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Date: April 23, 2008
Kelly Paylor
2831 Mayview Rd.
Raleigh, NC 27607
Re: Application for improvement permit for lot in Pinesborough Estates
Dear Mr. Paylor:
usuring 1 healthy cnvironment
The Person County Health Department, Environmental Health Division, evaluated the above-
referenced property at the site designated on the plat/site plan that accompanied your
improvement permit application on April 22, 2008. According to your application, the site is to
serve a 3 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
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-.1948, and the evaluation indicated that the site is iTNSUITABLE for a ground
absorption sewage system. Therefore, your request for an improvement permit is denied. A copy
of the site evaluation is attached. The site is unsuitable based on the following:
X 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)
Unsuitable soil depth (Rule.1943)
Presence of restrictive horizon (Rule .1943)
Insufficient space for septic system and repair area (Rule .1945)
Unsuitable for meeting required setbacks (Rule.1950)
Other rule:
These severe soil and site limitations could cause premature system failure, leading to the
discharge of untreated sewage 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 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 an
improvement permit shall not be issued for this site in accordance with Rule .1948(c).
phoue 336.597.1790
fax 336.597.7808
325 South Morgan Street, Suite C, Roxboro, NC 27573
However, a site classified as LTNSUTTABLE 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 attached. 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 SUTTABLE.
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 scientist. 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
6714 Mail
file a petition for a contested case hearing with the Ofiice of Administrative Heaou msa write the
Service Center, Raleigh, N.C. 27699-6714. To get a copy of the petition form, y Y
Office of Administrative Hearings or call the office at (919) — 733 — 0926. The petition for a
contested case hearing must be filed in accordance with the provisions 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.
PLEA5E 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 April 23, 2008. 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
iile 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 150B-23) to send a copy of your petition to the North
Carolina Department of Environment and Natural Resources. You must 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 your petition to your local health
department. Sending B 2p thatthou sendha clopy�to the Ofii ellof Gene al Counsel� NCDENR. ent
in N.C. Gen. Stat. 150 Y
You may cal] or write the local health department if you need any additional information or
assistance.
Sincerely,
f
�
Justin B. Smith
Environmental Health Specialist
Person County Health Department
Application Date: 9' �� �'d � M a� � e c� Tax Map:
Amount Paid: �d� . Ud , • � Parcel #: .
Receipt#: .� 8 A 3� a � '
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Application for Services
(Sentic Svstems and Wells)
Permit (Site Evaluation)
�300.00 (if > 600 gpd)
❑ Mobile�Iome Replacement or B�
$150.00 (if site visit required;
❑ Well Permit (New/Replacement)
$225.00/$125.00
Addition
Services
� Construction Authorization
(Fee is dependent on the type of sys
❑ Permit Revision
$75.00
❑ Repair of E�eisting Septic System
No Char�e
Important: If the information in the application for an Improvement Permit is incorrect, falsified, or the site is altered, then the I
Improvement Pennit a�zd the Authorization to Construct shall become invalid.
1) Services Requested by:
Name: Ke�� `� f /4 �iLo � ��-" Phone # (home):
Address: Z � 3 / i'� � V; �-� � � (work/cell): 9 / 4 3 �JS � � �o
,' l4LE/lrl� G Z.�6o7 ��,�,� 9!� �7l� `l� 10 X�og
2) Name and address of current owner (if different than applicant):
Name:
Address:
�i n �s 6 o r v H vl— �[} 2'� � 2.�5
� �Gr� Z /
3) Property Description: Lot Size: Subdivision: �5 t� s Lot #: � Z`� �
Address and/or directions to Property: Hwo 1 S� !J p S r g or r G,� s�rr�T�' o�/
�' r�s s thlc-�- -� (R ) Z i oN �� v�G eti �.c r�G. rc/
i'►� <c!!4 �ds (� k'
4) Proposed Use and Type of Structure:
Residential 7� Business/Type: Other
Number of bedrooms 3� / Number of people served (seats/employees):
Basement: Yes No .+r (with plumbing: Yes No _)
Garbage disposal: Yes No X
5) Water Supply:
Private Well x (Proposed Existing )
Community Well: Public Water System: ,
Are there on the adjoining properties? No
Yes � (please show location on site plan)
Note: A compleied application must also include:
➢ A plat/site plan of the property that shows property dimensions and the size and location of all
proposed structures.
➢ A sig�zed copy of the `Lot Preparatio�z' form verifying that the property is ready to be evaluated.
I am submitting this application to request services from the Person County Health Department. The
information provided is accurate. I understand that if any site is altered or the intended use changes, all
permits shall become invalid.
, ,� � /� (�2. ll . �f���o �i
Signature (Owner/Legal Representative). �� ` � � Date .
06/07 Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790)
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T�x M�p ' ; P��rcel # �
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Su�bdivision � . �
Ph�se Sect�ion Lot #
Improvement Permit
Permit Valid for Five Years No Expiration ' �
Type of Facility: �� _ QFSjd,QnP.P, New Addition _ Water Supply /�/P ��
# of Occupants �� # of Bedrooms �_ Projecte aily Flow 3(�n g.p.d. �---
Proposed Wastewater System: g �{- Type:
Proposed Repair: L " Type:
Permit Conditions: /�a��n-�-n jn �u t�a��s
Owner or Legal
Authorized State
Date:
Date: R - 7- 0%
r�
The issuance of this pernut by the Health Department in does not guarantee the issuance of other pemvts. It is the responsibility of the
applicant/property owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met. This
Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not
affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina
`Laws and Rules far Sewa�e Treatment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the
Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that
the water supply will remain potable.
Authorization to Construct Wastewater System (12equired for Building Permit)
* See site plan and additional attachments (_).
Proposed astewater System: �a� ,�1; �. i'�'�2 ���� Type� Wastewater Flow �00_g.p.d.
New � Repair_ xpansion Soil TAR• . g.p.d./ ft 2
Type of Facility: �r-i .a –��� Basement _ es _ No
Wastewater System Requirements
Tank Size: Septic Tank: f QD Ogal Pump Tank: gal Grease Trap: � gal
Drainfield: Total Area: OD sq ft Total Length � 00 ft Maximum Trench Depth /� in
o. c,
Trench Width � ft Minimum Soil Cover: � in Minimum Trench Separation: _� ft
Distribution: �1/ Distribution Box Serial Distribution Pressure Manifold
Specifications: Nle� �a;n Q�� Se{�Q��S So�� � CQ� ht45'F � � P` So' ��
Authorized State A�
Permit
Date: 8-7-0$
The type of system permitted is Conventional Accepted '—�ernative. I accept the specifications of the
permit.
O�vner/Legal Representative: Date:
PCHD rev. 11/10/OS
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Syste»a cvmponents re�irerent a�iproximr�`e�contours only: The contractor must flag the system prior to
beginning the i�stallatinn to i�sure thatpro�ergswwte i.r �naintained
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WELL PERMIT (New "�'Repair�
Tax Map: Z Parcel• Z-�
Subdivision: E Lot:
Applicant's Name: �
Mailing Address:
�
Phone Numbers: — — b 0 9 ta —(e7 (� -- 40 9 t�
of Property:
Permit Conditions: � �
1) See attached site plan for proposed well location.
2) All applicable State and Counry regulations governing construction and setbacks apply.
3) Permits expire 5 years from the date of issue. _
Other Conditions/Comments:
Permit issued by:
Date:
CERTIFICATE OF COMPLETION
New Well Inspection:
EHS/Date
Location:
Grouting:
Well Log:
Well Tag:
Pump Tag:
Air Vent:
Hose Bib:
Casing Height:
Concrete Slab:
Well Driller:
Pump Installer:
Well Approved by:
Date Sample Collected:
Person County Environmental Health
325 S. Morgan St., Suite C
Roxboro, NC 27573
Liner Inspection:
EHS/Date
Installer:
Depth:
Grout:
Well Abandonment:
EHS/Date
Completed:
Method/Material(s): _
License #:
License#:
Date:
Date Results Mailed:
Phone: 336-597-1790 Fax: 336-597-7808
8/1/08