HomeMy WebLinkAboutEHPR-04-2022-40792.TIF 8A o� THIS IS NOTA PERMIT Case# EHPR-04-2022-40792
CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
84 sSM Environmental Health Plan Review-Septic Malfunction
AUTH CONST- SEPTIC MALFUNCTION
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Applicant SALINA CHANG,249 1SENI IOUR PARK RD,TAYLORSVILLE NC 28681
B:8282918599
Contact Person POWELL SEPTIC TANK SERVICE (KEVIN POWELL),360 POWELL RD,TAYLORSVILLE NC 28681
B:8286321791 C:8283020758
Owner ASHLEY MILLER, 1368 CALEB SETZER RD,NEWTON NC 28658
NAME TO APPEAR ON PERMIT
Ashley Miller
SITE ADDRESS: 1368 CALEB SETZER RD,NEWTON NC 28658 PIN# 364908895476
NAME of SUBDIVISION: PLEASANT LANES Lot# 1 Section/Block A
PROPERTY SIZE: Square Feet 20,037.60 Acres 0.46
DIRECTIONS: Hwy 16 S,left Eastway Dr,right Caleb Setzer house on left
PRIMARY CONTACT: Contact Person SEWER TYPE: Septic Tank
((GALLONS PER DAY: 360 WATER SUPPLY: Private Well
(Or-SCRIBE WOR • 6/28/2022 REVISED TO 3 BEDROOMS top of tank cracked. see inspection report
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 residence
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE: 64 x 62
NUMBER OF EXISTING BEDR S: 3 #OF OCCUPANTS: 8
PROPOSED CONSTRUCTION
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?
EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES:
SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT):
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY:
Other described:
c h:,ppli:a�nr 06/28/2022 16:12 Page I of6
�yg. • CATAWBA COUNTY Case# EHPR-04-2022-40792
.i. Public Health Department Subdivision PLEASANT LANES
III 'q Environmental •health Division PINK 364908895476
' PO Box 389, 100-A Southwest Blvd,Newton,NC 28658
8. 7Iw
NAME ON PERMIT: (ASHI,EY MILLER), 1368 CALEB SETZER RD,NEWTON NC 28658
(Ashley Miller)
Site Address: 1368 CALEB SETZER RD,NEWTON NC 28658
Property Size: Square Feet 20,037.60 Acres 0.46
Directions: Hwy 16 S,left Eastway Dr,right Caleb Setzer house on left
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.
Date: Signature of Applicant or Agent
If you need further information or assistance please call 828-465-8270
AREA6
******►**********************************************M***************•*********M*#Milo**********►***********
FEENAME DATE FEE AMOUNT
Authorization to Construct(Repair) Fee 04/21/2022 $150.00
TOTAL FEES $150.00
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)
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