A33 70j -% Tax Map�#: � `33
�'� APplication Date: _ 1 �J � ( ,
Amount Paid:. � •U . -'
Receipt #: .� � 0 Parcel #: 7�
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APPLICATION FOR SERVICES
IF THE INFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS INCORRECT, FALSIFIED,
CHANGED OR THE SITE IS ALTERED THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT
SHALL BECOME INVALID.
1) Permit requested by: (Owner/agent/prospective owner): t�✓ --� o✓� eS /
Home Phone: S 9 7 2 6� �- A d dress: C• C� •
Business Phone: S03-Sy5 7 Pa�-� -SGn9/)r �. C. 27 35�3
2) Name and address of current owner: Sc�t -�
3) Property Description: Lot size:���, Township�o.����� � Subdivision:
Directions to the property (Inciuding road names and numbers):
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4) Proposed Use and Structure Description: answer each o� e f� wing�uestions:
a) Proposed � Existing _, Type of Structure:��; � �. �/ Width:5 � Depth: �b
b) Number of Bedrooms: .�.�. Number of occupants or people to be served: 3
c) Basement: Yes _, No ✓wll there be plumbing in the basement?
d) Garbage Disposal: Yes _, No �
5) Water Supply Type: Private �new ✓ or existing ��ublic , Community _, Spring _
Are any wells on adjoining property? Yes _ No _ If yes, please indicate approximate location on the site plan.
6) Does the property contain previously identified jurisdictional wetlands? Yes _ No _
PLEASE NOTE THE FOLLOWING:
➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION.
➢ PROPERTY L1NES AND CORNERS 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.
I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal
system for the above-described property. I agree that the contents of this application are true and represent the maximum
facilities to be place n the roperty. I u erstand if the site is altered or the intended use changes, the permit shall
become invalid. � - � �
Owner or Leg ep sentative Date
. PCHD, rev.10/17l01
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SCALE IN FEET
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; Audrey SQttertield
D.B. 204-74
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Audrey Sattertield
�.B. 204-74
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December 20, 2001
Robert Jones
2407 Ephesus Church Rd.
Semora, NC 27343
Re: Lot Evaluation (A33-70)/ 2.0 acre tract / Ephesus Church Rd.
Dear Mr. Jones:
On December 17, 2001, I met you at the property referenced above to conduct a site
evaluation. The property was being evaluated, to determine site suitability for the
installation of an on-site wastewater system (septic systems). The site was evaluated in
accordance with the North Cazolina Zaws and Rules for Sewage Treatment, And
Disposal Systems' (15A NCAC 18A .1900).
Soil borings were made in representative accessible areas across the property. Based on
these borings the property would be classified as Unsuitable for the installation of sepric
systems for the following reasons:
(Rule .1943) Soil Depth
(a) Soil depth of <18" to rock/saprolite
(Rule .1941) 5oil Morphology
(2) Soil Structure: Massive soil structure
(3) Expansive clay mineralogy
Septic systems must be installed in soils that will allow the systems to function properly.
Based on ttus evaluation, the soils on the property do not meet the minimum
requirements for the installation of a septic system.
You may request an informal review of our decision from the Regional Soil Scientist
with the North Carolina Department of Environment and Natural Resources. Please
contact our office if you would like to schedule an informal review.
You may also obtain the services of a qualified soil scientisdconsultant to evaluate the
property and submit a proposal to the Health Department. The proposal must be
accompanied by data which shows that the system will properly treat the wastewater, will
phone 336.597.1790
fax 336.597.7808
20-B Court Street, Roxboro, NC 27573
not contaminate groundwater or surface water, and will not dischar�e wastewater on the
ground surface.
As we discussed, you may wish to explore the possibility of obtaining a surface discharge
permit through the North Carolina Department of Environment and Natural Resources
(NCDENR). A qualified wastewater system consultant could assist you in exploring this
possibility.
In addition, you have the right to formally appeal this decision to the Office of
Administrative Heari.ngs. A formal appeal must be made within 30 davs from the date of
this letter. The proper paperwork must be submitted to the Office of Administrative
Hearings. A copy must also be sent to the North Carolina Department of Environment
and Natural Resources. Please contact our office to obtain the necessary paperwork and
mailing addresses. Once the required information has been submitted, a hearing will be
scheduled and held in Person County. _
Please contact our office (5971790) if you have any questions or if we can be of further
assistance.
Sincerely,
Harold Kelly, Soil Scientist