date 7^ Printed Name of Owner or Legal Agent !/ Catawba County EnvironmentAal Health �/- � - • 1 3 F r z 3 14 60 30J 117.00 •• 0 (35) o 9 60 O 116.51 P 175.00 ti,.+j 'o 106.60 1s Kr �e 40 %,,, 4.\\1/2)(7 Nru 3 tr 0o 1093 ,---1 Parcel: 279115542940, 5497 CLOVER ST lin=50ft HICKORY, 28602 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 04/20/2018 Parcel Report Page 1 of I • Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 279115542940 Owner: VANG VANG Parcel Address: 5497 CLOVER ST Owner2: City: HICKORY, 28602 Address: 5497 CLOVER ST LRK(REID): 48351 Address2: Deed Book/Page: 3070/1042 City: HICKORY Subdivision: CLEARVIEW ACRES PL 14-28 State/Zip: NC 28602-9415 Lots/Block: 4/G School Information: Last Sale: Plat Book/Page: 14/28 School District: COUNTY Legal: LOT 4 CLEARVIEW ACR PL 14-28 Elementary School: MOUNTAIN VIEW Middle School: JACOBS FORK Calculated Acreage: .550 Tax Map: 133H 08004 High School: FRED T FOARD Township: HICKORY School Map State Road #: 1247 Tax/Value Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: MOUNTAIN VIEW Zoningl: R-20 Building(s) Value: $124,200 Zoning2: Land Value: $16,700 Zoning3: Assessed Total Value: $140,900 Zoning Overlay: Year Built/Remodeled: 1969/ Small Area: MOUNTAIN VIEW Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710279100J Building Details 2010 Census Block: 2036 WaterShed: 2010 Census Tract: 011101 Voter Precinct: P24 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 hold 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. ©2017, Catawba County Government, North Carolina. All rights reserved. http://gis.catawbacountync.gov/nomap/parcel_report.php?key=279115542940&typ=P 4/20/2018 \ CATAWBA COUNTY Case# AU"I'E•I-4-l1-17046 ��q� \ Public Health Department Subdivision 44 Environmental Health Division CLEARVIEW ACRES PL 14 C )2 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Lot tl 4 gq PENN 279115542940 Applicant/Owner Yang Yang Site Address: 5497 CLOVER ST, Hickory,NC V®0_® -. R yet-Jdzsl Property Size: SF 0.55 ACRES Directions: RT OLD MOSS RID OFF OF 127S/2ND ST TURN RT GO I BLOCK/HSEON CORNER OF PENOAK&CLOVER Authorization to Construct Permit Authorization to Construct Wastewater System (Required for Building Permit' * See site plan and number of additional attachments ( ). Proposed Wastewater System: 50% REDUCTION Wastewater Flow 420 g.p.d Type: II1B - SYSTEM W/SINGLE EFFLUENT PUMP Soil LTAR: .35 g.p.d./ft2 Permit Category: Repairs Type of Facility: Primary Residence Basement? Yes Basement Plumbing? Yes Bedrooms: 3 Wastewater System Requirements Tank Size: Existing Tank Unknown Size Pump Tank 1,000 gal Grease Trap gal Dosing Volume gal Pump Specs: GPM @ TDH Pressure Head ft Draw Down in Drainfield: Total Area: 600 sq ft Total Length: 200 ft Maximum Trench Depth 36 in Aggregate Depth in Trench Width 2.0 ft Minimum Soil Cover 6.0 in Minimum Trench Separation 8.0 ft on center Number of Drain Lines 4 Distribution: Pressure Manifold PUMP REQUIRED Additional Specifications: GPD 420 due to 7 people living in home. Pre-construction conference required to determine pump size. Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved, and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. »»> DO NOT INSTALL SYSTEM UNDER WET CONDITIONS ««< Proposed Repair System Class: Proposed System: Distribution Type:: Soil LTAR: g.p.d./ft2 04/18/11 09:09 CATAWBA COUNTY Case 4 AUTH-4-11-17046 'Public Health Department Subdivision Environmental Health Division CLEARVIEW ACRES PL 14 Q PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 Lot# 4 PIN# 279115542940 Applicant/Owner Vang Vang Site Address: 5497 CLOVER ST, Hickory,NC y`J O Ij D Property Size: SF 0.55 ACRES Directions: RT OLD MOSS RD OFF OF 1275/2ND ST TURN RT GO I BLOCK/HSEON CORNER OF PENOAK&CLOVER The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Authorization to Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to Construct Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Ru/es for Sewage Treatment and Disposal Systems' (15A NCAC I8A .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Susan Bumgarner 04/15/2011 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 04/13/2016 No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. 04/IS/II 09:09 €SPR 4-1 ► I (, 5' Yoh - 1104(0 VOID Tit * PreSsort, Ran.: cod ca (�,�8 b� eek �rnot + cere0' tccit4ion '14 pY +0 • U4 5°• 5'm1A, tmm w j°'-- %Alit house, `K 500/o Y tri1,tc, tm. Department of Environment,Health,and Natural Resources Sheet: Division of Environmental Health File U: r z... ( I y C3 On-site Wastewater Section tC `1 11-l�er4a SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM CONTINUED P R o SOIL MORPHOLOGY OTHER • F .1941 PROFILE FACTORS I .1940 .1942 L Landscape Horizon A941 .1941 Soil .1943 .1956 .1944 Profile E Position/ Depth Structure/ Consistence Wetness! Soil Sapro Rest Class U Slope% (IN.) Texture Mineralogy Color Depth(IN.) Class Horiz &LTAR LS 0—Th r, cbk) Stif “- u S 1 EfiQ 4g �3 7" i (If'D lam ; I 11 , 4.0' COUNTY Tim il� I OOA SOUTHWEST 131WD NEWTON.NORTH CAROLINA 28658 RECEIPT PCIPIwnn >ilit —J PhIONE:828A65.8399 U MOP `C Friday,April 20,2018 \842 sa wv w.catawbacounq'nc.gov PAYOR: Vang,Vang PAYMENTS TRANSACTION NUMBER: "IRC-3446611-20-04-2018 PAYMENT DATE: 04/20/2018 PAYMENT TYPE: Credit Card 202887159 INVOICE NUMBER FEE NAME FEE AMOUNT 04-18-352048 Authorization to Construct(Repair) $300.00 Fee TOTAL PAYMENTS: 5300.00 EH PR-04-2018-28958 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5497 CLOVER ST, HICKORY NC 28602 Owner VANG VANG,5497 CLOVER ST, HICKORY NC 28602 C:8284596073 ** NC) PEOPLESOFF ACCOUNT ASSIGNED** receipt 04/2021118 16:19 Page 1 of 1