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Home My WebLink AboutIMPV-05-2022-170849.TIF . f f I t``` l f. cataw a county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: t110,12021. _ _ .__ __ _........._.,......_ Owner(`): Dcva*Monroe., , ____ Mailing Address _.._ : . .12._$_.Koiwtsctir Cd. Maiden,NC 2116S0 Property location/site kgal description. 134 Gibbs Cir,Maiden NC 28,50 PIN 10.61.11.64Z44.. Improvement Permit(IP) IMPV-05-2022-1701149 Date Issued: 516.'2022 I• �._. ,/VQcr _ _. on ro voluntarily relinquish my nghts to pursue a formal appeal through the North (print full name) Carolina Office of Administrative Hearings pursuant to NC General Statute I 30A-24 and 15013-23 and all other applicable provisions of Chapter 150B for the above referenced permit(s)(which includes the IPs and ACs)in order for the authorized agent/local health department to issue the applicable permit(new IP and/or AC)for the site. I understand by completing this form that the permit(s)for a _._1)tfi-25%.CGduclion (System description) i will be revoked immediately by the authorized agent/local health department. 1 tmderstand that the local health department's revocation of a permit can be appealed to the North Carolina Office of Administrative I tearings within 30 days of the revocation pursuant to the North Carolina Administrative Procedure Act. I understand that in order for the local health department to issue another IP and AC that the current IP and AC must be revoked I understand that the local health department's revocation of an IP or CA is not effective until 30 days from the revocation or,if the revocation is appealed.at the time that the Office of Administrative Hearings issues a final decision. I understand that by signing this form and relinquishing my right to appeal the permit revocation at the Office of Administrative hearings that the local health department's permit revocation will become effective immediately. I understand and agree that the revocation of a permit that takes effect immediately is in my best interest. I understand that by signing this form that I agree that I do not want to appeal the permit revocation. I understand that I am not required to relinquish my appeal rights but that this is an option available to me so I do not have to wait 30 days for the revocation of the permit to take effect.. Signature of'Property Owner.___ ....}\1\01tAtv Date Signed:_...._ .i . Z g-/Z.0 2, .. NCD IHS/DPH/EHS/OSINP Revised May 201S catawbacountyytc.gov Erviratttttanlal kttalth Cctc*ncc County Go+etn7 ent (enter 15 Government Drive I PO Box 389 1 Newton H(. 18658 I 818 465 8770 MAKING. LIVING. BETTER. NOW catawba county public health 1/10/2023 Devarta Monroe 133 Gibbs Cir, Maiden, NC 28650 Subject: Notice of Intent to REVOKE the Improvement Permit for 134 Gibbs Cir, Maiden NC 28650 PIN 363611764749 Catawba County Permit: IMPV-05-2022-170849 To Whom It May Concern: The Environmental Health Division of Catawba County Public Health intends to revoke your Improvement Permit 30 days from the date of this notice. If the permit is are revoked,you must apply for a new Improvement Permit (IP)and meet the requirements of the current laws and rules necessary to obtain a new IP You have a right to an informal review of this decision. You may request an informal review by the environmental health supervisor at the local health department. You may also request an informal review by the NC Department of Health and Human Services 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 file a petition for a contested case hearing with the Office of Administrative Hearings 1711 New Hope Rd, Raleigh, NC 27609. You may write the Office of Administrative Hearings, call the office at (984)236- 1850 or get a copy of the petition form from the OAH web site at http://www.oah.nc.gov . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150E-23 and all other applicable provisions of Chapter 150B. North Carolina General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. catawbacountync.gov Environmental Health Cctcwhc County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. 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 1/10/2023. Meeting the 30-day deadline is critical to your formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings,you are required by law (NC General Statute 150E-23) to serve a copy of your petition on the Office of General Counsel, NC Department of Health and Human Services, 2001 Mail Service Center, Raleigh, NC 27699- 2001. Respectfully, gA,Ue-PA—t j--- Cheyanne Morgan, REHS Environmental Health Specialist Catawba County Public Health I 76 s a CATAWBA COUNTY Case# IMPV-05-2022-170849 .�. 2 Public Health Department Subdivision d gg2 �,_\ � Environmental h ealth Division PIN# 363611764749 PO Box 389,25 Government Drive,Newton,NC 28658 LOTl1 l Site Address: 136 GIBBS CIR, MAIDEN NC 28650 Name on Permit: DEVARTA MONROE Property Size: Acres 1.76 Directions: From salem church rd you would need to make turn on Gibbs circle and drive to the home at the end on the left Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I am the owner or authorized agent(owner's authorization rcquircd)representing the owner of the property described above. 1" As the property owner or authorized representative, I have received the above referenced " permit(s)as requested in the application for service RBPR-10-2021-39140, by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) IElectronic Image Transmittal/E-mail (Return receipt required) As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900), and/or Well Construction Standards(15A NCAC 2C .0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 05/06/2022 �) Owner/Authorized Representative Signature I Date 12.6_0y Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature eiC _Date/Time gin pi. Method: Fax v Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yoaPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService deval!tt-m.0n,fh gi . c`trn ,,,,,„„, 05/06/2022 16:50 ler = • C.ATAWBA COUNTY Case ti IMPV-05-2022-170849 f~ .t.II Public Health Department Subdivision d Environmental Health Division PIN 363611764749 /g.2 PO Box 389,25 Government Drive,Newton,NC 28658 LOTII w Site Address: 136 GIBBS CIR, MAIDEN NC 28650 Name on Permit: DEVARTA MONROE Property Size: Acres 1.76 Directions: From salem church rd you would need to make turn on Gibbs circle and drive to the home at the end on the left Improvement Permit AN AUTHORIZATION TO CONSTRUCT MUST BE ISSUED PRIOR TO BUILDING PERMITS THIS PERMIT IS NOT FOR SEPTIC INSTALLATION Permit Category: New Septic Wastewater Flow 360 g.p.d Type of Facility: Primary Residence-New House Basement? No Basement Plumbing? No Bedrooms: 3 Water Supply: Private Well Maximum Occupants: 6 INITIAL SYSTEM SPECIFICATIONS Proposed Wastewater System: 25%REDUCTION System Classification: IIIG-OTHER NON-CONY TRENCH SYSTEMS REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50%REDUCTION VERTICAL System Classification: IIIE-PPBPS GRAVITY DOSED SYSTEM Permit Conditions: -IP only for loan approval to clear lot surrounding proposed house location. -AC will NOT be issued until clearing of septic area. -Do not drive, grade, cut or fill over any part of the initial or repair septic areas. -All septic areas must remain 10 feet from property lines and 5 feet from building structures. Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains,is not approved,and may result in failure to approve the initial system installation,or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant /property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. 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 for Sewage Treatment and Disposal Systems' (I5A NCAC I 8A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit modification.Please notify Environmental Health of this change prior to system installation. 371rt 11°17( 05/06/2022 Authorized State Agent Pennit Issuance Date 5/6/2027 Permit Expiration Date No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. s'lah miiI 05/O6/2022 16:50 Catawba County Environmental Health PQ- to- • . 1411 ./ Z°21_39IYo `/9 ,. ,9) i : • I2=e03 / i irz' ' /3,; pit a+`dNl2 Re . re4 30 sy, r 5-0 gr f t I ; I Parcel: 363611764749, 136 GIBBS CIR MAIDEN, 1in=100ft 28650 This mapheport product was prepared from the Cataurbe Cow*y,NC ceosprw Inhomstion services. ca ret&County hes made subelenteel semis to ensure the accuracy d lockion and labeling Homnllan • iiined on ids mq or deft on this report.Cadet*Courdy pwmpns end reco a sonde the independent vertid ion d any data corbeled on Mk mepireport product by the user.The County d Caeawbe,ilr employees.vents.end 11 personnel.cfedsi n,and shad not be held Sable kit any and ell dampen,loos or IabUty,whether deed.k+dired or aorwgtNndel which arises or may arise from this maphrport prcdud or the use Canto,by any parson ar inky. Copyright 2O21 Celeste County NC O5004/2022 DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheer of I DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL HEALTH SECTION PROPERTY ID#: l ` ! 'lf ON-SITE WATER PROTECTION BRANCH COUNTY: SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Completc all fields in fun) OWNER: De e / r,�e APPLICATION DATE l I ADDRESS: /Z� f M DATE EVALUATED: le i PROPOSED FACILITY:�e(✓ .rat:. PROPOSED DESIGN FLOW(.1949): 1 O 6/D PROPERTY SIZE: I. 7b 1,06 LOCATION OF SITE: /3 L 6;1,1,1 Cif, M i,4en Ax Zint5b PROPERTY RECORDED: WATER SUPPLY: I�Private 0 Public ElVeII 0 Spring 0 Other EVALUATION METHOD: 'Auger Boring 0 Pit 0 Cut TYPE OF WASTEWATER Sewage 0 Industrial Process 0 Mixed • . e x SOIL MORPHOLOGY OTHER 0 F (.1941) PROFILE FACTORS 1 .1940 E LANDSCAPE HORIZON POSITION/ DEPTH .1942 PROFILE a SLOPE% (f.\.) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS/ SOIL SA PRO RESTR &LTAR TEXTURE MINERALOGY COLOR DEPTH CLASS HORIZ Z s 0-3 L C fills , N7.5y Ps 3-Z1 C MK _ s s , r� 1 Z1-3( C. 4& Frtci5 f$e( Flt I O 5 0/v 34-VI C WSQ( ,1rjs/sp1 S '( Z! -3r. 0. Z5 o-1 id. 58K , ss1sfst 11 . I -S :33 . 6 Or sf ,Soy. li f.5 2 sv j3-ql C wcaK s s �x 8' ii. .3 L 0-LI L 6 f ss,$),s .ee S c{-30 e 58K .p4S Il is 3 3o-V e AA frSs ,s ys 3-0/a ' � �! a. 3 L S o-s ss/sr,s0(� �s 3-3° C SPC 5rSP5 , 45-1/ 3v-YS Ct Bc fir{SS,S/1S4KP �g d Wi K 0. 3 DFSCRIP'TION 1 INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): D SITE CLASSIFICATION(.1948): fs Available Space f.1943) �s / 1 f System"Type4s) 2 S°// re t7 o'' rCa EVALUATED BY: Act. AO/$i1 t �I44 /stgAr /a r� OTHER(S)PRESENT: �cOL[an4 ✓ Sue LTAR O. 2?5 (/. 3 "TT►► c6MMI.Nrs, !as Lod 1,/ ir;cm ('font >_n. Auo�i>e stilt 1 G $ Iipdamd February 2014 Catawba County Environmental Health ,ao r. 7) Rao_ !p-z°71-39/1/o Is:130 I-11Pv OS -Zo22 - 1?1,Ev9 it • . / . 1/111/ 2yg 0 2/ z3`, 3b ?rep der' 3 f3 _•/ • w tie / / 24, qv toys t/31 rr IN/' oit Tf, r / i Parcel: 363611764749, 136GIBBS CIR MAIDEN, 1in=100ft 28650 This roap tepod product was prepared from Vie Catawba County,NC In orrnatlon Se viosa. Catawba Cary has marte elects b ennee Ow achual/of loc tion and Wham Yiarndlon oa hi1on map or data an was spat.Catawba Carr pwnoies and recommends , the independent roamon of rely dabs o e1iwd on Na maphepott product by the user.The County of Cahwba its eropkiy ass,agents.and penormel.declaim,and shall nob be held liable for any End a1 damages,loss of Yabity,whether died Indir+ct at noneaqua list sitich vises or rosy arise from bite nap/repot product firths use thereof by any pet.un or entity,awba County NC 06104r2022