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HomeMy WebLinkAboutEHPR-06-2022-41245.tif $A �G THIS IS NOTA PERMIT Case# EHPR-06-2022-41245 fi Il CATAWBA COUNTY HEALTH DEPARTMENT ill �J PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 8 2 sM Environmental Health Plan Review-Septic Malfunction AUTH CONST- SEPTIC MALFUNCTION Applicant XA*YANG,5707 NC HWY 16 N,CLAREMONT NC 28610 C:704-402-5964 XAYANGOO@GMAIL.COM NAME TO APPEAR ON PERMIT Xa *Yang SITE ADDRESS: 5707 N NC 16 HWY,CLAREMONT NC 28610 PIN# 375406285853 NAME of SUBDIVISION: Sc HOLLAR ESTATE PT 11 Lot# Section/Block PROPERTY SIZE: Square Feet 1,312,462.80 Acres 30.13 DIRECTIONS: N NC 16 Hwy on left across from Shell Hollar Rd PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: tree roots replace tank and drainfield 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: 40 x 32 NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION BASEMENT? Yes BASEMENT FIXTURES? Yes 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: chapplicatitm 06/03/2022 I1:19 Page I of6 .yg. CATAWBA COUNTY Case# EHPR-06-2022-41245 laiRio II Public Health Department i;, 'f' • •Z Subdivision S C HOLLAR ESTATE Q '� Environmental Health Division , .,_. C PIN# 375406285853 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 8• s. NAME ON PERMIT: (XA*YANG),5707 NC HWY 16 N,CLAREMONT NC 28610 (Xa*Yang) Site Address: 5707 N NC 16 HWY,CLAREMONT NC 28610 Property Size: Square Feet 1,312,462.80 Acres 30.13 Directions: N NC 16 Hwy on left across from Shell Holler Rd 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 AREA2 *********************************.*********************************.**************************************** FEENAME DATE FEE AMOUNT Authorization to Construct(Repair)Fee 06/03/2022 $300.00 TOTAL FEES 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) ehapplicabon 06/03/2022 11:19 Page 2 of6 RECEIVED _ '22 c at awb a county Environmental Health public health Application for Environmental Health Services .i/�`l360 TII1S IS NOT A PERMIT Application is for: [ew C omtruction _ ( _h'.xistmg I'actht� ❑Improvement Permit ❑Authorization to Construct a tVew Septic EiSeptic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑Existing System Inspection or Reconnection [-]New Well ❑Replacement Well ❑Well Abandonment ❑ Well Repair Property Address 5=1'O [V G= ( ( !►>r„.wvw{ /J G ZS`e Acres_ , Subdivision Lot# Driving Directions to Property 17fi`> , 4u fUC Ci i .�c-y��`rc\s; <,1 ti4. r =i� I C.c.i- `%1 r�t- e.t �n r t t ��iryt'r^-4h: / y� Describe work e. /tom[e �] e �7�dc.Jw' �.'�4� e e- rr y. 1 I -ti tr'4i Applicant Name Xo Applicant Address p r.t G (C (�{,�.c*a-+wd /Vr- 2Q((o Phone f e LO 407, Sti 6 y Email X(,.y _ 866._v .,'L_Cc Owner 'ante X„ Y Owner Address `t Phone Email • Contractor Name Contractor Address } Phone Email Name to Appear on Permit? [ Qwner ❑Applicant ❑Contractor Who will be the Primary Contact? Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ❑ New Residence ❑ Addition to Residence tt of New Bedrooms"t if of Occupants �^ Project Description Structure Dimensions,also specify dimensions of decks&porches Basement ❑Yes ❑ No Basement Plumbing 0 Yes ❑ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions Basement 0 Yes ❑No Basement Plumbing ❑ Yes ❑ No —— Accessory Structurets)Describe Plumbing ❑Yes 0 No Describe Plumbing Needed — Structure(s)Dimensions_ — Nfulti-Family Residence #of Apartments 7/Bedrooms per Apartment*t Total#Bedrooms in Structure r Structure Dimensions Basementf #of Occupants ❑Yes ❑ No Basement Plunthint, 0 Yes ❑ No _- Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well ❑Senn-Public Well ❑community Well �--------, Abandonment Type ❑ Drilled C] Bored ❑ Dug j Well Repair Requested ❑Yes ❑No f eribe ❑ Unknown LWill certified Well Contractor Install Water Line or Electrical tine from Well Ilead to Pressure Tank?❑Yes ❑No -"—� cafa�rrhacatlntyi ci goy —— — — -- —___—. Environmental Health solowl,ri tourlty Government tenter 25 Goveicpent Drive 1 PO Box 389 I Newton NC 28658 828.465.8270 MAKING. LIVING. BETTER. 1 Xistittg Structures on Site �? c i,./ A+�- Structure Dimensions_ Q X Describe VriG��� Gl,;� i� �" [Cl #of lBedrooms' #of Occupants Basement Cl Yes ❑ No Basement Plumbing Yes Ifif No Existing Water Supply _ VIndividual Well ❑Shared Well—Number of Connections___— ❑Community Well County/City/Township ownship Water Line Is a public water supply available?** ❑ Yes L.I No Commercial ❑Proposed New Construction 0 Existing/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shins—.—._ Church #of Seats Daycare 0 Yes ❑No #of Children #of Employees per Shift #of Shills Commercial Kitchen ElYes 0 No Residential Kitchen 0 Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts -- Business/Other Specify _ Structure Dimensions Retail Floor Space #of Employees per Shift #of Shills Other Information Calculated Design Flow,Commercial t (This value will be determined by Ell stall) , I 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 ANo Does the site contain any jurisdictional wetlands? ❑Yes )21No Does the site contain any existing wastewater systems? 0 Yes off No is any wastewater going to be generated on the site other than domestic sewage? ❑Yes PJ No Is the site subject to approval by any other public agency? CI Yes j?'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): (systems can be ranked in order of your preference) ❑Accepted 0 Alternative ❑Conventional 0 Innovative 0 Other 0 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. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by Eli Staff. **If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTy AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Environmental Health soil/site evaluations require digging,angering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Euvirotuncntal Health is not responsible for damage to unmarked utilities. Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is(5 valid.years);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 it'site conditions arc altered such that they effect permit conditions or installation reguircments. I have read this application and certify that the information provided herein is true,complete and correct. Authorized count officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. land state understand that I am solely responsible for the proper r formtictttion 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. Signature of Owner or Legal Agent r�-ZS — -- ,__ Date 2- 2 ' Printed Name of Owner or Legal Agent IIIIIIIPII ; :_ A B �{ ti ::::,...,,....:.•:,•:.,.:,,,,:,,,..‘•:•.::,,,,„ ,:, , ,• :',,,,v E w+E'v, 7*t . ,r6 . ,; _- et�,�r..<K:9:.. ` *r r. x o a.f ' ;. 3 • t. 10 • / •1 a - 4yL } f f-N---<1\ 7,-,it.' __ ,p- •,,,, .,..- . . ... 4- , r; 4.- '' .,, . .-:'' At .- �y11!7. T^ , t let A ; , Catawba County Environmental Health . o . a •.,, 1' 03 11" '' igt5760 N. ` 4i A. R I 'Z. .• CEJ lill' 5767 `SHELL HOLIARjR�� 4. ' .74\5311, Iiii. . • '_AL $4-•. ti It EA g : :K ��. 'WP 5627 4 0000000000011111,1r II Ir ( '8) m I d 5724 Parcel: 375406285853, 5707 N NC 16 HWY 1 in=400ft CLAREMONT, 28610 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 2021 Catawba County NC 06/03/2022 6/3/22,9:01 AM Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 375406285853 Owner: YANG XA JESSE Parcel Address: 5707 N NC 16 HWY Owner2: YANG LILISEE THAO City: CLAREMONT, 28610 Address: 5707 NC HIGHWAY 16 N LRK(REID): 42536 Address2: Deed Book/Page: 3619/1944 City: CLAREMONT Subdivision: S C HOLLAR ESTATE State/Zip: NC 28610-8109 Lots/Block: PT 11/ School Information: Last Sale: $270,000 on 2020-12-11 School District: COUNTY Plat Book/Page: 11/69 Elementary School: OXFORD Legal: PT LOT 11 PLAT 11-69 Calculated Acreage: 30.130 Middle School: RIVER BEND Tax Map: 0900 00047 High School: BUNKER HILL Township: CLINES School Map State Road #: 16 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: OXFORD Zoning1: R-30 Building(s) Value: $75,300 Zoning2: RC Land Value: $157,100 Zoning3: Assessed Total Value: $232,400 Zoning Overlay: FPM-O Year Built/Remodeled: 1947/ Small Area: ST STEPHENS/OXFORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: 3710375400J If available, Building Permits for this parcel. Septic 2010 Census Block: 2000 links are not permits. 2010 Census Tract: 010201 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details alirlG� ey if WaterShed: r Voter Precinct: P27/Voting Map 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. ©2022, Catawba County Government, North Carolina.All rights reserved. gis.catawbacountync.gov/nomap/parcel_report.php?key=3754062858538type=u 1/1 e4: CATAWBA COUNTY Case# WCOC-11-2021-161761 1 fl Public Health Department Subdivision S C HOLLAR ESTATE "'�� i EnvironmentalDivision PINK Health 375406285853 \/0 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# PT 11 f � Site Address: 5707 N NC 16 HWY,CLAREMONT NC 28610 Name on Permit XA*YANG Property Size: Acres: 30.13 Directions: HWY 16 N ACROSS FROM SHELL HOLLAR RD WELL CERTIFICATE OF COMPLETION Permit Number:WELL-06-2021-153446 DATE COMPLETED INSPECTION TYPE STATUS INSPECTOR 09/10/2021 EH Well Grouting Approved Dean Evans 09/13/2021 EH Well Record Received Approved EH Admit) 11/29/2021 EH Well Head Approved Cheyenne Morgan Teylorsville Well Drilling(Donald Russell) 09/10/2021 Well Driller Date Drilled 141°744 11/29/2021 Authorized State Agent Issuance Date ehwencoc 12/0612021 10:31 Page 1 of 1 • 'i Catawba County.Environmental Health • t l4+r N _ aoat cgtoo .. • s t r:,. 8 ;•"•• • ..-� •7.. t i t 1V��1^ • ii F SItR�[[[.', y, ••:'. 4, , � 1 .�;,. �..l ,i�l Tl,,'f• ,..,. 7l _yy'_l�,,Mb�...: ,: 'j Y.•. • •• . t• • •• • • Nr S„� ! +j'• /1 •'y '!• 't• 1 ••-•1 Aip ter.: •w . i ,..• , • �►;.• y M .sJ..i a�eK:''NEPiO{r i y i i s l Mi • i !14h.tf '.tf . • . 1 , \,. t i t 4 f • ...'.t:.• p .er,• .,,y:..,.,•,�.••••t'':•! - ._ • • • • • • r' ' : •' r•M I 'r i • ' lei • , ' • !•.. • ' . � • " '• , ,LPeroe�• 37510626 ,5T07NNCae HWY ' , 1 �r6M�ldgrM+ • dAREMONr,28610 • I�f tritho slum * l iMNhbMambYd O MItNti4�r4_I dNIlx4neydtxala . ' oaeqwwyTMComboMcwa►1sww0014trll old ,me re ‘+ oaa: oshi df+noNia� 0!�b ;iM �dM �:wiaoraaMoo Wrl i tl M1afrwrwsotM1141010110 ' , •Scanned with:Camscanner 4$A • CATAWBA COUNTY 100A SOUT11WEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 Friday,June 3,2022 1$4 2 SM www.catawbacountync.gov PAYOR: *Yang,Xa PAYMENTS TRANSACTION NUMBER: TRC-4 1 00 1 776-03-06-2022 PAYMENT DATE: 06/03/2022 PAYMENT TYPE: Credit Card 290804841 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 06-22-407285 110-580200-663000 Authorization to Construct(Repair) S300.00 Fee TOTAL PAYMENTS: $300.00 EH PR-06-2022-41245 CASE TYPE: Environmental Health Plan Review WORK CLASS: Septic Malfunction SITE ADDRESS: 5707 N NC 16 I IWY,CLAREMONT NC 28610 Applicant XA*YANG,5707 NC I1WY 16 N,CLAREMONT NC 28610 C:704-402-5964 XAYANG00 n GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 06/03/2022 II.l8 Page I of I