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� APPUC�tTtON FOR� SERV�ICES •
SHALL BECOME tNVALID. �
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1) Permit requested by: (Ownerla nt/prosPecfive ownerj: �' �� •
Home Phcne: .�d).�1�'-4IS'�g Address: %���'��
Business Phone: .S� �
2) Name and address of cvrrent owner. � �
Lu �7 a � � �o..�,.�--
3) Property D�escription: Lot size: _��Tawnship: _� S ivision: N
Directions to the property (Inciuding r+oad.n� �� nd numb �): ��b �-A- �� �
11 n(��n P-e C t� L c1 � M. i _fJ_� _L�
Lot#: ��
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4) Proposed Use an Structure Description: answer eact� of the foilawing questions:
a) Proposed _, F�dsting Type of Struc�ure: I�o �-b lcw i d, e 1�,� 1.� Width: 3�Depth: ��
b) Number of Bedrooms: � Number of occupants or people fio be served: � ,
c) Basement Yes _, No Will there be piumbing in the basement?
d) Garbage DisposaL- Yes _, No �
5} Water Supp(y Type: Privafie �ew _ ar exis�ng �, Public_, Community _, Spring _
Ar+e any welfs on adjaning properiy? Yes _ No � tf yes* piease indicate approximate location on the site plan.
6) Does the property cantain previousfy identified jurisdictional wetlands? Yes _ No -_—`
PLEASE NOTE THE F�LLOWING:
'➢ A PLAT OF THE PROPERTY OR StTE PLAN MUST HE SUBMI7TED WITH THIS APPLICATION.
➢ PROPERTY UNES AND CORNERS MI�ST BE CLEARLY MARKED.
➢ THE PROPOS� LOCA770N OF ALL STRUCTURES MUST HE STAKED OR FLAGGED. �
9 THE SITE MUST BE READILY ACCESSIBLE �OR AN E1/ALUATION BY THE HEALTH DEQARTIIAF.IVT STAFF.
!� hereby make application to the Petson County Health Department foc a siie evaivation far the on-site sewage disposal
system for the abov escnbed p e�ty. I agree that the cantents of this application are true and represent the maximum
faalities to be pl on the p I u nd ifi the site is altered or the intended use c ang the permit shall
became inv ' �
Owner or Legal Rep tative �,
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March 7, 2002
Lamont Bass
1210 Thaxton Rd./ 1517 Pine Ridge Dr.
Roxboro, NC 27573
Re: Application for improvement permit for Wastewater system for property at
McGhees Mill Rd. �
Person County Health Department File: Tax Map #A025, Parcel #122
�^ Dear Mr. Bass:
The Person County Health Department, Environmental Health Division on March 6, 2002 evaluated the above-
referenced property at the site designated on the plabsite plan that accompanied your improvement permit
application. According to your application the site is to serve a four bedroom residence with a design wastewater
flow of 480 gallons per day. The evaluation was done in accordance with the laws and rules goveming 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 .1940
through .1948, the evaluation indicated that the site is UNSUITABLE for a ground absoiption sewage system.
Therefore, your request for an improvement permit is DEI�TIED. The site is unsuitable based on the following:
1. Soil depths to saprolite unsuitable (Rule .1943).
2. Unsuitable soil characterisrics (Morphology) (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
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
condit�ons 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 currendy classified
IJNSUITABLE, and an improvement permit shall not be issued for this site in accordance with Rule .19480.
However, the site classified as iJNSUITABLE 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 scienrist 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 an infoimal review
must be made in writing to the local health departmen�
You also have a right to a fo�nal 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. The petition for a contested case hearing must be filed in accordance with the provision of North 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 perition form with the Office of Administrative
Hearings WITHIN 30 DAYS OF THE DATE OF THIS 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 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 Nat�u�al 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 perition to the local health deparnnent 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,
� � ��
���
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Adam C. Sarver, RS
Environmental Health Specialist
Environmental Health Division
Person County Health Department
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