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A24 43ConnectGIS Feature Report Page 1 of 2 http://gis.personcounty.neUconnectgis_v6/DownloadFile.ashx?i=_ags_map54�fLOc1 f1584e00a9678b85dbO10a85x.htm&t=p... 2/26/2013 � Application Date: �!o /3 Amount Paid: ZOD • oa Receipt #: �C''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/Repair) $3 00.00/$200.00/$75.00 '��'?, ) f ���� `U��. V Tax Map:--� ��.���� Parcel#i If";.�mo nn-�cn�¢nn�rnae�.xnd�m.� lEH��.ai.11.�::�n. ilication for Services Services Requested ❑ Construction Authorization (Fee is dependent on the type of system permitted) ❑ Permit Revision $75.OU ❑ Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 K 1) Applicant Information: � Name: � — ��/�7 Address:� C'�D - �f • K 2) Name and address of current owner (if different than applicant): Name: Address: Phone (home): ��6 -���� ' d ��� (worWcell): (��.p � �1� �"�=� �� Phone: �C 3) Property Description: Lot Size: G e�i� Subdivision: ��p.?r� I"7,�- Lot #: �/'> ! Add: ess and/or directions to Property: ❑ yes C�t3'�n Does the site contain any jurisdictional wetlands? ❑ yes C�d"n�' Does the site contain any existing wastewater systems? ❑ y�r Ct�'no Is any wastewater going to be generated on the site oth�r than domestic sewage? �yes ❑�� �n Is the site subject to approval by any other public agency? ❑ yes fd'no Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Ose and Type of Structure: ❑R ' ential ew Single Family Residence Maximum numbec of bedrooms: � 0 Expansion of Existing System If expansion: Current number of bedra� s: ❑ Repair to Nlalfunctioning System Will there be a basement? ❑ yes C�no W ith plumbing fixtures? ❑ yes � ❑Non-Residential Type of business: Total Squar� footage of Building: Maximum number of employees: 1�laximum number of seats: 5) Water Supply: !!J New well ❑ Existing Well ❑ Community Well ❑ Public Water ❑ Sprit�g Are there any existing wells, springs, or existing wateriines on this properiy? ❑ yes ❑ no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): � Cl Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other �'Any I cert� that the information provided above is complete und correct. I also z�nderstand that if the information provided is inaccurate, or ifthe site is subsequently altered, or the intended use changes, all permits and approvals shall be invalid. � Signature (Owner/ Legal Representative*) * Supporting documentation required. �-��- ao�� Date Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat. A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (10/11) Person County Environmental Health, 325 S. tilorgan St., Suite C, Roxboro, NC 27�73 (336-597-1790) �� �� � �;.. �,�`F �� � � „�-,- �, �w=,_ � � ���� ��n.�n�a�nan�c��n.��,� ���.���n Ada Evans Hinton 255 Oak Grove —1�1t. Zion Road Roxboro, NC 27574 nsuring a healthy environment February 27, 2013 Re: Application for improvement permit for property adjacent to 1061 & 1056 Shore Acres Drive; Health Depa.rtment file: Tax Map #A24, Parcel #43 Dear Ms. Hinton: The Person County Health Department, Environmental Health Division on February 27, 2013, evaluated approximately 1.0 acres at the above-referenced property 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 aallons 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 ivTorth 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 followin�: Unsuitable soil topography and/or landscape position (Rule .1940) X Unsuitable soil characteristics (structure or clay mineralc�gy) (Kule .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 .194�) _ Unsuitable for meeting required setbacks (Rule .1950) _ Other (Rule .1946) These severe soil or site limitations could cause pr�mature 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. phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 For the reasons set out above, the property is currently classified UNSUITABLE, and no improvement permit shall be issued for this site in accordance with Rule .1948(c). Ho�vever, the site classified as UNSUITABLE 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 enclosed. You may hire a consultant to assist you if you wish io 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 Health & Human Services 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) 431-3000 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. Piease note: If you wish to pursue a formal appeal, you must file the petition form with the Office Af Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER `The date of this letter is February 27, 2013. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere ��-ith.any informal rzview that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeai. 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 Health & Human Services. Send the copy to: Office of General Counsel, N.C. Department of Health & Human Services, 2001 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 af General Counsel, NCDHHS. You may call or write the local health department if you need any additional information or assistance. Sincerely, .1 ' � . : Derrick A. Smith, LSS, REHSI Environmental Health Specialist Encl.: Rule .1948d `�� \� � . � ., � . , ;. . � a f .j �-^ ' �� (� � nsunng a healthy environment � a � �` �1..� � ���� , r. �,,. .. . .��.�.,n �r .., ....,, „ .� . .�..e a .:�r n,=.o w., rt� �.� ..,«n. a .. r�a4 =a, o v �� e n. u f I��m�n�-��.��-��:�m �:�.Jl IC-�I �;�.]1�;11�. October 5, 2016 Frederick H. and Ada Hinton 255 Oak Grove Mount Zion Rd. Roxboro, NC 27574 RE: Shore Acres Drive Property/ Tax Map: A24-43 Dear Mr. and Mrs. Hinton: The Person County Health Department has been contacted about the use of the property referenced above. Individuals have expressed concern about wastewater possibly being dumped into Hyco Lake in conjunction with use of the property. Since we have no way of verifying that this is true, the purpose of this letter is just to make you aware that State law requires the disposal of wastewater in an approved wastewater treatment and disposal system (GS 130A-335). As you know, a site evaluation of your property was completed in 2013, by the Person County Health Department. Unfortunately, the lot was classified as unsuitable for the installation of a septic system due to soil characteristics. Exploring alternative wastewater system options, such as surface disposal, would require the services of a consulting soil scientist. Included with this letter is a partial listing of consultants. Please feel free to contact me if you have any questions (336-597-7435). Sincerely, Harold Kelly Environmental Health Supervisor phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 d ��s� /�cs�Ac�� -ev �a�e\ Svro� A�5 02.