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A34 27Application Date: � � �' � 3 Amount Paid: � 0� Receipt #: g LF 1 1'T OC _Y_ �_,� �#� � 3 � A Improvement Permit (Site Evaluation) ' $200.00/$300.00 (if> 600 Qpd) Mobile Home Replacement or Building Addition $150.00 (if site visit required) Well Permit (New/ReplacementlRepair) $3 00.00/$200.00/$75.00 ��,�f ��1 V Tax Map: �1 3 � ,_, : N- � � ��,�� Parcel#: � ;C'.a3vai-onana�d-aaars� :E :�c�eifli�� Services for Services Construction Authorization (Fee is dependent on the type of Permit Revision Repair of Eaisting Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information: Name: PJo tJ !J 1�, iY�E E I..ER. Address: (o $ S E� L.ES� tt2. 0.�D • RO�.�� 1J G a?57�f 2) Name and address of current owner (if different than appticant): Name: i�3A�K1„I�l� p LT'p . Address: b 1 Z N. MAr�i�,�-DIJ �LV 1.�. QO�.P,�Ro. NC. a7573 3) c,� r- F o Phone (home): 5 9`�• 3a3 7 (work/cell): S9 - 2 �.g5 Phone: J� 48� • z �-g `�J Property Description: Lot Size: • 5� �c Subdivision: Ai/A Lot #: A. Address and/or directions to Property: ►-! iN `1 5? T(3 ('A N tA � �• T U PJJ 1� 1(, N T �� ' �� ' �-bA .-fv2fJ I.EF� OA1T0 iY�Clrt�:. /7t�t_.t_ R/�. C7d /�P��U7 a/��L�S. VACAIUT !-D? �/ti � yes � no Does the site contain any jurisdictional wetlands? ��; � UST L FO ''f�-', g� 3 y. mc. Gµ� D yes � no Does the site contain any existing wastewater systems? m��-� R� ❑ yes � no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes �1 no Is the site subject to approval by any other public agency? � yes �l no Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Use and Type of Structure: ❑Residential � New Single Family Residence Maximum number of bedrooms: 3 � Expansion of Existing System If expansion: Current number of be�rooms: ❑ Repair to Malfunctioning System Will there be a basement? ❑ yes �S,l no With plumbing fi�ctures? ❑ yes ❑ no ❑Non-Residential Type of business: Ma�cimum number of employees: Total Squaze footage of Building: Maximum number of seats: 5) Water Supply: �,New well ❑ Existing Well ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes � no 6) If applying for �Authorization to Construct', please indfcate preferred system type(s): � Conventional ❑ Accepted O Innovative ❑ Alternative ❑ Other ❑ Any I cert� that the information provided above is complete and correct. I also understand that rf the information provided is inaccurate, or if the site is subsequently altered, or the intended use changes, all permits and approvals shall be invalid. `%L - Signature (Owner/ Legal Re reser * Supporting documentation required. -�,2- -J� / 3/ Date Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat� A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (10/I 1) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) ��.Sf ��$.�� `-= � � � �� 1C��ua-��.��.Il IF3L��.11�1� Site Plan Worksheet All aanlications must include a site �lan. The site plan shows the preferred location of the house, driveway, and any other proposed structures. The proposed location of the septic system and well may also be shown. You will be contacted by an Environmental Health Specialist if the proposed site plan needs to be adjusted to accommodate the well and septic system. The slte plan must include the following information: Dimensions of the property. (E�cisting or proposed). Proposed size and location of the house. The exact footprint of the house is not required as long as it fits within the proposed area. Measurements from at least two pmperty lines to the proposed house location must be shown. Proposed driveway location. Proposed location of the septic system and well (optional). Location and size of additional structures (Proposed or future additions). This includes sheds, garages, workshops, pools, etc. Locations of wells or septic systems on adjacent properties (if known). Location of easements (access, power lines, or others) on the property (if lmown). Proposed Site Plan (Note: The site plan does not have to be to scale, but must include the information listed above.) ioo' . � O N �� V �R(r��l �I�. MCC:NE1cS M►l...l. 2uA0 �'T� CE�Fc7 �7f�7L" _.L11JC:______ ______ ---------.. ------_ __._ ___ _____ _ _ - - --- ------ ---___ _ ---__ __.___._._.�._.__- 325 S. Morgan St., Suite C, Roxboro, NC 27573 Phone: 336-597-1790 Faac: 336-597-7808 �� ,. P A .i � �\ .�,1��, � ~ 4 �p� � � � � � � �n�n�n��7rn�c��.� �c��.��n. Bonnie Meeler 685 Ed Lester Road Roxboro, NC 27574 nsuring a healthy environment January 29, 2013 Re: Application for improvement permit for property adjacent to 5534 McGhees Mill Road; Health Department file: Tax Map #A34, Parcel #27 Dear Ms. Meeler: The Person County Health Department, Environmentai Health Division on January 25, 2013, evaluated approximately 0.5 acres at the above-referenced property that accompanied your improvement permit application. According to your application the site is to serve a three bedroom residence with a design wastewaier 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 including 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 through .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: 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) Unsuitable soil depth (Rule .1943) Presence of restrictive horizon (Rule .1944) X Insufficient space for septic system and repair area (Rule .1945) Unsuitable for meeting required setbacks (Rule .1950) Other (Rule .1946) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, into surface waters, directly to 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 se��vage to another area of suitable soil or off-site to additional property. phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 For the reasons set out above, the property is currently classified UNSUITABLE, and no improvement permit shall be issued for this site in accordance with Rule .1948(c). However, the site classified as iJNSUITABLE may be reclassified 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 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 Health & Human Services regional soil specialist. 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 Center, Raleigh, N.C. 27699-6714. To get a copy of a petition form, you may write the Off ce of Administrative Hearings or call the office at (919) 431-3000 or from the OAH web site at www.oah.state.nc.us/form.htm . The petition for a contested case hearing must be filed in accordance with the provis�on 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 WITHIIV' 30 DAYS OF THE DATE OF THIS LETTER The date of this letter is Januarv 29, 2013. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginiung 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 Health & Human Services. Send the copy to: Office of General Counsel, N.C. Department of Health & Human Services, 2001 Mail Service Center, Raleigh, N.C. 27699-1601. 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; NCDHHS. You may call or write the local health department if you need any additional information or assistance. Sincerely, �.,,� a• .�. Derrick A. Smith, LSS, REHSI Environmental Health Specialist Encl.: Rule .1948d