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Home My WebLink AboutIMPV-06-2022-172728.TIF catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 3/21/2023 Owner(s): Boyce...Stott Hart Malting Address: 2580 Old Shelby Rd Hickory,NC 28602 Property location/site legal description: 2570 Old Shelby Rd,Hickory PIN: 278116856070 Improvement Permit(IP) IMPV-Q67022-172728 Date Issued 6/2/2022 Authorization to Construct(AC) AUTH-06-2022.172729 Date Issued 6/2/2022 Ce }} 'lvoluntarily relinquish my rights to pursue a formal appeal through the North (print full name) Carolina Office of Administrative Hearings pursuant to NC General Statute 130A-24 and 1508-23 and all other applicable provisions of Chapter 1508 for the above referenced permits)(which Includes the 1Ps 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 3g-201d3e.ductian (System description) will be revoked immediately by the authorized agent/local health department. I understand that the local health department's revocation of a permit can be appealed to the North Carolina Office of Administrative Hearings 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 1P 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 tome so I do not have to wait 30 days for the revocation of the permit to take effect. 1 f Signature of Property Owner. Date Signed: March 21, 20 23 NCOHHS/DPH/EHS/OSWP Revised May 2015 catawbacountync.gov Environmental Health Cctcwbc County Government (enter 25 Government Drive I PO Box 389 j Newton NC 28658 ( 828.465,8270 MAKING. LIVING. BETTER. catawba county public health 3/21/2023 Boyce Scott Hart 2580 Old Shelby Rd Hickory, NC 28602 Subject: Notice of Intent to REVOKE the Improvement Permit and Authorization to Construct for 2570 Old Shelby Rd PIN 278116856070 Catawba County Permits IMPV-06-2022-172728 and AUTH-06-2022-172729 Dear Mr. Hart: The Environmental Health Division of Catawba County Public Health intends to revoke your Improvement Permit and Authorization to Construct 30 days from the date of this notice. If the permits are revoked,you must apply for a new Improvement Permit and Authorization to Construct (IP/AC) and meet the requirements of the current laws and rules necessary to obtain a new IP/AC. 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 150B-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 Cotowhe County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKI G. 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 3/21/2023. 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 1506-23)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. Res ectfully, f „, s can Evans, REHS Environmental Health Specialist Catawba County Public Health SY,4 CATAWBA COUNTY Case# 1MPV-06-2022-172728 Public Health Department ion Q t Environmental Health Division PIN# 278116856070 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# A • Site Address: 2570 OLD SHELBY RD, HICKORY NC 28602 Name on Permit: SCOTT HART Property Size: Acres 5.01 Directions: 140 W to Exit Old Shelby Rd, Turn L go Approx 1 mile past Hildebran Shelby Rd on R,then turn Left to Property 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 d 9•P• Type of Facility: Primary Residence- 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: 25%REDUCTION System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP Pump Required Permit Conditions: • Right-of-way and property corners must be staked at the time of the septic construction. Construction of septic system shall not be started without right-of-way and property corners being staked. If stakes are moved or removed, a surveyor will be required to place stakes again prior to construction. • Do not drive, grade, cut, or fill over the initial septic or septic repair areas. I pc m a 07/06/2022 I4:40 554 CATAWBA COUNTY Case# IMPV-06-2022-172728 1.7 •t,I ,y, Public health Department Subdivision '-'3 Environmental Health Division PIN# 278116856070 PO Box 389,25 Government Drive,Newton,NC 28658 LOTti A git a' Site Address: 2570 OLD SHELBY RD, HICKORY NC 28602 Name on Permit: SCOTT HART Property Size: Acres 5.01 Directions: 140 W to Exit Old Shelby Rd, Turn L go Approx 1 mile past Hildebran Shelby Rd on R,then turn Left to Property 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' (15A NCAC 18A.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. &,1...:I., p . ✓��lJ 06/02/2022 Authorized State Agent Permit Issuance Date 6/2/2027 Permit Expiration Date No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. chprnnit 07/06/2022 14:40