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A28 14Apalication Date• s Amount Paid: 2 O Receiat #• 2 .Sh 2- Tax Ma #: �—V �� : l � �1�� Tl��T'I� �Y J[�...n.n-v.n a-sy�e-i. �a-nrn �aa.�tn.7l 7E�C �.m.71 <Ell-n ImprovemeMs Permrt - 5t50.00 (Mobfle Home RepiacemenUAddition) RepaidReplBce F�dsting System Pem APPLICATION FOR SERVtCES $150.00/3200.00 1) Permit requested by: ( er/agent/prospective owner): ��e /��'�"�� Home Phone: ,�� '3� 3053 Address: S bL'n� �, 9 Qusiness �hone: �'I/' t-fS/ �2.�� ,_.,��'� l� c 2�� 2) Name and address of current owner. �� `� �"' �� `'�' ' �� c� 2'7' 3) Property Descriptlon: Lot size: �� Township: �,� Directions to the proper�y (Includi�g road name�s and numbers): _ ca�t Lot # �� 4j Proposed Use a�riStructure Description: answer each of the foilowing uestions: a) Proposed l/ Facisting Type of Structure: 0/ �✓ ""� ��`'�J�u� �d�: � Depth: �� b) Number of Bedrooms: � Number of occupants or people to be served: - c) Basement: Yes_, No ✓GVill thele be plumbing in the basement? d�'� d) Garbage Disposal: Yes �,, No =! 5) Water Supply Type: Private new _ or existing.��ublic,_, Commun'ity_,., Spring _ Are any wells on adjoining propert�? Yes��io _ If yes, �lease indicate approximate location on the site plan. 6) Does your property contain previously identified jurisdictionat wetlands? Yes No � PLEASE NOTE THE FOLLOWING: ��Q�S� �`� � R 1��g� �0�5 � SD � C A� rV►�'e��f- �% e�l.e. ��n SF�- - ➢ A PLAT pF THE PROPERTY OR SITE PLAN MUST BE 3U8MITTED WITH TH1S APPLICATION. ➢ PROPERTY LINES AND CQRNERS MUST BE CLEARLY MARKED. ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAKED OR FlAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT STAFF. 1 hereby make appiication to the Person County Heaith Department for a site evaluation for the on-s'ite sewage disposal system for the above-described property. I ag�ee that the contents of this application are true and represent the maximum facilities to be plar�d on the property. I understand if the site is altered or the intended use changes, the permit shall become or Legal Representative l' �/ l a PCHD, rev. 08/27/02 ! " s ,; � , �...,, '+,..r ' ��'), � � , i�� . ` �r._ui� � �+� !i� �� r(, . � . � � i �>��. ry �" � s '�: �:��'""' nsuruig a�'�ealthy environment ` `' ° �'� � � ��_ . _ , ,, _. ��n.�a��na�n.c��,� �c��,�� Date: November 15, 2005 Eddie Burton . 53 Hillsborough Rd. Timberlake, NC 27583 Re: Application for improvement permit for lot off on Hillsborough Rd.. Person County Environmental Health - Tax map: A28Parcel #:014 Dear Mr. Burton, The Person County Health Department, Environmental Health Division, on November 15, 2005 evaluated the above-referenced property at the site designated on the platJsite plan that accompanied your improvement permit application. According to your application, the site is to serve a 3 bedroom facility with a design wastewater flow of 360 �allons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1900 and related rules. Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940-.1948, and the evaluation indicated that the site is UNSUTTABLE for a ground absorption sewage system. Therefore, your request for an improvement permit is DE1�iIED. A copy of the site evaluation is attached. The site is unsuitable based on the following: Unsuitable soil topography and/or landscape position. (Rule.1940) X Unsuitable soil characteristics (structure or clay mineralogy) (Rule .1941) X Unsuitable soil wetness condition (Rule .1942) X Unsuitable soil depth (Rule.1943) Presence of restrictive horizon (Rule .1943) X Insufficient space for septic system and repair area (Rule .1945) Unsuitable for meeting required setbacks (Rule.1950) Other rule: These severe soil and site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, in surface waters, directly into ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified innovative or alternative systems. However, the Health Department has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. � For the reasons set out above, the property is currently classified IJNSUITABLE and an improvement permit shall not be issued for this site in accordance with Rule :1948(c). phone 336.597.1790 fax 336.597.7808 20-B Court Street, Roxboro, NC 27573 However, a site classified as UNSUTTABLE may be reclassified as PROVISIONALLY SUTTABLE if written documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is attached. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal review of this decision. You may request an informal review by the soil scientist or environmental health supervisor at the local health department. You may also request an informal review by the N.C. Department of Environment and Natural Resources regional soil scientist. A request for informal review must be made in writing to the local health department. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. To get a copy of the petition form, you may write the Office of Administrative Hearings or call the office at (919) — 733 — 0926. The petition for a contested case hearing must be fled in accordance with the provisions of North Carolina General Statutes 130A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335(g) provides that your hearing would be held in the county where your property is located. PLEASE NOTE: If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is November 15, 2005. Meeting the 30-day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 150B-23) to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. You must send the copy to: Office of General Counsel, N.C. Department of Envirorunent and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-1601. Do NOT send the copy of your petition to your local health department. Sending a copy to the local health department will NOT satisfy the local requirement in N.C. Gen. Stat. 150B-23 that you send a copy to the Office of General Counsel, NCDENR. You may call or write the local health department if you need any additional information or assistance. Sincerely, � Justin B. Smith Environmental Health Specialist Person County Health Department Attachments (copy of site evaluation and copy of Rule.1948 (d)).