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-. 11#11 .• THIS IS NOT A PERMIT Case# EHPR-05-2023-44221
d(.......T ft a CATAWBA COUNTY HEALTH DEPARTMENT
PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
\8 ski Environmental Health Plan Review-Septic Malfunction
IMPROVEMENT-AUTH CONST- EXPANSION- SEPTIC MALF
q 1001)3 _ichs€d kph b)icida eNCTION
Applicant MEE LEE,520 FAIRGROVE CHURCH RD SE,CONOVER NC 28613
C:8289941084 MMLEE89121@GMAIL.COM
Owner LONG YANG,520 FAIRGROVE CHURCH RD,CONOVER NC 28613
NAME TO APPEAR ON PERMIT
Long Yang
SITE ADDRESS: 520 FAIRGROVE CHURCH RD SE,CONOVER NC 28613 PIN# 3722157311349
NAME of SUBDIVISION: Lot# 1 Section/Block
PROPERTY SIZE: Square Feet 35,719.20 Acres 0.82
DIRECTIONS: Corner of Tate Blvd and Fairgrove Church RD
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLONS PER DAY: 480 �ATER SUPPLY: Public Water
DESCRIBE WORK: repair expansion Tank and drainfield needed shared well with 430 Fairgrove Churcd
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: 62 x 49
NUMBER OF EXISTING BEDROOMS: 3 #OF OCCUPANTS: 8
h PROPOSED CONSTRUCTION
#OF NEW BEDROOMS:: 1
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: YES
Other described:
ehapplicat ion 08/10l2023 16:0I Page I of6
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Viras CATAWBACOUNTI'
case tti El iPR-OS-2023-44221
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Public Health Department Subdivision
. .yl s Environmental Health Division
?INN 372215731849
\ / PO Box 389,100-A Southwest Blvd,Newton,NC 28658
NAME ON PERMIT: (LONG YANG),520 FAIRGROVE CHURCH RD,CONOVER NC 28613
(Long Yang)
Sits Address: 520 FAIRGROVE CHURCH RD SE,CONOVER NC 28613
Property Size: Square Feet 35.719.20 Acres 0,82
Directions: Corner of Tate Blvd and Fairgrove Church 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 80 months(5 years).Permits may be revoked if the information on this apptication/site plan changes or if the attended use for the
proposed facility Changes. Permit!may be revoked if site conditions are altered such that they effect permit conditions or instanetion 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 solety
responsible for the proper identification and labeling of all property lines end corners and making the site accessible so that a complete site evaluation
can be performed
The undersigned is the owner of
thee property or legal agent of the owner.
Date: Z� i-t Signature of Applicant or Agent
11-you need further infortnation or assistance plea 11 828- 65-8270
AREA2
FEENAME UAL FEE AMOUNT
Authorization to Construct Fee(New/Expansion) 05/01/2023 S300.00
Fee
Improvement Permit Fee 05/01/2023 S150.00
TOTAL FEES S4S0,00
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)
chapphk at 8,ai 08'10l2023 I ri01 Page 2 of 6