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A23 27■■��� � . � � ■■■'��������� � �■■I��'■IL11■,■, ��������� ��� ■■���� "��� ■■�I_�■„■■��, �■ ■ �� �,� ���■ �����, - �-o�u�m�--�-=W- :"_ _�.t.� __ ������■����� �d���������� . , 4u_ :'1� " , 'i � :�,. � y $X < ,.� ' .. I ; �.fi � ►�'..� M :� "a=s � �s-,�. o `o;r. ►+. - a' ' � °;- � �. � � �. o � �. � ,s N pi� � p � c � N � N C) F, � � r � � N O �� � � � � � � � w w � � � c m .. �0 � �w � � � � � `�, a � y O � � � � w �� b � � � :: � w :�� � y v�i w � � C � � N• �. ' o � n � w r. �,. `�° . . ��3 „ aZr� ;� 1 ._._..-...� � . . .-� The:..:District..Health � Dep�ortm�wt � , . �:. • :- Orauge ,.Person,, �aswell. _Chatham..-Lee •Couaties-`. � +.. . ; • ` � ; :. • , Water Supp.ly and Sewage :Dyi's, �osal ` � ,. I1�iFAQVEMENTS PE ..�✓' -: � Date ���� �� . � , � Owner �: ' - ; - ... �� . ~ � . . F� ���� � . . ' ' ._. �' Location � � � �� �• ::.��� � ` �, , ��_ ':k� � __ r, � ,� ���,g�� �Gontractor �'.' .; ' `�% 1 L •� o ""'T c� . . '_ -' . ' . 4r I ; � Wales. Supplps Pnvate � Public � _ Sewage.Disposal Facilities: TJo. be� .' her,-Disposal,. � washing machme, t e autom tic .appli8rices .. ;'"Size",of tank: -�-`Nitrification line ��� �� � . � . \ , . . . . . .. - . . . . ' =:Ottier. disposal facili:ty , - ` � `�'' � � � � Water supply� and.''sewage' disposal"facilities location� installation and -:protection' must meet s�ate and :local regulations. ,,_ � .;Septic tank�sliould }se pumped out every.,3: tq 5 years..and `shall be main- I '' . tained by owner m such a manner as not .to.; ereate a public health �hazard: �� , `•Septic -tank and nitTification line ` MUST- BE INSPECTED' AND'-AP- PE�,OVEB BY A MEMBER OF THE• DISTRICT HEALTH DEPAR.TMENP � '5TA�'F BEFORE ANY PORTION' OF. THE INSTALLATION' IS COV- I`"'""E� ANI3 PUT INTO USE. � — Dat.e approved• Sigrie '. ,�`" . : �r We�ll: _Sanit ' an Sewage Disposal• . Couriter , . � ,.� BY, . . 'sign _=; . ' 4q ..n. r o is.re esenta i e� . ;._ - . Certiiicate of Completion Date A roved: � B . ��� . _ PP Y a itarian-� . (OVER) . .._ �:::>: Location. of well' and sewage disposal faci�ities sketctied on back. ,��nlicaiion Oat�: �" �'7� ��l�nourrt �aid• O � R�i �: �� . 3333) �srsan Caurrtv �ieaith Det�arimer�t ���> � �s�vironmental Heaith Seclion b APQUCATlOM FaR S�iVICFS �ax �aes �: f� .2 3 F9r�! �: 2. % � ( � ev-� �q-Q ct ✓`boJ�- / IF THE INFflRMAT10N IN THE APPLICATION FOR AN IMPROVfilAAE3NT PERMIT IS F,4L3IFiE� C�lAA1GE�. OR THE SfT'E 15 ALTERm. THEIV THE IMPROVE�IAEiNT PEiiMTt' AND AUTHORIZATION TO CD[VSTRUCT SFlALL BECOME INVALID . 1) Permit requeabed �:(awrterfa endprospecttve oxme�:�f�l �% �C',-�� � f�?"JC�f �fS Home Phone: -0 Address: (� ! rG J� U r�-- Busir�ss Phane:. �'d�!- i 9�,� �� I� 2) Name and address of current owner. �J �'YY1 `2 � 3) Property De�ription: tat size: Townahia Diredtons to the property (induding road names and n�rpl 4) Proposed Use and Strudure DescrlQtion: answer each of the following questicns: a) Proposed f� Existing ❑ . b) � Stldc Built ¢�' Modutar Q. Single Wide Q Dauble �de � c) Number of Bedrooms: . � Mumber of occupants or peopie to be seived:.. e .... �semer� . Yes Q,. Nc� �_lf,� �' r - -- - -- ,, : -- -. _� . , . .: 1 _.. _ . _ fes, ,� o; basr�t�,� �xtu.� �_�---- . . : fl Gar�ag� Oisposal: Yes q No � =- jo�.x/ �yi1 __ .._---.. g) Dimensions of ProQaged Strudure Wictth: tie�t: �oa "7 � UVa�er Supply 3ype: Private �(new Q or�existin9 �, Pt�blic q Cammuntly q Sprmg-� . Are arry weUs on adjaining properiy? Yes �. No Q If yes, lacatlon 6) Ptease Indlc�te Desired System. i ype: (systems can be ranked In oNer of yo�ir prefer�nca) Comrarrtto�sal _Modi�ied Comrerrtionai _ Altemattve . Innovative �' (sP�r)= . CL�IRLY STA6(E ALL CORNE�lS AND i_tNES OF THE PROPEiZTY, STiiKE THE COWdF�S aF ALL PROPOSED STRUCTURE�. Pl.�1SE A'rCACN SURVEY Pi�►T OR SiTE PLAN TO THIS APPLCATION 1 herebY make app�iCation ta the Person County Health Departmerrt fior a s�e evaivafion for the on-s�ie sewage dispasai �system for the above�desaibed property, � agree that the corrterits of this appiir.ation are true and represent the ma�dmum facxLties to be piaced on the Property. I understand ifi the site is aitered ar the irrtended use ci�anges, the per�nii shail became invaiid. I understand that as appiic�nt, I am responsii�le for ide�iiying and markic�g property I'u�es, camers and maldng the siie acc�ssiiiie far the personne! af the Persan Caunty Heatth Department to condud their evaluatians. l understand that i am respor�ible far notiiying the Hea�h artrnesrt iF my property cantains arry wetlands as designafied by the Artny Corps af Engineecs. � . �- l �' � Owner ar Legai R entatNe � Qa� .PCND, rev. i0112199 �� � � ��` ' 7 �� �� �t � � w �`�G��. I-Co� � ��e 1 Yerson County Health Department Existing Sewage System Report For: Mobile Home Replacement Addition - Requestee: � �e'rS Ony (,(JQS��! Home Phone# � b���i �OV14 Qa � Busi.ness� C. �� (v � �'Pax Hapx , � _.. Location/Uirections: _� l.e����n��aw. ��t � ��k.�►n �h Original Permit Located ND Septic System Uesigned �'or: Kesidential ✓ f3usiness Other (specify) . # E3edrooms 3 # Employees Other Uate Tnstalled Uh�hD�� Water supply ���C�� Type of 5ystem G1vu�c-InDu�h Nitrification Line �n �►�oN1h Tank Size U�Vti��v�OUJh --YJ�����t �ha�• — Certified Operator Required �a � . On site wastewater disposal system showes no visually apparen� malfunction on ��-�'' � � ' Yermission is granted to: PvLG��S� i�D"�1n • o-� �ran"�' �Q��' � �n O�,cSe –I,b GY��n.�e .�.c SU. n roo �'�– According to the�attached site plan. Comucents: Environmental Health $�t�G. � ':�;;; i: -. . ;.�=�y`'r'... -Z - D DATE Application Date: g— � ��� S J(" ��4 ���}� Tux Map: ,��3 AmountPaid: (50,OD Cce�;{— .,._.,; �•;�- r Parcel#: a'7 ReceipE#: ,1�2q`�2 �'������' 1�+:��n.-v�i n•aana unn�cx»+E.tall 1L 7E•c:.enil%is Annlica�ion For Services Services Improvernent Permit (Site Evaluation) Mobile Iiome Replacement or Bniiding Addition $IS0.00 (if site visit required) Well Permit (Ne�v/Repiacemenf/Repnir) $300.00!$200.0(l/$75.00 Construction an tiie tvae of Permit Revisiou $'75.00 Repair of Existing Septic System A�lication: Na Chazgel CA $ I50.00 or $300.00 1) Applicnnt Tnformation: Name: ��P1L ��,�5� - Address: g3�� S`��OQlt {2,p Sti(�� �^�C. a�3�}3 2) Nt�nie and address af current owner (if different than applicant): Name: �-�Y'�ti LLC. Address: '38�) ��t2�'�AL� t�A��3r,(L s mdr� c�c. a"���1�� Phone (home): (tivork/cell): R � � - S :� �l - S 13 $ Phone: 3) Yroperty Description: Lot Size: •�� ° Subdivision: Lot #: �_ Address and/or d'u•ections to Pmperty: �Q�r� \t�1 i�lo(tYy �i�f!•T vr+ C�rl�a)�Il>1•i �rn �1 � a � �, �.�v�T o I C� t-t � C �-s o C-�s�r � �� Y. RT 1 ❑ yes � no Docs tha site cantain any jurisdictiona3 wetlands7 '��� �'fl� �❑��� �n -- Does the site contc�in any existing wastewater systems7 ❑ yes �'no [s uny wastewater going to be gencrated on Q�e site other tlian damesdc sewage? ❑� s 8� o Is the site subject to npprovai by uny other public agency? , f3' yes ❑ na Are there :uiy easements or rigirt of ways on this property7 (if`yes'ischecked,pleFiseprovidesapportingdocumentation) S���ti� �����h'A� �l � L(� l� �� � 4) Propased Use and Type of Structure: ,S-���a � F�Nt � j�Residential UY�,�.�4 {�;g�t.,, c'1o�}Lt "�o �t Q- New Single Fa�nily Residence 'f Mnximum number of bedrooms: �_, 0�xpansion of Existing System If expnnsion: Clirrent number of bedrooms: ❑ Repair to Maliunctzoning System Witl there be a basemant? ❑ yes 0 no With plumbing fixtures7 ❑ yes � no ❑ NomResideniiat Type of business: Ma4in�um �zumber of employees: '1'otal Square footage of .Building: M�ximum number of seats: 5) Watex Supply: ❑ New well '� Existing Well � Communiky Well ❑ Public Water ❑ Spring Are there uny existing wells, springs, or existing waterlines on this property? l7 yes ❑ no G) If applying f.ar `Authorizatian to Construct', please indlcate preferred systern type{s): � Conventional ❑ Accepted Q lnnovative � AlteLnaNve ❑ Other ❑�ny I cer•tify that tlze infortnatian rovirted czbove is corrtplele and correct. l alsa asnde��starul that if the fnfarntation provided zs inc�ccurate, o f th� bseqttently altered, or the intended use clianges, al! permits and appr•ovals shall be invalid. �-i-�i, Signuture (Owner/ Legal Representative�`) * Supporting doeumentation required. Date ❑ Permits arc vaiid far either 60 months nr are non-expiring �vhen accompanied by an appraved plat. 0 A completed `X,ot Preparatiora' for�n must accampany any application requiring a site evaluatinn. (ln/11) Person Couney Environtnental Health, 325 S. Margan St., Suite C, Raxboxo, NC 27573 (336-597-1790) ���� � . , `�4 ,� . :�-�. �_� . . .5�.. .-. .' . � �� �� � � �� J� � ��n.a.,..��. .... .....�r, :.�n.s�sra, o� a�«= , .nsunng a healthyenvironment ra�d..n. �a�ma a � �n Kr 1C��u1���.�.��.��.11 IC-�I�:�.11�;11�. . August 25, 2016 Kirk West 8377 Semora Rd. Semora, NC 27343 Re: Septic System Expansion/ Tax Map: A23-27 Dear Mr. West: You submitted an application to the Person County Health Department requesting a permit to expand (from two to three bedrooms) the existing septic system. A site visit and soil evaluation was conducted on August 25, 2016. The soil evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina (GS 130A-333, NCAC T15A: 18A .1900). Based on this evaluation the soils would be classified as Unsuitable. In addition, there is insufficient space available to expand the existing system to accommodate an additional bedroom. The soiUsite would be classified as Unsuitable for an expansion due to: Rule .1945: Available Space Rule .1956: Unsuitable Saprolite The existing system was installed on June 14, 1976. The Improvement Permit indicates that the system was designed to serve a mobile home, and consists of a 1000 gallon septic tank and 240 linear feet of drain line. Based on the amount of drain line installed, we assume that the mobile home was a two-bedroom single wide. At that time, a three bedroom home would typically have had up to 4001inear feet of septic drain line. The mobile home was eventually replaced by a stick-built home that was connected to the existing septic system. You have the option of hiring a soil scientist to review our decision. A soil scientist may propose a system expansion that meets the requirements of Rule 1948(d). You also have the right to request an Informal Review of this decision by the State Regional Soil Scientist. A request for informal review must be made in writing (form available) to the local health department. An informal review is conducted at no cost to you. In addition, you have a right to pursue a formal appeal of our determination. 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, NC 27699-6714. To get a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 431-3000 or download it from the OAH web site at http://www.ncoah.com/forms.html . The petition for a contested case hearing must be filed in accordance with the provision 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. 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. The date ofthis letter is April 12, 2016. Meeting the 30 day deadline is critical to your formal appeal. phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 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 serve a copy of your petition on the Office of General Counsel, N.C. Department of Health and Human Services, 2001 Mail Service Center, Raleigh, N.C. 27699- 2001. (Note: Do not serve the petition to your local health department. Sending a copy of your petition to the local health department will not satisfy the legal requirement of NCGS 150B-23). Please feel free to contact our office if you have any questions or need any additional information. Sincerely, ' �L� Harold Kelly Environmental Health Supervisor Person County Health Department .�� °�/ �`!� � i� <� - �,ur ,�,r.e ��.�: 3 • � �v� � � �►�`` ,�o�,� ���� � ���'��� �� � F��, �. �' _ � ��� � �<�t/�� �� � �� Y� . ,�: ��� :�: � :: ..:,.�,. .. . :;-.