A35 67Application Date: 7- � 4' ' ��
Amount Paid: O�
Receipt#: 1I 0� 0 g
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Application for Services
(Septic Svstems and Wells)
Services
�Improvement Permit (Site Evaluation)
' $200.00/$300.00 (if> 600 gpd)
❑ Mobile Home Replacement or Building Addition
$150.00 (if site visit required)
❑ Well Permit (New/Replacement)
�225.00/$125.00
Tax Map: � 3 �
Parcel #: �Z
❑ Construction Authorization
(Fee is dependent on the type of sys
❑ Permit Revision
$75.00
� Repair of Existing Septic System
No Char�e
Important: If tf:e information in tlie application for ai:lmprovement Permit is incorrect, falsified, or tJ:e site is altered, then the
Imnrovement Permit and the Authorization to Construct shall become invalid
1) Services Requested by:
Name: y�A-v �.D w- ('�,pOL /-�O�L II�IG E�2
Address: ���o0 8�D G,�EE�t1.S7�o�eo I�A • -��
Lrl�/�PFL / L ;_ i .Z � S/L
Phone #(home): 7�5 - d s �- ODS- 7��JP>
(work/cell): %/�� l r�-l�(�.�L6 i
2)Name and address of current owner (if different than applicant):
Name: �j"D�lA7'tfAN �,LE TWooD
Address:
3) Property Description: Lot Size: � Subdivision: /I�d,(/G Lot #:
Address and/or directions to Property:
��,yu� LA/�F 7� D�yG,�ov� �fTz�o�/ �v aA,�,Gr2oU�
Cli�� LaKe � �l/l�('Y1,�es A.��'(1 r�.J �--y��,F: {'ornvA-- sLd� Z�aa> > �5 K�rrasP
4) Proposed Use and Type of Structure:
Residential �_ Business/Type: Other
Number of bedrooms � / Number of people served (seats/employees):
Basement: Yes No �(with plumbing: Yes _ No � Garbage disposal: Yes _ No _
Approximate size of building foundation: Length�� Width �_
� Water Supply:
Private Well _� (Proposed Existing _)
Community Well: Public Water System:
Are there wells on the adjoining properties? No Yes
(please show location on site plan)
Note: A comuleted apnlication must also include:
➢ A plat/site plan of the property tltat shows property dimensions and the size and location of all
proposed structures.
➢ A signed copy of tlte `Lot Preparation' forrrt ver�ing that the property is ready to be evaluated
I am submitting this application to request services from the Person County Health Department. The information
provided is accurate. I understand that if any site is altered or the intended use changes, all permits shall become
invalid.
Signature (Owner/Legal Representative): (� li�-Y � ' � Date: /
11/07 Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790)
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Date: August 28, 2008
David Hollinger
3500 Old Greensboro Rd.
Chapel Hill, NC 27516
Re: Application for improvement permit on Oak Grove Rd.
Dear Mr. Hollinger:
nsuring a healthy environment
The Person County Health Department, Environmental Health Division, evaluated the above-
referenced property at the site designated on the plat/site plan that accompanied your
improvement permit application on July 22, 2008. According to your application, the site is to
serve a 4 bedroom residence with a design wastewater flow of 480 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. A copy
of the site evaluation is attached. 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)
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 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 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 336.597.780�
325 South Morgan Street, Suite C, Roxboro, NC 27573
However, a 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 attached. 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 Environment and Natural Resources
regional soil scientist. A request for informal review must be made in writing to the local health
deparhnent.
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 perition form with the
Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The
date of this letter is September 27, 2008. 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
deparhnent. Sending a copy to the local health deparhnent 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 department if you need any additional information or
assistance.
Sincerely,
�
� �..
Justin B. Smith
Environmental Health Specialist
Person County Health Department