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Elliott Chandler .
801 chub Lake Road
nsuring a healthy environment
Roxboro, NC 27573
May 14, 2007
Re: Application for improvement permits for lot on Concord-Ceffo Road
Health Department file: Tax Map # A25 Parcel # 14
Dear Mr. Chandler:
The Person County Health Department, Environmental Health Division on May 14, 2007,
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 four bedroom residence with a design wastewater flow of 480 gallons
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 North 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. A copy of the site evaluation is enclosed. 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)
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 .1945)
_ Unsuitable for meeting required setbacks (Rule .1950)
_ Other (Rule .1946) �
These severe soil or site limitations could cause premature 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
20-B Court Street, 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).
However, 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 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 request an informal review by the N.C. Department of
Environment and Natural Resources 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) 733-0926 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.
Please note: If you wish to pursue a formal appeal, you must file the petition forrri with the
Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS
LETTER The date of this letter is Mav 14, 2007. 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 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 local health department if you need any additional information or
assistance.
Sincerely,
' ,�������"' �`�-�'
Bonnie Holt
Environmental Health Specialist
Appiication Date: `�' � � � C� �
Amount Paid: ( - r - • � ' �->>
Rec�ipt #• 3 �� 1��
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Tax Maa #: ��
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APPLICATION FOR SERVICES
�'" `l ��
Fur+���.�
N�`� P
1r�/ a � /�A� �' °"T
IF THE INFORNIATION IN THE APPLICAT60Pl FOR AN IMPROVEMEiVT PERMIT IS INCaRRECT FALSiFaEa
CHAIVGED. OR THE SRE IS ALTE}iED, THEiV THE IMPROVEMENT PERMIT AND AUTHORIZ.�►TiON TO
CO(VSTRUCT SHALL BECOAflE INVALID. •
1) Pertnit requesied by: (Owner/agent/prospective owner): � � � ci l� . Ch `d1 �� r
Home Phone: -� Q`� - 40 6� Address: _{�'D I l- I�
Business Phone: Q �,r�Xlt�n ►r[� l�1 �� 7� 7.3
��� � � � - � � �
2) Alame and addrr�sss of current owne� __��� -P �
� � an�
3j Property Description: Lot size: �� 'fownship: �'��'''l Subdivision: N� Lot#
Directions to the prop�y (Including roadr�ames and numb� �� MC � ee �lrl,
�.a �-n �P ��1-c� —( L� ��1 u 1�r e 7/� M.
e
4) P'roposed Use ansi $tructure Description: answer each of the following questions:
a) Proposed •� Existing Ty e of Structure: Mod u� a� Width: � Depth: �,
b) Number of Bedrooms: �p�lumber of occupants or people to be served: _
c) Basement Ye� . No _.�Will the�e be plumbing in the basement? -
d) �arbage Disposal: Yes � , No � -
5) Water Suppiy� Type: Prnrate _�(new _ or existing�, Public� Community , Sp�ing _
��1re any wells on adjoining property? Yes_ No _ If yes, please indicate approxima#e location on the
'site plan. � . �
6) Does your property cantain previousiy identified jurisdiciional wetlands? Yes_ No �
PLEASE NOTE THE FOLLOWING:
➢ A PLAT OF THE PROPERTI OR SITE PLAiV MUST BE SUBMITTED WITH Tai1S APPLICAT10iV.
➢ PROPERTY LINES AND CORNERS MUST BE CLEARLY MARKED. �,.
➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAKED OR FLAGGED. �
➢'THE SI7E MU$T 8E READILY ACCESSiBt.� FOR AN EVALUATiON BY THE HEALTH DEPARTMEiVT
STAFF: �
I hereby make app�ication to the Person County Health Department for a site evaluation for the on-siie sewage disposal
sysiem for the above-described property. I agree that the cantents of this application are true and represent the maximum
facilities to be piaced on the property. I understand if the siie is altered or the intended use changes, the permit shalt
hcrnmc invaliri
Da e S_ O�
�_ � - �p / PCND. rev. 06127/02
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Applican� � � � i
T�x Map �• ' �rc�ei :
Su�bd;ivis�io�a
Fh�:s�e S�ct+ion� Lat �
Imgravement �ermit ' �
��a mit °,�aaid �or � �ve �� �a ��piration
Type of Facility: -' -� ' ; New � Addition �Vate� Snppiy w�� �.
# of Oc�upants �o�c # of Bedro ms � Proje�ieci Daily Flow g.p.d
Propose3 Wastewater System:�{- �mn �,�n-�-i ��9 � D Type: �'%
Proposed Repair:`�v,mn ^r� �n-�; crr�� � Type: -�T' b
Permit�Conditions: �1�� .� �I�e �P�C�
Uwner br Legal Regres ' e Signature:
Authorized State �Agen� 1
Date:
%5'
The issuanece of this pe�it by the Health Department in does not guaia� the ?s���se of other permits. It is the responsibiliiy of the �
aPPli��P�Y owner to in sure that a11 Person County Plaanmg and Zaaing and Bw'lding lnspections requir� are met� Bi�is
Improvement Permit is snbject to revocation if the sife plan, plat or the intended use changes. The Impruvemeert Permit is aoi
affec#erl by a ciiange in ownerstup of the property. This permit was issned in compliaacs.with tlte provisions of the North Carolina
`Laws and Rules for Sewage Treatjnent a�d �isnasal Svstems' (15A 1�TC�,C 18A .1900). Neither Person �onnty nor the
Enviranuaeatal Seaith Speeialist'warrants Wat. thg septic tank system will cantinue ta function satisiac#only in the futnre or'that
the water suQply w�71 remain�potabie. - — . _ . " .
Authorization to Constract Wastewater Sys�em (Reqnired for BuiIding Perm,it)
* See site plan and additi.onal attachments i�)• rbr'�K. .�i
. - � 9I3la�
Praposed Wastewater System.-�1��D C,��vP rs%io� � Type .11s-% Wastewater Flow ��.p.d.
New � Repair Expansion . Soil LTAR: . u 0 g.p.d1 ft 2 �
Type ofFac�ity: �.( (r', 8lno�P m� �,u C�l.��lli►�Q Basement_Yes k No - � ,
� . , i��%tSED ' 9 �31�
�aste�vates Syste� Reqnia�ements .t�, ��
�ank Size: Se�tic Tank: ��� gai Pnmp Taak: l oc�,1 gal �Grease Trap: —' gai
�rainf eid: 'Tot�l A.�ea: 'a� sq �-Total Length �_�o o� 11�a�mum Trench Deptia �3 m
Trench',7Vidt� 3 ft 11�'iniimuu� Soil Cover. � in lOTaimnm Trench Separation: � ft
�istr'sbntion: �'istribuiion �oa� Se�ial Distribntion �C Pressure Manifold
s�pe�ifications: �1t� 5,�e ��ce�-cf� ,� l�r�A �h� , t�t� i C1� �eS�i��ns C��c+ f=nv.
�ntiaorize� State Agsn#: Y�c �
Permit Expiration Date:
Date:
The type of. system permitted is � on na.i Acc�te3 Alternative. I accrpt the spe�ifications of the
� er/�egal �8apres�ntative: Date: g -� `-� c�
' PG"� rev. 11/lU/OS
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Tax Map: ��5 Paresi #: 1�} Date: 51aa1� .
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L�ss: I, 7� ft per 100 ft of supply line x f ai� ft of snpply.line =10d = a. � ft
�• I ft z 1.2 =�, 5 ft of fricrion head �.
. Ii�tanifold Si�: �„ &'orc� 1�Iain Size: � " PVC
�otaI Dyna�snic �ead =�Zft of Flevation head +.�_ft of Pressnre head +�� 5 ft of
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Sloped To Shed Water 12" Separation
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6" Cover • ' � Access Cover• .• , ' : ; � 1 �
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In1et Fmm Septic Tan]c Portland Cement Grout (Dovm Hill)
4" SCH 40 PVC Pipe �
Check
Tax M�E� � . P�,rcel #
Suhclivision
Ph���s�e Sect;ion Lot #
Ihut Seal Both
Ends Of The Concbiit
� 24" Mininnun
,..�.•, •. . �
Threaded G�te Valve
Zip Coxd
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CostcrEte Risex
� ` 6" Separation
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�„rPortland Concrete Graut
Mutu • - '
� Opexung Filled With
Supply ' portlaiud Ceznent Grout
Line ••
Outlet To Dutnbution
2" SCH40P�C Pipe
. Valve �Pe Float Wires .<
High Water Alarzn Level : ;
' (6" Separation� _
High Level- Fump On i�
�VaporLock � Floats ..
:, /� Hole .•
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F1oat Tzee , ,
. Law Lavel -Puznp Of£ .
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� �;.; (Material Strength y3500 PSn Block � I "
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SITE PLAN
Name C� `� O�� �'}�Q[�� Tax Map #� Patcel #�_
� �division Secrion/Lot
�t�x1.�n 1�Q�— �5. � J�
Authocized State Agent Date
Syetem cnmponents reptesent appmadmate conmuts only. The conmctot must tlag tGe system priat to begianing the insta!/ntion m
iasure that pmpergrade is mainrtined
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3 '�L �
360 �.�d
3,f,o � �k �C c�v.l�r-,e
c�.?�'�r�-t�erCh cleP�
�t res9.�.�e �c����,d
Scale:
1"=�(�'
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tnv- aeal`�h � �37-(�9�
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PCHD, rev. 09/12/Ol
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o� �: ((�of �(nood���
I.oc.ation: /nn r.,i [P I�n Q
Gcoat Log -
- T�� ls �#rY
Subdivisi� - - - . - Lot #
• WeII Constrac.fion
Distance From nea� Pmpetty Line (Minimum 10 fcet) _1 �(1
Distauce from Septic system (M'mim�n so feet) 6�
Total Depth: �,�_ ft Yield ���- GPM - St�tic Water Level- � ft
Water Beazing Zo� Depth f'I S ft ft ft ft
�
Depf�: Fmm Q to �� ft. Diamet�: _�_ m -
1`ype: Galwani�ed St+eel � . -
Weigi� Thiclaiess: �_ Height above Gc�amd: .� 2 in .
� . /
Drive Shae: Yes No Any probleias encountered whle s�ting casing? YesV No
If "yes" give r�: ' �
t�ut: - . � - . '. -
. Nea� Sand/C�t Cancret� GRaveUCe�ent
. --. A�nul�ar Space Width • inches Water in. A�ular Space Yes ' No
Met�od of Gmu� Pum�ed Press�u�e - Pouc�ed � Depth " to Ft
Materiats IIsed� - _
Liner.
Ido. Bags Pordaad cem�nt " Weight o� 1 Bag � Pounds
If mi�ure (sand, gravel, �) — Ratio bo
ID plat,e� _ Yes _ No 4 x 4 s]ab _ Yes _No
� - -<,.
Depth: Uabe Instail+ed:
Driitisg Log
Grou� 7nstatled by: -
I�ocation Drs►wing
F�om To Rorms►t�on . •
QJf� � Q.� • .
c.J '
. 2 .. • .
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[ h,ereby ce�tify that ti�e abov+e' iafa�ti�t is comect and H�at t�is well was c� in a�e wi8i regulations set fa�
by the Person County Hea18� Deparh�it . -
�a�re of Co�r � 1 � - ID # � 6 � D�ie 9 �' �'�
. PamP Ia�thaeat -
Pnmp 7nstallation �:cxi�actor: I� u rn t�'� W o/ I St�e R�� N�nb�: � 2 6' 7
Pump I�eP�: 1 l o - ft st�tic V�iater Lewel: �,�' $ '
'ump Make & Model: I? � Z 3'a v!� a�.— Pump Size and Ra�� � r �� hP � 8Pm
[ he�by c.ertifY t�at t�is pump was ins�Iled and the well I�ead �armpleted acx.ording to t�e Pe�tson Coimty Well Rules in effect
ai this dabe and ti�at a capy af t�is record bas Ueea p�+ovided to �e wdl owaer. . .
�p �� � �. . �`� . . � ,� I O �P PC� revOU27/04
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PLEASE SEE A'�`�A�C�ED PL.r�' �'�I2 �I.,L S� LAXOii7['
Tax Map �5 Parcel # I� Township:
Applicant• �Il���n c���-,c>1 �
Subdivision; Lot # �
Location: t�Cf�he�S Mill 2r1 -�C5 � C��rcl- C��� � lo�- ��-,�
(�h, ,� `�� tv�•� . .
'�ype of 3Water Supply:
Ytequire�ents:
5/�
Individual _ Comrnunity Public
� R�`�('�c�lJ ��J/lb�DB `f' � �.J G"�� � `i- �^ -�`j l �%V�
b�`-,� �pv����; -T r3w
Site Approved By: �4c,J � ���oq�o�
Grouting Approved By: �� o r%�/o�
Well Lug. S�3 � �q� 1��0� .
Pump Tag � .
WeII Tag: � _
Air Vent: .
I3ose Bib: �
Casing Height: �
Concrete Slab: -
WellDriller• �� �` E'���
Well A rove b : �
PP � Y
*�**See A�ached Sate Sketch****
Liner:
'Installed by: _
Depth set: _
Grouted•
Date:
Water Sample:
Wells must be 10 feet from property lines. ��- �
�ells must be 100 feet from septic systems.
Wells must be at least 25 feet from any building foundation.
Other canditions:
Date�. � �' l 7 0 �
PCHD xev 01l27/04
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App(icant: ��l�a'�' C�a�l�f � � .
Location: -�- -__ � � �� n �, rl
- . . er�tio� er i� c���
� System Type (ln Accordance With Tai�ie Va): ��
TH1S SYS?El1l1 H.�S �EEY�9 11�ISTt4LL�i� (N COMPLiANC� 1A/t'i'H APPLlCABLE . ORTH
�'AROLIR�A GEiVE�►L ST�4TUTES, R[J�ES �OR SEWAGE TREAiMEi�T A[�ID DISPOSAL,
AND - LL COI�lDITiOiVS OF � THE liViPROVE�E�T PERMlT AND CONSTRUCTION
.4UTH T10Rl. - .
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Authorized State Agerrt Date
1 ns#alted. B f �f'tt� �� Date: - �� S O b .
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Ow�erlAppiicant � Subdivision
Address/Locafion Se�/Phas� Lot # �
Se��ac. �°'ara�s in0��9I�a� %la���c��on an� in��d� at� �
State�lD/date S.?,2 $�Pi Trenct� �dth� � ft.
Ca aci �9JO. al. � Trench De th Z'i in:
Tes and Filter � � �_ T.renci�t Len�ih 2z � ft. _
Baffle
Sealant
Ris�r (ifi appiicable)
Tank Outfet Seal
Permanent lViaricer
Pump l'anls �
State D/date -S
Capacitv (,8a v gal.
Waterproof ISealani
Riser
Wafier Tight � ��
P�ae�a�
Checfc VaivelGate Valve �
Ant�-s�p on o e .
�larm visable and au�ii�le
Electrical Componenis
� Rate m ..
A roved Pum IViode!
Bloc� Unde�- Pum �
Pum Removal Ro elChain
. � Dis�abu�on;Sy��ern
� Serial Distribufion
�ressure an o
Low Pressure Pi e
A r. Pi e Il�llate�iai and Grad�
., , — .
�
Trenct� Gtade �
Trenci� Spacing
Roc�C Depth and G
Dams/Stepdowns
Pcessure Laterais
Hole Sbacina �
Sieeve
Required' Seiba��
From� Wells �
From Property lines
5urface Waters
Public 1Nater Suppi
Ve�tica( Cuts (>2 ft
Water Lines
VeFiicle �Traf�ic
Easements/Right of V'
O�er
Easemenis Recorded
pc:�d rev. 3113/Q1
PERSON COUNTY HEALTH DEPARTMENT
SUBSURFACE WASTEWATER SYSTEM NdO1VITORING REPORT
� / s/,� �I� �� � - �b � 1�
ate of Inspectan System Installation Date Type Tax Map Parcel #
q�1 � C� �,� — Ce�a 12cQ• .
Property Address
Instructions: Ghec� yes or no for appropriate items and explain inspace prQvided for remarks and
comments. If an item is nnt applicable, indicate by "�iA". If an item is not or cannot be ev�luate�, indicate
by "N" and explain. Nate that tizis monitoring form is not totally inclusive for all �ystems. Alt maintenar.ce
and monitoring items specified in the permit are to ba cat;ied out.
INSPECTION R�SULTS
COLLECTION SYSTEI`d:
Evidence of leal:s ?
Tank risers accessible, free of
infiltrati�n and surfac� water diverted ?
Ssptic tank needs pumping ?
�nches of solids:�_
Septic tznk filter cleaned ?
FFFLLTENT DOSING SYSTFM:
Required pumps present & funatianal7
High wate: alarm operating properly ?
Floats, valves, etc. in good condition 7
Control panel & components in good
candition Y
Efftuent free of e�cess solids ? ��
Inchss of sblids(,ncmp/�oss ±ank):�
Blapsed timc readiags r_ in a
Counter read;'ngs 7,� �
Draw�down rate: c
YES / NO
❑ � ❑
� � � N
❑ / �
►.
►�
!1 ■
►: ■
►. ■
DISPOSAL FIELD:
Evidence of efIIuent st�rfacing ? ❑
Evidence of effluent ponding in trenohes ?❑
Surface water �ffectively divsrted ? �
Di��srsio:is/swales properl;/ maintained ?
Vegetative cover maintainad ? ❑
Protected from trafiic/urcauthorized uses ? �
Distribution deviees in goud condition 7�
Field free oi settled or low arsas ?
�
/:
■
■
■
REMARKS
� 5��;� ���c ,,r�- acc�ss� 6�
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,pa�.� � bo�c.
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� �,c,�, 1�� d,�. ���e� a� �
��fas5 �l r Q��O�7 cop� Su(�`i-�
� S7sk�•-. � c���l roc� ��:��-�,
PRESSURE DISTRISUTION SYSTEM:
Tumups/�le3nouts/valves/taps intact &
accessib:e ? �- � ❑ �� � �-�'t,
Pressare head properly adjusted ? "� � ❑ ��u� �
COMPLIANCE:
Compliant '�—
Non-compliant ❑ .
Needs i�iaintenance �
AUDiTIONAI. CONIN�N i 5: � �S �� )''1 1 � � �� ( I ��� *� V � '
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