The URL can be used to link to this page

Home My WebLink AboutWELL-09-2022-181527.TIF NOV catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 5/31/2023 Owner(s): Jamie and Amy Laity ___ Mailing Address: 4199 Fishermans Ln _ Maiden,NC 28650 Property location/site legal description: 4145 Fishermans Ln,Maiden PIN: 367703417267 Well Permit WELL-09-2022-181527 Date Issued: 9/_30j2022__ ,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 1S0B-23 and all other applicable provisions of Chapter 150E 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 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 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. 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 rel. quish my y 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: 70 r ""` %, Date Signed: /1 NCDHHS/DPH/EHS/OSWP Revised May 2015 catawbacountync.gov Environmental Health Cuun:y boaern:licni Center 25 Government Diiv i PO Rex 389 Newlor NC 28658 1873.465.82/C1 MAKING. 4 : �s. catawba county public health 5/31/2023 Jamie and Amy Laity 4199 Fishermans Ln Maiden, NC 28650 Subject: Notice of Intent to REVOKE the Well Permit for 4145 Fishermans Ln,Maiden; PIN 367703417267 Catawba County Permit: WELL-09-2022-181527 To Whom It May Concern: 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 fora 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. 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 5/31/2023. Meeting the 30-day deadline is critical to your formal appeal. catawbacountync.gov Environmental Health Cc tcwhc County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 BAKING. 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, Cheyanne Morgan, REHS Environmental Health Specialist Catawba County Public Health I . mi, CATAWBA COUNTY Case# WELL 09 2022 181527 • Public Health Department Subdivision Environmental Health Division PlN# 367703417267 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3 v+ Site Address: 4145 FISHERMANS LN, MAIDEN NC 28650 Name on Permit: JAMIE&AMY LAITY Property Size: Acres 3.36 Directions: 16 S, R on Buffalo Shoals, L Olivers Cross Rd, L on Burton, R on Fishermans property on Right 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. 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 I lealth at 828-465-8270,before drilling the well. Grouting Depth:20 feet minimum Casing I[eight: 12 inches minimum above finished grade All newly constructed private drinking water wells arc required to be sampled in accordance with the North Carolina Rules Regarding Private Drinking Water Well Testing(I SA 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. 3/iirifft 1)17(A \ 09/30/2022 Authorized State Agent Permit Issuance Date 9/30/2027 Permit Expiration Date Apernni 09/30/2022 13:45 Catawba County Environmental Health PBPa-08- 021-Log 85> 7-w,pv-09- 7,011- l'°Z(1 At44, o - z on 057. •., we 20 1- 18f5Z- o I I '1.° 9, \a •41'• a \\V 9 t \�O 0.4 IV ♦ P h' 07 CS' /5' f '411' N,.i ce tad , `�� 4�� privG F 0 Q LI\ 428,50 '1 Q II) No Fd 7 21.85 lb' •4159 42.29 N.' to IV 4' Parcel: 367703417267, 4145 FISHERMANS LN lin=80ft MAIDEN, 28650 This map/report product we.prepared from the Catawba County,NC Geospatlel Information Services, Catawba County hes mode substantial efforts to ensure the accuracy of location end labeling information contoured on this map or dole on this report.Catawba County promotes and recommends the Independent verification of any data conlalnod on this map/report product by the user.The County of Catawba,Its employees.agents,and Personnel.dlsclelm,and shall not be held liable for any and all demagos,lose or liability,whether direct,Indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 09/28/2022 WPDT Report Area of Interest (AOI) Information Area : 3,134,508.63 ft2 Sep 30 2022 13:52:50 Eastern Daylight Time • Nr ,`r • t \\\ . r ti i... NNN NNN 1:4,514 Non-System Roads — Other State Agency Route o 003 0 06 4.'2 m+ I ti l ti 5 • — Federal Route — Secondary Route =`05 t 0.2 km Non-System Primary Roads Other System Roads Interstate ee c<.•x•Ry M„r:Cr roo+wrs.wtM_a Count' stale.<N,n+ C43,1,4 001 ;i (px,Stegtilp. HxxsMt Es, HEOt, (i.nn tiatxiixrt — Ramps.Rest Areas,Non-Mainline — uS Route -atTo.nngyvs,n,UTMASA,USGS,ESA.NIPS US Ccnws Nrcusu U53A NC00?G S U,,t. E.»rrs sr ANws OS tISGS.NOS kASA ••' Projected Route — NC Route 4145 Fishermans Ln, Maiden, NC All North Carolina Department of Environmental Quality(NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The NCDEQ makes no warranty of any kind,express or implied,concerning this information, including but not limited to any warranties of merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy, reliability,completeness,timeliness,or usefulness.The data is not intended to constitute advice nor is it to be used as a substitute for specific advice from a professional.Users should not act(or refrain from acting)based upon information in the Data without independently verifying the information and obtaining any necessary professional advice.Users are solely responsible for ensuring the accuracy,currency and other qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and attribution of GIS features and makes no warranty concerning same.