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A24 157�-1�olication L�ate: 'TJ� 1 r� L-- ,�A:.�ount Faid: � Recai�st #: ��,3 Person Countv Health Deqartment Environmentai Weaith Section APPLICATION FOR SERVICES Ta� Mao �� Parc2! #: IF THE INFORMATION IN THE APPUCATION FOR AN IMPROVEMENT PERMIT IS FALSIFIED. CHANGED OR THE SITE IS ALTERED, THEN THE lMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME IPIVALID. 1) Permit requested by: (OwnedagentJprospective owner): �� ii, �p �� a �.� �� rFus �o� Home Phone:- 3'36 -_ S'3 7-9R�0 Address: �t �, s mc��, .,� •1 _�, � �� a Business Phone: SS?3-173�/ _ C� ,y,��, �v �" r� � 3— 3 2) Name and address of current owner. c'� ., �� 3) Property Description: �ot s Directions to the property_ (In ize• � � CTownship• cludind road names and numbersl: ��1'� �aU►.� �-�' a'� 4) Proposed Use and Strvcture Description: answer each of the foilowing questions: a) Proposed � Existing ❑ b) Sticic Built �, Modular 0, Single Wide� Double Wde � c) Number of Bedrooms: 3 d) Number of occupants or people to be served e) Basement: Yes 0, No I�s, # of basement fixtures: � � Garbage Disposai: Yes �, No [�' g) Dimensions of Proposed Structure: Wdth: �� Depth: �� 5) Wa4er Supply Type: Private�(new � or e�usting 0), Pubiic �, Community ❑, Spring ❑ : Are a(�y�vells on adjoining property? Yes ❑ No ❑ If yes, location 6) Please Indicate Desired System Type: (systems can be ranked in order of your preference) �ventional ,_Modified Conventional _ Alternative Innovative Other (specifyj: Dccm �� , �� - S- 3-0� CLEARLY STAKE ALL CORNERS AND LIiVES OF THE PROPERTY. STAKE THE CORNERS OF ALL PROPOSED STRUCTURES. PLEASE ATTACH SURVEY PLAT OR SITE PLAN TO TNIS APPUCATION I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the properiy. I understand if the site is altered or the intended use changes, the permit shall become invalid. I understand that as applicant, I am responsible for identifying and marking property lines, comers and making the site accessible foc the personnel of the Person Courity Health Department to conduct their evaluations. I understand that 1 am responsible for notifying the Health Depart nt if my prope contains any wetlands as designated by the Army Corps of Engineers. � - �02 . � 0 ne r Lzgal Representative Date PCHD, rev. 10/12/99 m �a7L�T711r"�]m�lY�c�Im��,� �c��.��JY� June 12, 2002 Phillip Andrew Hughes 4165 McGhee's Mill Road Semora, NC 27343 r enviroiunent Re: Application for Improvement Permit for wastewater system for property located behind 4233 McGhee's Mill Road Person County Health Department File: Tax Map #A24, Parcel #157 Dear Mr. Hughes: The Person County Health Department, Environmental Health Division on June 5, 2002, 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 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 and related statutes and Title 15A, Subchapter 18A, of 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 .194Q 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: l. Soil depths to saprolite unsuitable (Rule .1943). 2. Unsuitable clay mineralogy (Rule.1941) 3. Soil wetness conditions indicated by chroma colorization (Rule .1942) 4. Topography and Landscape Position (Rule.1940) 5. Available Space (Rule.1945) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewlge 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 conditi�ns 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 he issued for this site in accordance with Rule .1948 �O. However, the site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if written doc�rmentation 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 reques[ an informal review hy the � phone 336.597.1790 fax 336.597.7808 20-B Court Street, Roxboro, NC 27573 N.C. Department of Environment and Natural Resources regional soil specialist. A request for an 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 O�ce 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 o�ce at (919) 733- 0926. The petition for a contested case hearing must be filed in accordance with the provision of Nor[h 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 THLS 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 pe[ition 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, � 1� � e Joel N. Hicks, RS Environmental Health Specialist Environmental Health Division Person County Health Department �.. � \� � ` �' � � � I� � � � ,a�'- (�