A29 43APR-ii-2011 12:49PM F OM- T-997 P.00 /�aa F-568
Application Date: �I- t ax Map;
Amount Pa.id: a 00 . 0 Parcel #: ��
Receipt#: � I 0 Q�y- _
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Application for Services (Septic Systems and Wells)
1) Services Requested by:
Name:
Address• `� (Z ���nn,rv. .
�t2�S�z[ecQ�I�IC_ �151�
Phone # (home): '33(a- �G'7-�3_�
(work/cell):
2)Name and a.ddress of currept owner (if different than applicant):
Name• KPn �r��e�h,rr�
Add[ess: ��n C,OLi�.� �-�,e � �
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3) Property Description: Lot Size: �3•�-1 Subdivision: N` t4 I.ot #; ��_
Address and/or direction to Property: - —
5
4) Proposed Usc and Type of Strucfure:
Residential ✓ Business/'Y'ype: Other
Number of bedrooms ____�_ / Number of people served (seats/employees): _�_
Basement: Yes No _a� (withplumbing: Yes No �
Garbage disposal: Yes No ✓
S� Water Supply:
Private Well ✓ (Proposed ,� Existing _�
Community Well: P.ublic Water System:
Are ihere wells on the adjoining properties? No � Yes
(please show location on site plan)
Note: A completed anplication musl a�lsv inc[ude:
9 A plal/site plan of the property that s/tows property dimensions and ilie size and location of all
proposed structures.
➢ A signed copy of the `Lot Preparation'form ver�ing that the property is ready to be eva[uared
� am submitting this application to request services �f
if the informafion provided is incorrcct or if thc �ifc is s
permits aud approvals shall become iavalid. ,
Signature (OwnerlLegal Representative):
rson Couqty �ealth Department. I understand that
ntly altered, or if the intended use changes, all
Date : � `� ��
10/08 Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790)
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Date: April 19, 2011
Clayton Homes
3970 Durham Rd.
Roxboro, NC 27574
Re: Application for improvement permit on Hester's Store Rd.
To Whom It May Concern::
nsuring a healthy environment
1 � � e �f�ra�-4�
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The Person County Health Deparhnent, Environmental Health Division, evaluated the above-
referenced property at the site designated on the platJsite plan that accompanied your
improvement permit application on 4-14-11. According to your application, the site is to serve a
3 bedroom residence with a design wastewater flow of 360 gallons 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 denied. 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 modifcations, 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 UNSUITABLE 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
325 South Morgan Street, Suite C, Roxboro, NC 27573
However, a site classified as UNSUITABLE may be reclassified as PROVISIONALLY
SUITABLE if written documentation is provided that meets the requirements of Rule .1948(d).
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 SUTTABLE.
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
departrnent.
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 filed 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 WTTHIN 30 DAYS OF THE DATE OF THIS LETTER. The
date of this letter is April 19, 2011 . 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 Environment 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 departrnent if you need any additional information or
assistance.
Sincerely,
�
��
J tin B. Smith
Environmental Health Specialist
Person County Health Department