HomeMy WebLinkAboutIMPV-06-2022-173010.TIF catawba county
public health
VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS
Date prepared: _October 20,2022 _...._,..._.._.
Owner(s): Kevin C'ox& Mark Cox
Mailing Address: 2112 Arney St.
Lincolnton,NC 28092
Property location/site legal description: 3394 Sweetgum Ln,Lincolnton NC 28092
PIN: 361702577095
Improvement Permit(IP) IMPV-06-2022-1730I0 Date Issued 6/7/2022
Authorization to Construct(AC) N/A Date Issued _ NLL1
Kevin D Cox , voluntarily relinquish my rights to pursue a formal appeal through the North
(print full name)
Carolina Office of Administrative Hearings pursuant to NC General Statute I3OA-24 and 150E 23 and all other applicable
provisions of Chapter 150B for the above referenced permit(s)(which includes the II's 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
25%reduction systettt(11IG) ^T
(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 he appealed to the North Carolina Office of Administrative
Ilearings 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 II'and AC must he 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 ofa 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.
l 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: ) s&n., rQ, �L
Date Signed: 10/24/2022
NCDHHS/DPH/EHS/OSWP Revised May 2015
catawbacountync.gov
Environmental Health
Cotowbo County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
t;: 1
catawba county
public health
October 20, 2022
Kevin Cox
Mark Cox
2112 Arney St.
Lincolnton,NC 28092
Subject: Notice of Intent to REVOKE Improvement Permit; 3394 Sweetgum Ln,
Lincolnton; Catawba County Permit IMPV-06-2022-173010
Dear Sirs:
The Environmental Health Division of Catawba County Public Health intends to revoke your
Improvement Permit 30 days from the date of this notice.
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 I-Iealth 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.
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 October 20, 2022. Meeting the 30-day deadline is critical to your formal appeal.
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
If you file a petition for a contested case hearing with the Office of Administrative Hearings, you
are required by law(NC General Statute 150B-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,
Megen cBride, REHS
Environmental Health Administrator
Catawba County Public Health
cc: Robbie Phelps, REHS, Environmental Health Supervisor
re CATAWBA COUNTY Case# IMPV-06-2022-173010
i k Public Health Depanment Subdivision BLACKBURN RIDGE PH 2
" - . Environmental Health Division PIN# 361702577095
likiptfry PO Box 389,25 Government Drive,Newton,NC 28658 LOT, 26
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Site Address: 3394 SWEETGUM LN, LINCOLNTON NC 28092
Name on Permit: KEVIN COX
Property Size: Acres 0.53
Directions: Startown Rd turn right onto Blackburn Bridge Rd, turn right onto Woodgreen Dr, turn right onto Sweetgum Ln,
lot is on the left in cul-de-sac
Owner/Authorized Representative Acknowledgement of Permit Receipt
e-I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
.�CCAs the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-04-2022-40755,by the following method(s):
Received in Person
-y- Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
t.LC-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(1SA 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:06/07/2022
Owner/Authorized Representative Signature C$`►//Yl a
-1 Date 07/29/2022
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
/J )17/,,
Signature Di' ' Date/Time 7
Method: Fax iEmail 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
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