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a? Proposed (�Exi�in9 Q 3�` � • .
` b) Stldc Hu�t 0. Modular �. Singla Wida 0. Oouble Wide cd� ,
� . c� '':. Number of Bedreams: `�; . ` � Number of o�ib� a� P�Pb � � �� �
° e) '� Ba� Yes q No O�if yes� #� cf basement tix�u�ex .' ,,•
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t�.,� � ,a � . - .
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r -%' CLEARLY STAKE ALL CORNERS ANO L1NES OF THE PROPSt71f.
>,, . STAKE THE CORNERS OF ALL PROPOSED STRUCTURES.
P��ASE ATTACt! SURVEY PLAT OR SRE PLAN TO THtS APPUCATION
��Y �� to tha Pe�on Co�u�ty t�ealth D� foc a a�e avaknatlon for the on-aioe sewape dispo�i syai�m
- tt'ie above�descr�ed propedy. t ag[ee tl�at the cor�tents af this app6r�on a�s ht�e and ra�ent ttte tna�dmtun faa�tlas to
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October 15, 2003
Sammy Hawkins
5455 Hurdle Mills Rd.
Roxboro NC 27574
Re: Application for Improvement Permit for wastewater system for property at
Oakridge Acres S/D Lot 52
Person County Health Department File: Tax Map #A040, Parcel #340
Dear Mr. Hawkins:
The Person County Health Department, Environmental Health Division on October 14, 2003
evaluated the above-referenced property at the site designated on the plat/site plan that
accompanied your improvement permit application. According to your application the site is to
serve a four-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
North Carolina Administrative Code, Rule .1900 and related nzles.
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. I regret to inform you that your request for an improvement
permit is DENIED. The site is unsuitable based on the following:
1. Topography and Landscape (Rule .1940)
2. Available Space (Rule .1945)
3. Soil Wetness Conditions (Rule .1942)
4. Soil Cl�aracteristics (Morphology) (Rule .1941)
5. Unsuitable fill material (Rule .1946)
These severe soil or 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.
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�.
You may request an informal review by the N.C. Department of Environment and Natural
Resources regional soil specialist. You may also obtain the services of a qualified soil
scientist/consultant to evaluate the property and submit a proposal to the Health Department.
phone 336.597.1790
fax 336.597.7808
20-B Court Street, Roxboro, NC 27573
The proposal must be accompanied by data which shows that the system will properly treat the
wastewater, will not contaminate groundwater or surface water, and will not discharge
wastewater on the ground surface, as required by Rule .1948(d). Your site has some other
possibilities, but at this time the area that we looked at cannot carry a conventional or innovative
system of standard types. Please contact a private soil consultant or our department and we can
discuss some other options that are available.
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, call their office at (919) 733-0926, or log onto
www.oah.state.nc.us/forms.htm. The petition for a contested case hearing must be filed in
accordance with the provision of North Carolina General Statutes 140A-24 and 150B-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 150B-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. Department of Environment and Natural Resources, 1601 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, NCDENR.
You may call or write the Person County Environmental Health Department if you need any
additional information or assistance.
Sincerely,
Adam C. Sarver, R.S.
Environmental Health Specialist
Environmental Health Division
Person County Health Department
9 -a 7-60
, Aoottcatlon oato: ��z
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P_ersao CcuMi► Hesith Deoattmurt
Frrvironmerrtzi Heaittt 3ectlon
- � • �• - � �:�� ��
T�_,�-3� 1
IF THE INFORMATION IN THE APPUCATION FOR �AN IMPROVEiI�ENT PERMIT 13 FAL31R�. C�WNGED OR THE SiTE 1S
ALTERF�. THEN'THE 1MPROVEi111Ei�IT PERMR AND AUTHORiZATTON TO CONSTRUCT SHALL BECOME INVAUD
i� P!lJ�1� 1^�QW�d ���Mffletii�l�f'O�piCl�YY OMfflOt�. �/� m vn u fii Lt c,.� E4 ? n 5
Hortts Pttionx _� � `1 '2S � � • Ad� .S'l ,5� � c.4.��,1 r rr,: c�5 !'tcl r
Bt�aineas Phona � � - R � hr��a
Z� Nams artd addcess of c�rr+et�t owne� ��, p
3) Prop�rty Dfscription: Lot sm� ��,z Tawut� ��
Direc3tons to the proQecty road names�rtid ru�s� 1.� � 1� f7 n�.' �.r�n �.
�� ka �, � -�?* l�; .r.l •
_ �
4) PtoQosad Ua� and Structut� Descriptlon: anawet esc3� of the toOa�W qua�acm:
� ProQosad (��ds�rp �
b) Stlydc Bu� Q Moduiac Q Slnale Wfde Q Da�b Wids LLY
c� Number of Bodtoocrix �, � NtuN�er of ocxupaNs� ar peopla to be sa�va� y
e) Base�c�nt Yea 0. No m-if`yas, � of basemert fixtucax
'� Gacba6e Dls�a� Yes q No [iY
� Qirtlec�cnsai Pnoposed S�x�ua: WidtlL' �R Da��tx.�g
�i ��PPhr � P�irrats a(new a oc �d�to DI. �e 4 C�r 4 sp�w a
Aro any wdls on �djoining propert�? Yes � No 0'iryes. locatlon
6j Pl�ass Indlcab D�sii�d Syatem'iYPe: (systocna can be rrc�io�d !n o� of Y� P�l
�Coaveatlasal ModitiedC�anvsntio�tial _Aidmatlw _,,,�nnovaiiw
Oit� (sp�cNy):
CLEARLY 9TAKE ALL CORl�IERg ANC L1NES OF THE PROP9tTY.
3TAKE THE CORNERS OF All. PROPOSED STRUC7URES.
PI.EA�SE ATTACtI SURVEY PU1T OR SRE PtAN TO TH{S APPUCATION
��Y �� tc trie Pe�an Cou�rty Health DaQactmm�t 1br a m'Es a�on tor tbs an-si�e seiw�qe dispoaal sYs�m
ths abo�e�ssc�'Ibed ptopetty. t apres tlza# fhe cont�enb of tt�s app�ptton ace hus and rop�'esactt the maodrtw�n ia�tles bo
Piaced on the pc+oQecty. I u�derstand if the siCe ls altet�ed orths �sDerded us� ct�attpes� the pem� shaa becoms inw�d-1 �st�
tt�t as ap�, I am taspora�ie ta ideNiiying and n�ar�in9 P�'�Y iiroa, cane� and maldng Ute aihe a� iac
pecaonr�d af the Person Cairrty Heaqh Departrnmt tc cnnduct their avaltrattocu. l�stand thak 1 atn tesp� ��9
Heaah art lf rtry ����x� any v�etlands as dai�ns�ed bY the Army CcrPs oi E�i�rs-
l
f � 2t 60
o� L�I R��ative . De�tD
���,s� ���..���
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IE��a-��„-„-„ ��.�.�.IL IF���.Il�I�.
T��x M�� , � P�.rcel #
S�u�bcilivi5�ion �� � �' �� �
IPh��se S�ct+ion Lot #
Applicant: � • 1���� �'l5 ,
Location: r n �t �„ r-�/1 __ �
Permit Valid for � Five ears No
Type of Facility: '�j�j •
# of Occupants 4'"lQ� # of Bedrooms
Proposed Wastewater �stem: �
Proposed Repair:
Permit Conditions:
Owner or Lega1 Represe�
Authorized State Agent:
Permi�
��
��
`� tia-�1
� 2,
iZ�ter Supply �l%���
Type:
Type: �'i�
Date: , _
Date: �j--l��0,�
The issuance of this permit by the Health Deparhnent in does not guarantee the issuance of other permits. It is the responsibility of the
applicant/property owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met. This
Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected
by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and
Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health
Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water suppiy will remain
potable.
Authorization to Construci Wastewater System �Required for Building Permit)
* See site plan and additional attachments (_).
Propos Wastewater System: �p 1,��'l�� Type�!-�f"'� Wastewater Flow ��.p.d.
�
New ' Repair Expansion� Soil LTAR: •'7 g.p.d./ ft 2
Type of Facility: �R� ��, Basement Yes �No
Wastewater System Requirements
Tank Size: Septic Tank: gal Pump Tank: ]�_ gal Grease Trap: gal
Drainfield: Total Area: ��O .sq ft Total Length `�'T6 ft Maximum Trench Depth �� in
Trench Width � ft Minimum Soil Cover: �_ in Minimum Trench Separation: � ft�' C'
Distribution: Distribution Box Serial Distribution Pressure Manifold
5pecifications: �I �I Uv� �f `?L'� 1/�'1.4� � 1~'l��t� E'C7� p►��i(+Mr� S"�'"" �.
Authorized State Agent: � l.� � �
�'� fV2� _ Date: PO'��%
Permit Expiration Date: -- �'�' � 1�- �- 2p �s �� �ci TS
The type of system permitted is � Gonventional Innovative Alternative. I accept the specifications of
the pernut.
Owner/Legal Representative:
Date:
PCHD 1/17/2003
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'38'55"W
122.37'
S833$ 55 W
159.48'
oAK RiDGE ACR�S �.LC.
D. B. 329--17
SAMMY B. HqyyK�N;
NADEAN A. HAWKI
D. B. 143- 9 7
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I.ane Tap Tap (Sc�) Tap �'lo� Y�ine I,�ngih Flodv / foot
# �iameter(in) ( m) -�, ft)
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Manifold Siae: �� "�orce Main Size: � " PVC
�otal Dynamic �$ea 2 ft of Elevadon head +'� ft of Pressure head +�ft of
Friction Head = �_TDH
Pump ltequireanent: � GPM @ l�'6 � ft of Head
DraWdown: ��� �al per dose � 21 gal per inch =� inch drawdown per dose
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s�a����on: (YaZr��.e /�C✓� s��m: �.ot• J 3
�'�e of Wates Saa��l;r V�-Individual Community Public
R�c�u�ffien�•
Site Approved by
GroutYng Approved bp
Well Log
Well Tag..
Air Vent �
Hose Bib
Concrete Slab
Well Da�ller.
Well A�proves�. ��: I��te•
'�See Attac,�aesi Sit� Sk�tch�*
�
Wells must be 10 feet from property lines.
Wells must be 100 feet from septic systems.
Welis must be at least 25 feet from anp building founda.tion.
Other conditions: —
PC�ID, rev. 09/07/Ol