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Home My WebLink AboutIMPV-07-2022-176599.TIF 1111018N catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 11/15/2022 _ — --- Owner(s): Teen Challenge North CarolinaAdolesccnt Program Mailing Address: 6692 Valwood Dr Conover,NC 28613 Property location/site legal description: 6584 Valwood Rd,Conover PIN: 3745026B3831 Improvement Permit(IP) IMPV-07-2022-176599 Date Issued 7/28/2022 Authorization to Construct(AC) Date Issued ,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 130A-24 and I50B-23 and all other applicable provisions of Chapter I50B for the above referenced permit(s)(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 lllg-25%REDUCTION (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 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 rev tivtl7 1 understand that I am not required to relinquish m a eal ri th ton available to me so I do not have to wait 30 days for the revocation of the permit to ect. Signature of Property Owner. Date Signed: NCDHHS/DPH/EHS/05WP Revised May 2015 catawbacauntync.gov Environmental Health Catawba County Government Centel 25 Government Drive I PO Box 389 I Newton NC 28658 1828,465.8270 MAKING. LIVING. BETTER. �■tart. _ u RBPR-09-2022-42345 er CATAWBA COUNTY Case �j Public Health Department Subdivision i' f2 PINY) 374502683949 i Environmental}{e>il�pivision 'iif PO Box 389,100-A Southwest Blvd,Newton,NC 28658 i4r NAME ON PERMIT: TEEN CHALLENGE NORTI I CAROI.INAADOLESCENT PROGRAM (*JOHN STEIGERWALD),PO BOX 11460, HICKORY NC 28603 Teen Challenge North Carolina F Site Address; 6584 VALWOOD RD,CONOVER NC 28613 Property SUS: Square Feet Acres 2.5 Directions: Lefl of of St Peters Church Rd onto Valwood Rd.Large lot at the corner of Valwood Rd and Central Dr. Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan•80 months(5 years);with complete plat .without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct Issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permts may be revoked If site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the Information provided herein is true,complete and correct Authorized county and state officials are granted right of entry to conduct neoessary Inspections to determine compliance with applicable laws and rubs. I understand that I am solely responsible for the proper Identification end Labeling of all property lines and corners and making the sit.accessible so that a complete site evaluation an be performed. The undersigned is the of property or legal agent of the owner. lid Signature ofApplicant or Ag e � / Date: / 8 If you need further infonnotion or assistance ple •2II 8 i-4. { AREAS FEENAM& BATL FEE AMOUNT Authorization to Construct Fee(New/Expansion) 09/23/2022 S 150.00 Fee Improvement Permit Fee 1 2107/2 02 2 $70.00 TOTAL FEES S220.00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) :L>rptuauuu ., mown t&i4 Page 2otl catawba county public health 11/15/2027 Teen Challenge North Carolina Adolescent Program 6692 Valwood Dr Conover, NC 28613 Subject: Notice of Intent to REVOKE the Improvement Permit for 6584 Valwood Rd PIN 3745022683831 Catawba County Permit IMPV-07-2022-176599 Dear Sir: 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 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 Ccicwhc 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 11/15/2022. 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, '.i('Y1 ✓4r+1 Dean Evans, RENS Environmental Health Specialist Catawba County Public Health