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�srson C�untv Health De�partment
E�vironmentai �iealth Section
APPI.lCAT10N FOR SERViCES
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IF THE INFORMATION IN THE APPLlCATION FOR AN IMPROVE�IIEiVT PERMIT IS F,4LSIFIED, CNAWGED. OR THE SITE !S
AL'T�liED THEAI TFiE IIIAPROVEi1AAEAIT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID
1) Permit requested b: Owne ent/prospective owner): � +� �• a!�(
Home Phone: � C��- � - �}S9 � Address:
Business Phone: a i � - �.3 �- �� � .� �30�
2) Plame and address oficumerrt owner. ��� 3
Nelsw�r -c
3) Property Descriptlon: �at size: �`� � Township: �'
Diredions to the property (Indudin� road names and n}�rN
���'1
�%. �20.
4) Proposed Use and Structure Description: answer each of the following questions:
a) Proposed Ef Existing a
b) Stick Built�Modular �, Single Wde 0, Double Wide ❑ �
cj Number o Bedrooms: 3+ d) Number of occupants or people to be served:
e) Basement Yes 0, Na [�'If yes, # of basement fixtures:� '
fl Garbage Disposal: Yes �, No ❑ s` �
g) Dimensions of Proposed Strudure: Width: Depth: ��� d s� �� ���' 't't�'�'`-
5) Water Supply Type: Private �(new � orexisting �), Public Q, Community �, Spring ❑
. Are any welis on adjoining property? Yes � No � If yes, location
6) Please Indicate Desired System Type: (systems can be ranked in order of your preferenca)
✓Converrtional _Modified Conventional _ Aitemative _Innovative
Other (specify);
CLEARLY STAKE ALL CORIdERS AND UNES OF THE PROPERTY.
ST.4KE THE CORNERS OF ALL PROPOSED STRtlCTURES.
PLEASE ATTACH SURVEY PLAT OR SITE PLAN TO THIS APPUCATION
1 hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposai system for
the above-described. property. I agree that the contents of this appiication are true and represent the maximum faalities to be
placed on the property. I understand if the site is altered or the irrtended use changes, the permit shall become invalid. I understand
that as appiic:ant, I am responsible for identifying and marhing property lines, comers and making the site acc�ssibie for the
personnel of the Person Cour�fy Health Departmerrt to canduct their evaluations. t understand that I am responsibie for nofiiying the
Neaith Departmerrt ifi property cor�tains any wetlands as designated by the Am�y Corps of Er�ginee
� D�/�Ce/ � �
' wner or Legal Representative D e
�� PCHD, 2v. 10M2/99
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��n�a���n.�rn�c�n���.� �c��.�.��
December 17, 2001
Samuel Parker
206 Pebble Beach
Mebane, NC 27302
Re: Application for improvement permit for Wastewater system for property at Byrd's
Creek Subdivision Lot 1, Located at the intersection of SR# 157 and SR# 1115.
Dear Mr. Parker:
The Person County Health Department, Environmental Health Division on May 24, 2001 evaluated the above-
referenced property at the site designated on the plat/site pian that accompanied your improvement permit
application. According to your application the site is to serve a three bedroom residence with a design wastewater
flow of 360 gallons per day. The evalua[ion 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 North
Carolina Administrative Code, Rule .1900 and related rules.
Based on the criteria set out in Title iSA, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940
throuQh .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system.
Therefore, your request for an improvement permit is DENIED. The site is unsuitable based on the following:
1. Unsuitable soil characteristics (Morphology) (Rule.l941)
2. Soil wetness conditions indicated by chroma colorization (Rule .1942)
3. Available Space (Rule.1945)
These severe soil �r 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 evalultion included consideration of possible site modifications, and modified, innovative or alternative
systems. Ho�vever, 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 currendy classified UNSUITABLE, and an improvement permit shall
not be issued for this site in accordance with Rule .1948 �O.
However, the site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if written
documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is enclosed. You may
hire a consultant to assisst you if you wish ro try to develop a plan under which your site could be reclassified as
PROVISIONALLY SUITABLE.
You have a right to an informal revie�v 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 specialist. A request for an informal review
must be made in �vriting to the local health department.
phone 336.597.1790
fax 336.597.7808
20-B Court Street, Roxboro, NC 27573
.�
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 Center, Raleigh, N.C. 27699-6714.
To get a copy of a 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 provision of North Carolina
General Statutes 140A-24 and i50B-23 and all other applicable provisions of Chapter 150B. N.C. General Statue
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. 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 i50B-23) to send a copy of your petition to the North Carolina Department of
Environment and Natural Resources. Send the copy to: Office of General Counsel, N.C. Depattment of
Environment and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-] 601. Do NOT send the copy
of the petition to your local health department. Sending a copy of your petition to the local health department will
NOT satisfy the legal requirement in N.C. General Statute 150B-23 that you send a copy to the Office of General
Counsel, NCDENR. .
You may call or write the Person County Environmental Health Department if you need any additional information
or assistance.
Sincerely,
Joel Hicks, R.S.
Environmental Health Specialist
Environmental Health Division
Person County Health Department