A24 43A�►aaltcation Date: ."� i`1 �
Amdunt Paid•
Recei #: �
Person Countv Health Deaartment
Environmental Heaith Section
APPLICATION FOR SERVICES
Tax Mao #:
Parcei #:
IF THE INFORMATION IN THE APPLlCATION FOR AN IMPROVEMENT PERMIT IS FALSIFlED. CHANGED OR THE StTE IS
ALTERED. THEN THE IMPROVEMENT PERMIT AND'AUTHORIZATION TO CONSTRUCT SHALL BECOME INVAUD
1 j Permlt requeated by: (Ownerlagerrt/prospecfive owne�: ^ 6 O - � i�� �,.✓%t r'
Home Phone: 336 �.�y-7�2 � Add .
Business Phone:3.�`— S3 � S�yy ,v , ��
2) Name and address of current owner:
3) Property Description: �ot size: �,�2 Township: � u.�.,vi.v�►wr
Diredions to the property (Indudtng road names and numbers). �c �, ��
. � �� .
4) Proposed Use and Structure Description: answer eact� of the following questions: Gt%F� ��
a) Proposed 0, Existing � �
b) Stldc Built �;1Nodular ❑, Sin le Wide �, Double wde ❑ �
cj Number of Bedrnoms: � - � Number of oxuparrts or people to be served:
e) Basemer� Yes �, No � If yes, # of basement fixtures:
� Garbape Disposal: Yes �, No ❑ �
g) Dimensions of Proposed Strudure: Width: Depth:
� Water Supply Type: Private�e�(new � or e�ds�ng �, Public ❑, Community o, Spring �
� Are arry wells on adjoining propertyT Yes [YNo � If yes. locatlon
6) Please Indicabe Desired System Type: (systems can be ranked in order of yaur preference)
�Comrer�ttonal �,Modified Conventlonal _ Altematfve _Innovative
Othe� (sPeciiY):
CLEARLY STAKE ALL CORNERS AND UNES OF THE PROPERTY.
STAKE THE CORNERS OF ALL PROPOSED STRUCTURES.
PLEASE ATTACH SURVEY PLAT OR SITE PLAN TO THIS APPLICATION
I hereby make application to the Person County Health Department for a site evaluatlon for the on-site sewage disposai system for
the above-described property. I agree that the corrtenb of this application are true and represent the maximum facilities to be
plac�d on the property. I understand if the site is altered o� the intended use changes, the permit shall become irnalid. ! understand
that as applicant, i am responsible for identifying and marking property lines, comers and making the site accessible for the
personnel of the Person Courrty Heaith Department to condud their evaivations. I understand that 1 am responsible for notifying the
Health Departme " 'ns any wetiands as designated by the Army Corps of Engine rs.
Owner or Legal RepresentaUve . Da
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PERSON COUNTY ���'�'�`���"�
December 1, 2000
Mr. C. R Pointer
P.O. Box 796
Roxboro, NC 27573
PERSON COUNTY HEALTH DEPARTMENT
ENVIl20NMENTAL HEALTH PROGRAM
20-B Court Street
Roxboro, North Carolina 27573 .
(336) 597-1790
Re: Application for Improvement Permit for wastewater system for property owned by
Jim Stovall at �ak Point S/D lot 43A -
Dear Mr. Pointer:
The Person Couvty Health Department, Environmental Health Division on November 29, 2000 evaluated the above-
referenced property at the site designated on the plat/site plan that accompanied your improve.me�t permit
application. According to your application the site is to serve a four be,droom residence with a design wastewater
flow of 480 gallons pes day. The �aluation was done in accordance with the laws and rules governing wastewater
systews in North Carolina General Stawte 130A-333 and related stawtes and Title ISA, Subchapter 18A, ofNorth
Carolina. Administrative Cod� Rule .1900 and related rules.
Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Admimshative Code, Rules .1940
through .1948, the evaluation indicated that the site is IINSUITABLE for a ground absorpdon sewage system
Therefore, yow request for an improvement permit is DENIED. The site is unsuitable based on the following:
1. Soil depths to saprolite unsuitable (Rule .1943).
2. Unsuitable so� morphology (so� stcucture and clay mineralogy} (Rule .194I)
3. Soil wetness (Rule .1942)
4. Topography and Landscape Position (Rule.1940) �
5. Available Space (Rule.1945)
These severe soil or site limitations could cause premature system failur� leading to the discharge of uutreated
sewage on the gound su�face, in surface waiers, directly imo ground water or inside your saucture.
The site evaluation included consideration of possi�ble site modifications, and modified, mnovatrve or altecnative
systems. However, the Health Deparlmem has determined that none of the above options will overcome the severe
conditions on ttris site. A possible opkian miglrt be a system desgned to dispose of sewage to another area of
suitable soil or off-site to additional property.
For the reasons sei out abov� the property is cairrentty classified IINSIIITABLE, and an improvement permit shall
not be issued for this site in accordance with Ruie .19480.
However, the site classified as ITNSUITABLE may be classified as PROVLSIONALLY SIITTABI.E if written
documentation is provided that meets the requirements of Rule .1948(d). A copy of tlus rule is enclosed. You may
You have a right to an informal review of this d�:ision. You may request an informal review by the soil sciernist or
enviro�ental health supervisor at the tocal health departmeat. You may also request an informal review by tt►e
N.C. Department of F..nvironment and Natural Resources regional so� specialist. A reyuest for an inforcnal review
must be made in writing to the local heatth department.
You also have a rigirt to a formal appeal of this decision. To pursue a formal appeal, you must file a perition from a
contested case hearing with the Office of Adminisaative Hearings, 6714 Mail Ceater, Raleigh, N.G. 27699-6714.
To get a copy of a perition foim, you may write the Office of Administrative Hearings or call the office at (919) 733-
0926. The petition for a comested case hearing must be filed in accordance with the provision ofNorth Cazoliaa
General Statutes 140A-24 and 150B-23 and all ather applicable provisions of Chapter 150B. N.C. General Statue
130A 335 (� provides that your hearing would be held in the couuty where your property is located.
Please note: If yau wish to pursue a formal appeal, you must file the petition foim with the Office of Administrative
Hearings WITHIl�i 30 DAYS OF THE DATE OF TBIS LETTER. Meeting the 30 day deadline is critical to
your right to a foimal appeal. Beginning a formaI appeal within 30 days will not interfere with any informal review
that you might request. Do not wait for the outcome of any iuformal review if you wish to file a formal appeal.
If you fiIe a petition for a contested case hearing with the Office of A,d�inistrahve Hearings, you are requued by
law (N.C. General Statute 150B-23) to s�d a copy of your petition to the North Carolina Departmern of
Environmem and Natural Resources. Send the copy w: Office of Genera( Counsei, N.C. Departmeut of
Environmeat and Natural Resources,1601 Mat� Service Center, Raleigh, N.C. 27699-1601. Do NOT send the copy
of the petition to your local health departmen#. Sending a copy of your petition to the local health departmeut w�l
NOT satisfy the legal requiremeut in N.C. General Statute 150B-23 that you send a copy to the Office of General
Counse], NCDII�iR.
You may call or write the Person Courny Environmental Heahh Departmeut if you need any additional information
or assistance.
Sincerely,
� i �'
M'ichael E. Cash, RS.
Emiromnental Health Program Specialist
Emrironmental Health Division
Person County Health Department
Cc: Janet Claytoq Environme�rtal Health Supervisor
Mazc Kohlman, Health Director