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A34 86Application Date: � a'� � �� Tax Map• � 3� Amount Paid: I 0.�U �� .'':�� Parcel#: . 8�- Receipt #: � ( � I�� I�,;�tn-� n.a•a,��n�,,.n.Il ].H[��.11��ln. � Services O Improvement Permit (Site Evaluation) $200.00/$300.00 if> 600 d) Mobile Home Replacement or Building Addition $150.1i� (if siie visit required�) O Well Permit (New/Replacement/Repair) $300.00/$200.00/$75.00 for Services ❑ Construction Authorization (Fee is dependent on the type of ❑ Permit Revision $75.00 ❑ Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 �1) Appiicant Info mation: Name: /�,�,+Z�l� G. ��-G � Phone (home): .�36 -Ss"�✓� ,�t,, q Address: d,E, pn (worWcell): _„�,?6- S��- 3GL ,' . i i► �Z 1 2) Name and address of rrent owner (if different than applicant): Name: _...�.1� r�c �1i��s Phnne: ��i�— �v?��o7,s�d � Address: •; 2 Z 1 NIl" 6 N�ES /�'I i � t �Z � ��/s'I6 r G. /�% � �,Gie 3) Property Description: Lot Size:. }S Sub�i��sion: /�l/ � Lot #: Address and/or directions to Property: / __ � ❑ yes ❑ no Does the site contain any jurisdictional wetlands? ❑ yes ❑ no Does the site contain any existing wastewater systems? ❑ yes ❑ no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes ❑ no Is the site subject to approval by any other public agency? ❑ yes ❑ no Are :here any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Use and Type of Structure: ❑Residentiai ❑ New Single Family Residence Maximum number of bedrooms: ❑ Expansion of Existing System I:`expansior,: Currznt nunber of bedroon:s: ❑ Repair t� :��zlfun�t:onir.g System JviIl there be a basement? ❑ yes ❑ c►o With plumbing fixtures? ❑ yes ❑ no QNon-Residential J r Type of business: -.l ��'j'7 �/ c�C,lJ��- s�g�'�'S Total Square footage of Buiiding: �� Maximum number of employees: Maximum numb�; o; scats: v� �) Water Supply: ❑ New well L�xisting Well ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes ❑ no If a, ying for `Authorization to Construct', please indicate preferred system type(s): Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any I cert� that the inforrnation provided above is complete and correct. l also understand that if the information provided is inaccurate, if h site is subse f , intended use changes, all permits and approvals shall be invalid. _ � � -Z- f z Signa�fire (Owner/ Legal Representative*) * Supporting documentation required. 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. (10/11) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) � � ` � � �� ► � . � � ��.. �J �� IL'��IL7��7rD�.It71.'11,c�IL1L'��.�L ��r�'�� Building Additions/ Mobile Home Replacements Tax Map #:�� Parcel#:�_ Address: S Z Z � Af�c �, a P� � c � �� . Sew�ora r (C 273 �'�_ Approva� Req�:ssted for: Mobile Nom� Renlac�ment Building Addition . _l Applicant Name: ��u� �.� ��r_�' ��dress: �1� �n ��"' � Phone #'s: 2�i� - S3y-3Co�9 3�� - S� -4�ol�S Permit Located: _�Yes t/ No 5 d ' S Installation Date: , Design flow: ,( 5_(gp )�I �I f�rr� r�al �t' � e vn�o�� Current Contract with Certified Operator on file (if required): Water Supply: � Well Public or Community :'4�as#ev�-ater system sho�x�s no visual ev�der_ce of fail»re on: �-/�-/ 2 (datel (Applicant's signature if site visit is not required) Addition/Replacement Approved � Env ronmental Health Specialist 7-�2.-/2 _ Date Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 Phone: 336-597-1790/ Fax: 336-597-7808 www.personcountv.net Application Date: �� J`� 3 Amount Paid: (�CS�� Receipt #: 5 31� 7� L/� 7t � v � A ., ❑ Improvement Permit (Site Evaluation) _ $200.00/$300.00 (if> 600 gpd) G Mobile Home Replacement or Buildiag Addition $ I50.00 (if site visit required) ❑ Well Permit (l�iew/Replacement/itepair) $300.00/$200.00/$75.00 �� ) f �� l V Tax Map: � 3� ..r..; �' � Parcel#: � � �� I'C' ua-ynn'�sn.�rca�znd.m.IL IHL¢�.�..ILd��n. Services for Services C Construction Authorization (Fee is dependent en the type of ❑ Permit Revisi�n ❑ Repair of Existing 5eptic Sy�stem Application: No Charge/ CA $150.00 or $300.00 %"1) Applicant Infor ation: Name: � Address: , 2) Name and address of current owner (if different than applicant): Name: Address: 3) Property Description: Lot Size: ��— Subdivision: Address and/or directions to Property: Phone (home): � � Scl � � 7 � (work/cell): / �l 7 �- a Phone: Lot #: ❑ yes � no Does the site contain any jurisdictional wetlands? �s 0 no Does the site contain any existing wastewater systems? ❑ yes L1'no I� any wastewater going to be generated on the site other thati domestic sewage? ❑ yes �ino ls the site subject to approval by any other public agency? ❑ yes [�o Are there any easements or ribht of ways on this property? (if `yes' is checked, please provide supporting documentatien) 4 Proposed Use a�d Type of Structure: Resi en ' � � � (ra'New Single Pam ' nc aximum num er of bedrooms: ❑ Expansion of E'' ystem ent number of bedrooms: System Will thera be a ClNon-Residential "-�-_ - Type of business: �"'�'�-�— Maximum number of employees: _ fixtures? ❑ yes ❑ no Total Square footage of Building: l a-)( �� eco� U��-1 ��— Maximum number of seats: 5) Water Suppi,y: ❑ New well L►7 �xisting V1%ell � Community Well ❑ Public Water ❑ Spring A;e there any existing wzlls, springs, or existing waterlines on this property? ❑ yes L'�no ' 6j If applying for `Authorization to Construct', please indicatc preferred systern type(s): �Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any 1 cert� that the ir formativn provided ubove is cvmplete and correct. 1 also und�rstand tli�t if the informatian provided is inaccurate, or if the site is subsequently altered, or the ir:tc�nded use changes, all permit� and crpprovals shall be invalid. � Signature (Oivner/ Legal RepFesentative*) * Supporting documentation required. �'� �s �/.� Date • Permit§ are valid for either 60 months or are n�n-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) � � :�� ')� )�{ l �i ��. �� t�, � `i %�� y�a ..� �� , . "� V ' � �,. .� ^ �.��"�'�1�� ,��.z-�-�.:��:��.�.�A-z.�a:��,�1. �I��.�.Il�::� �a��1�� t��m��/ ��a�bn�� a�� fl�a��na��n�5 � Ta.Y Nlap #: �3�} Parcel#: g1� Address: 5aa,l M� 6��5 �'+►�- � � . sF.r�ottA �►�c. �*13y�.---- Approval Requested for: Mobile Home Replacement �( Building Addition Applicant Name: 1�Yt�. N-u 6N�5 Address: s'�sv N►ct��s t��►- � _ s�x.owa � �c. d� ��3 Phone #'s: 33�-sq.�j` �'141 `t i 4— hay � aS 4l0 Permii Located: Yes �_ No Installation Bate: u�1Ka�.� Design flow: ^�I oo (gpd) Current Contract with Certified Operator on file (if required): � A . Water Supply: � Well Public or Community Wastewater system shows na visual evidence of failure on: as I (date} (Applicant's signature if site visit is not required) Comments: /�ppR-av�ep �otL A I�f xa�} ' A�mo�.i �c,''� QAcIL � �usztaG S-sv(Z,� '�£w P►.�t' stK►w�aG OiR+�e..1.F�tD £A�ME� R.��11Jt�.�J • R�ct,M�.tc� .tas��c� �.vw Fww ��xcU¢�s Aao t�u,�nr�ac� ��vPn�_�t� � �1�1�x��/��a��a� ��p��v�e� ��,.,�. Q. ,�. Environmental Health Speciaiist 5'1�13 Date Person Coun�i Env;ronmentai �Teaith, 3�5 S. tiiorQan St., Suite C; RoYboro, NC 2 i�� 3 Fhcne: ��b-��7-??9C/ ra�:: ��-�9�-780� � �-v�%v^,��.�ersoncouirtv.i;e. ti� G; � � :., H .� � �J 9 � � � V � � 4 �y ,C .� � CCg �� ('� e � y J� yy Q y �p � 'I-F s � � ~ y � � r� ci: � �� a� � t; a �S ,�; , o � � �v b V— � `� a �� z � d s v � � a � � � Q� W U M � E-1 � cn �1 (� � .��, �. � ° %T � o � Ar, � Fi O /, J� � � �- � � I � i � '� v ��' q'� f� � I� � bD � � � y •: r � v 'U i b V � � � �^ O � � a C � o ro 3� � �s � �� y N � y .�j �f��, , - � � a y ...=-= C - — � _ -- — - -- _ . -=- �M ,:�1� 7h�N' z�" .,'4F1��. 'f.s �\5 H,t, ,y �' � �� l . � 2, ✓ v`i , ;�.� � g �'`,: � ��/� �%�� y�r �� t:;.y �. y�% �� / Y rt �, G'"'" �\ � �..�\ �'% Fy� '�yr Q. 'i � -171E aPi,'�k � ,�� . '„�� ,i, rti 11 � �. '(, oi ;- � �� . ` 3` � ' � u. �+ � ��: : f _ � r? /�io � � � �; � ,�` � '�.`?" /G, , aG � 1 , r � H `=iyn� ,.c- .•--- 'S, � a..,, . 5��, �i u . �� ,-�'� . . 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''� � r ,�e� � w� � � # �. � � � � �' '" � �� s�"ja, �� a°� e�.s- x �g; y r >� "�.`: k;.d% � % % � � ��a � � 'i- , A� �� r"�i _��r"� p.,� " ��, - '}^. �"�' ,��`� ��;�, i- �i i"�.�� .----�i �,�, ' ��_� �.'�r �,. _ _ , ��` �� {�} Y � � :., �3 �+^�r_r �__ . .� , ..- ��.h�4,. ,�,. �'�! .�,7�ki�� -;`y'' .:� �� --�--'--` . . �`�� ' � �� ` � � . �� ._.— � � . . �� µ ,, r a7b p � '' I/ �i� '7 �'`� ��' F r �i � f� z y w � �. 2 '�S' �a�,�s '� � _i. .� 'fc � 5 i'.. i� �,(�s. � .�^�s �..�, # ° b s � t�r�,��i� '; �� ... �� ,� r� - :'j' .'�i:� � ��` .r s`.� L / � s 4 � � �� '�� ;: �v5� % p �Y / � p'a��n � � � � � �! � ��' u�" � ,F'� �/ � � ,? �r�"„y4 —�.� � T'j ,� r �� y x/ d e� �}a to Hk �� ar y g � i.. k i �� .� � �y, � ��%r� ,� � �' '�. ' .�E 'S , ��'� `; � ,y �, e i � � ; ti � ,. . � k o / nh r �% 1 n�y � �C: ,M ,� '9,.. Mi"'p"+� ry:i/J.r :.�:'T � d . ... ;;�. r r' �,,..,, � - , �,, e ✓�' /,.-.s. .. ��j � n-+n-;,-,��,�,�,,,,� s-r'��y `4 %... �� v � .. � �� . . . . � �..� . . , ' ��nrf,#�n � :,�' ,. . , . .. . . .,. li�� , �e;, � � .� , � � �.'?-►^ :� �n �7�� nsurin� a healthy environment �� ApriI 26, ZOI3 :E_�;:�z-,-_�:,--�>:,,:�,� �--_►,�t ��:( :[ _[ � �Z�-�1� Re: AppIication for Improvement Permits for Wayne Moore at 5221 McGhees Mill Road, Semora Health Department file: Ta��: Map # A34 ParceI # 86 Dear Mr. Hughes: The Person County Health Department, Environmental Health Division on 4-23 &=�-2�. 2013, evaluated the above-referenced property at the site designated on the plat�site plan that accompanied your improvement permit application. According to your application you wanted ta upgrade the current system to accommodate a two bedroom residence with a design wastewater flow of 240 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 Titie 15A, Subchapter 18A, of the Nortli Carolina Administrative Code, Rule .1900 and related rules. Based on the criteria set out in Title 15A, Subchapter 1 SA, of the North Carolina Adminisuative Code, Rules .1940 through .1948, the evaluation indicated that the site is UnSUITABLE for a ground absorptio�i sewage system. Therefore, your request fox an impro��ement permit is DENIEll. 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 .1944} X Insufficient space for septic system and repair area (Rule .1945} Unsuitable for meeting required setbacks (Rule .I950} 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 ti�•ater or inside your stnicture. The site evaluation inctuded 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 rhe recrsof7s set o:rt crboi�e, the property is currently classifted UNSUITABLE, cri�d no improl�ement perniit shall be issued,for a ttivo bedroom on this site in accordance ti��ith R:rle .19-l8(c). This property does still have a valid permit with an existing septic st-stcrn that appeans tcr be,fsnctioning properly �rhich could s�rre a business with ed�si�r flo►t� not tv exceed 100 gullons per dtry. phone 336.597.1790 fa�c 336.597.7808 �?5 South Mor�an Street, Suite C, Roxboro, NC 27573 However, the site classified as UNSUiTABLE may be cIassified as PROVISIONALLY SUITABLE if �vritten documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is enclosed. You may hire a consuItant to assist you if you �vish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informaI 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 �tiriting to the local health department. You also have a right to a formal appeal of this decisian. To pursue a formal appeal, �•ou 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, �•ou may w-rite the Office of Administrative Hearings or call the office at (919) 733-0926 or from the OAH web site at www.oah.state,nc.us/forni.htrn . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes ]30A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-33� {g} provides that your hearing would be hetd in the county where your property is located. Please note: If you wish to pursue a formal appeal, you must file the petition form ��-ith the Offtce of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER The date of this letter is April 26, 2013, 2013. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere tvith any informal review that you might request. Do not wait for the outcome of an�� informal review if you wish to file a formaI 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. Send th:e copy to: Office of General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-16U1. Do NOT send the copy of the petition to your local health department. Sending a copy af 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 Ofiice of General Counsel, NCDENR. �C'ou may call or «7ite the local health department if you need any additional information or assistance. Sincerely, Derrick A. Smith, LSS, REHSI Environmental Health Specialist Encl.: Rule .1948d