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A24 127c. v � a ,_„ p1-,. a 1L1 N CO N � � � ' 1 � 6 � fr.� . �_ . � � � Person County Health Department � Sewage System Improvements Permit Date:'��' ��,�his Permit Void After 5 Years ,, a�� Owner: .� --J !�i'!n eS '�T n� S'; , 1� SR# i,��.:� Location/Directions: � ' Subdivision Name: Lot #��— ' Lot Size: Type of Dwelling: ' . , Water Supply: Private: !' Public: Community: ' Bedrooms: .� Garbage Dispos�l Basement Basement Fixtures . INFORMA D BY Sa7IltaTlall� ��'� o�5ner ar represenwtive • REPAIRr . :.• :• : REEVALUATION: Size of Septic Tank: –�� gallons Size of Pump Tank: � ; Nitrification Line: �' � � ; Depth of Stone: 12 inches "7._ � ; Max Depth of Trenches: � Altema[ive System: Conv. Pump LPP Pump C� Remarks: . ��^��.��.�`��. Date Well Approved: Well should be 100 f� from any sewer system BY Sanitarian Date Sewage System Approved: BY Sanitarian CERTTFICATE OF COMPLETION Contractor. " ► i • _ — — — — — — — — = — — — — — — — — — — — — — — — — '� Sewage System location, installadon, and protection. must meet stste and local � reguladons. Septic tank should be pwnped out every 3 to 5 years and shall be maintained � by owner in such manner as not to create a public health hazard. Septic tank and'ti nitrificadon line must be inspected and approved by a member of the Person County � Health Depaztment before any portion of the installation is covered and put into use. If the site plans or intended use change this permit is subject to revocation. .� (G.S. 130 A-335F) � /J .� A lication Date�=a5 Amount Paid: �— Recei t : � R' .'� 2 8�a� °� M �N Tax Ma #• O ' Parcal #• � Z % ��t ��,�� 1�'II�I�:� �� az� - - --� �� a-�� .��.��.a �a�.m.��. APPLICATIOM FOR SEiiVICSS • IF THE INFORMATION IN THE APPLICATION FOR AN .IMPROVEMERIT PERMIT IS IPICORRECT. FALSIFIED. CHAiMGED OR.THE S(TE IS ALTERED THEA1 THE IIVIPROVEMENT PERMtT AiVD AUi'HORIZAT10iV TO COPISTRUCT SHALL BECOME INVALID. • _ � � 1) Permit requested b: Owme gentlprospective owner):� z-� Home Phone: ! -Q 9� Address: �� 3� � �uP1��-- �• Business Phone: �,,� � y�� oc, - �E'.� , n ��,,,,_,2) YUame and address of curre�t owner. v� � d �-.e-�� ,��Z-��,� . . ��: �� ' i ' .. ij` � . ! /'.� _ Z S �.i/'ii�-� . .. �V � � 3) Propetty D�scnption: Lot size: 2 Township:,�.� �2.� Subdivision: �a. l�, ��' Lot # 3 3 Directions to the property (tncluding'road names and numbers): �f��-n �G�.k�. . ��R /�21 . 4) proposed Use and Structure Description: answer each of the following questians: , a) Proposed ✓. Existing , Type of Strvciure: �/-s.u� Width:�Q, Depth:� �.�- ` b) Num6er af Bedrooms: 3 Number of occupants or people to be served: � c) Basemen� Yes_, No �Will there be piumbing in the basement?� d) 6arbage Disposal: Yes �, No _ .� s . . 5) Water Suppiy Type: Private �(new �+/ or existin9� , Public_, Community___, Spring _ Are any wells on adjoini�g propetty? Yes✓ No _ If yes, pleasa indfcate approximate location on the 'site plan. 6) Does your proper#y contain previously identified jurisdictional wetiands? Yes No ✓ �. � PLEASE NOTE THE FOLLOWING: . � . ➢ A PLA►T OF THE PROPERTY C�R STT� PLAN MUST BE SUBMITTED WfTH THIS APPLICATION. ➢ PROPERTY L1NES AND CORNERS MUST BE CLEARLY MARKED. •, ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STi4F�D OR FLAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATIOPI 8Y TNE�HEA►L.TH DEPARTI6AAEAR STAFF. I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposaf system for the above-described property. I agree that the contents of this application are true and represent the maximum facilities to be piaced on the property. 1 understand if the site is altered or the intended use changes, the' permit shail become� invalid. Owner or Representative � �o-aS Date PCHD, rev. Os127/02 't �+, �r :':�..✓ . � ``'.rt 1� y n�yrjf 1 . . . . . . � . , . . . ��...,:�-�. _, - �' " J r �"�" (,` �I'� . � � . ; nsurin a; healtli environment ` • . �. .� '�� ` ��` '��,�-�c� � } . .. ~ ...:_._' �1"'1 � �l./ � �./ �� V �� .�.:.".. :..�„ . ..�'� , -:�- � ..:�., � �.. g y �,. �I�n.�a��L�c��.Jl �c��,�� September 16, 2005 Re: Applicationzfor Improvement Permits for Sarah Jones at Oak Pointe S/D Lot 32 Health Department file: Tax Map # A24 Parcel # 127 Dear Mrs. Jones: The Person County Health Department, Environmental Health Division on September 14, 2005, evaluated the above-referenced property at the site designated on the pladsite plan that accompanied your improvement permit application. According to your application the site is to serve a three bedroom residence with a design wastewater 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) 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 .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 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 no improvement pernut shall be issued for this site in accordance with Rule .1948(c). phone 336.597.1790 fax 336.597.7808 20-B Court Street, Roxboro, NC 27573 However, the site classified as UNSUITABLE may be classified 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 Environment and Natural Resources 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 Office of Administrative Hearings or call the office at (919) 733-0926 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 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. . 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 The date of this letter is 9/16/2005. 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 i50B-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 deparhnent. 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 local health department if you need any additional information or assistance. Sin er ly, � � � �� Adam C. Sarver, RS EH Program Specialist Encl.: Rule .1948d