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Home My WebLink AboutWELL-06-2022-174414.TIF (' ) catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: __..8/14/2023 Owner(s): Ned Williams Mailing Address: 6134 Park Hill Rd Charlotte,NC 28277-0151 Property location/site legal description: 3954 Cedar Wood Tr,Terrell PIN: 461704733329 Well Permit WELL-06-2022-174414 Date Issued: 6/22/2022 I, Ate/ DUI /l1ep,..,j ,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 I 30A-24 and 150B-23 and all other applicable provisions of Chapter 150B for the above referenced permit(s)in order for the authorized agent/local health department to issue the applicable permit(Well permit)for the site, I understand by completing this form that the permit(s)for a New Well (well permit type) 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 1 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 Well Permit that the current Well Permit must be revoked. I understand that the local health department's revocation of the Well Permit 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. 1 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 1 do not have to wait 30 days for the revocation of the permit to take effect. Signature of Property Owner: /vq,1 'c i.--(.4411-1--"•-' Date Signed: /1 '/z3 NCDHHS/DPH/EHS/oSWP Revised May 2015 catawbacountync.gov Environmental Health Catowba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 I 828.465 8270 MAKING. LIVING. BETTER. catawba county public health August 14, 2023 Ned Williams 6134 Park Hill Rd Charlotte, NC 28277-0151 Subject: Notice of Intent to REVOKE the Well Permit for 3954 Cedar Wood Tr,Terrell PIN 461704733329 Catawba County Permit: WELL-06-2022-174414 Dear Mr. Williams: The Environmental Health Division of Catawba County Public Health intends to revoke your Well Permit 30 days from the date of this notice. If the permit is revoked,you must apply for a new Well Permit and meet the requirements of the current laws and rules necessary to obtain a new Well Permit. 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 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, 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 1508. 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 Catawba 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 8/14/23. 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, qt..,, Robert Phelps, REHS Environmental Health Supervisor Catawba County Public Health L >� � CA7: W:t\('bt V•I' i, Puhl.:I Lalth 1 1'pa�meat p I ti uhJi�rs�an • Environmental health Division Plea 461704733329 IK)Buy.1Kv,25 Government Ikicr,Newton.NC 'MOH/yti:�'. !O'I'N 1 Site Address: 3954 CEDAR WOOD TR. TERRELL NC 28682 Name on Permit: NED WILLIAMS Property Size: Acres 0.66 Directions: head on 150,turn on Kiser Island Rd.Across from the light at Marshall Steam Station,3rd Left onto Cedar Wood Trail Owner/Authorized Representative Acknowledgement of Permit Receipt /G'' r I rertilj that I ant the Owner or authorized agent(owner's authorization required)representing the owner of the property described ahos e. Z� � As the property owner or authorized representative. I have received the above referenced permits)as requested in the application for service RBPR-05-2022-41156, by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) J Electronic Image Transmittal/E-mail (Return receipt required) L'/ ___As the property owner or authorized representative I have reviewed and understand the specific conditions , ol'the permit issued, and further understand that all applicable regulatory requirements specified p d under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC i 8A.1900), anti/or Well Construction Standards(I5A NCAC 2C.0100), shall apply to the issuance o1'this permit and the construction of the wastewater system andFor water supply \yell permitted. Permit Issue Date:06/22/2022 /crOwner/'Authorized Representative Signature ," i c'2t-d - Date_____A ✓Or..- -7' Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted h} (nwne n/•person sending pernrit') Signatu __re e — --- t'1)ail✓ Method: Fax 'TiDate�Time Email US Mail _ Other Oss ner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yotelease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService ne(I1 Il<<i„ss �:''<5n o• r. 4.11 1 r ,0.2 2.22 16 22 •-v• CATAWBA COUNTY Case# WELL-06-2022-174414 .i. y Public Health Department Subdivision d e Environmental Health Division PIN# 461704733329 v\9 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1 /•. J Site Address: 3954 CEDAR WOOD TR, TERRELL NC 28682 Name on Permit: NED WILLIAMS Property Size: Acres 0.66 Directions: head on 150,turn on Kiser Island Rd,Across from the light at Marshall Steam Station, 3rd Left onto Cedar Wood Trail NEW WELL PERMIT REQUIRED WELL SETBACKS: Septic Systems and Repair Areas for Single Family Dwellings 50 ft. Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft. Underground Storage Tanks 100 ft. Animal Barns 100 ft. Lakes/Ponds 50 ft. Streams/Brooks/Creeks/Rivers 25 ft. Building Foundations 25 ft. All Other Sources of Groundwater Contamination 100 ft. Saprolite Septic Systems and Repair Areas 100 ft. Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft. PERMIT CONDITIONS The 50ft buffer and southeast property line must be survey staked before the well can be drilled. Wells shall be constructed in accordance with state regulations: Article 15A North Carolina Administrative Code Subchapter 2C The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of the above setbacks,contact Catawba County Environmental Health at 828-465-8270,before drilling the well. Grouting Depth:20 feet minimum Casing Height: 12 inches minimum above finished grade All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private Drinking Water Well Testing(15A NCAC 18A.3800).The fee for this sampling is included in the cost of the well permit.It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health. 06/22/2022 Authorized State Agent Permit Issuance Date 6/22/2027 Permit Expiration Date ehpctntit 06/27/2022 10:58