HomeMy WebLinkAboutWELL-07-2022-175759.TIF catawba county
public health
VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS
Date prepared. May16,7023__.
Uwnerlsl• Richard and Kristin Salkowskr
Marling Address 1896 Lptus En
Denver,NC 780.17 7896
uroperty location/site legal description: 3974 Cedarwood Tr,Terrell,NC
PIN 461704734177
Well Permit WEL1-0/-2022-175759 Date Issued: 7/14/1027
,voluntarily relinquish my rights to pursue a formal appeal through the North
1pr,nt full Hamel
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 permit(s)in order for the authorized agent/local health department to issue the applicable permit(new
Replacement Well permit)for the site. I understand by completing this form that the permit(s)for a
_New Well _..
(well pcimit 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 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 th.s 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 slnrng this form that I agree that I
do not want to appeal the permit revocation
I understand that lam 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 Proyrrty owner:__
Date Signed:- 5/.6/L
NCDHHS/DPH/ENS/OSVrP Revised May 701
catawhacountytic.gov
Environmental Health
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catawba county
public health
May 16, 2023
Richard and Kristin Salkowski
1896 Lotus Ln
Denver NC, 28037-7896
Subject: Notice of Intent to REVOKE the Well Permit for 3974 Cedar Wood Tr,Terrell, NC,
PIN 461704734177 Catawba County Permit: WELL-07-2022-175759
Dear Richard and Kristin Salkowski:
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 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 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 5/16/2023. Meeting
the 30-day deadline is critical to your formal appeal.
catawbacountync.gov
Environmental Health
Cctcwbc County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
M M UNG. 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 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,
90,-.1%44. -it 424,02.
James R. Ross, REHS
Environmental Health Specialist
Catawba County Public Health