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\'OLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS
l,rcp:; . ! April 28.2023 -- —
ioncl Walley
131 Sagcmore.Rd_-._____
',looresvillc, NC 281 17
is t;.'siie legal description: 9685 Island Point Rd
462891469009
r;t, (1P} IMPV-10-2022-182429 Date Issued 10/17/2022
. ::'unst,uct(AC) IMPV-10-2022-182433 Date Issued 10/17/2022
, voluntarily relinquish my rights to pursue a formal appeal through the North
name)
k. il.c of Administrative I learings pursuant to NC General Statute 130A-24 and 15013-23 and all other applicable
pr wisi•,r;c:f:'';,dpter 150B for the above referenced permit(s)(which includes the IPs and ACs)in order for the authorized
gtrn;.'':ucai health department to issue the applicable permit(new IP and/or AC)for the site. I understand by completing this form
that the permit(%) for a
50%reduction system(lllb)
(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 II'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 I learings 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 re inquish ty peal rig . ut that this is an option available to me so I do not have to wait 30
days for the revocation of the permit t take ef t.
Signature of Property Owner:
Date Signed:
NCDHHS/DPH/EHS/OSWP Revised May 2015
catawbacounty
nc.gov
Environmental Health
Cetowhc County Government Censer 3"r
25 Gavernnteni Duna PO Box 389 I Newton NC 28658 1828.465.8210
MAKING. LIVING. BETTER. •
,
Catawba county
public health
April 28, 2023
Lionel Wadey
13l Sagemore Rd
Mooresville,NC 28117
Subject: Notice of Intent to REVOKE the Improvement and Authorization to Construct
Permits for 9685 Island Point Rd, Sherrills Ford; PIN 462801469069; Catawba
County Permits IMPV-10-2022-182429 and AUTH-10-2022-182433.
Dear Mr. Wadey:
The Environmental Health Division of Catawba County Public Health intends to revoke your
Improvement Permit and Authorization to Construct 30 days from the date of this notice.
If the permits are revoked, you must apply, which you have already done, for a new
Improvement(IP) and Authorization to Construct(IP/AC) and meet the requirements of the
current laws and rules necessary to obtain a new IP/AC 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 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.
catawbacountync.gov
Environmental Health
Cctowbo County Government Center
25 Government Drive PO Box 389 Newton NC 28658 828.465.8270
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 April 28, 2023. 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 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,
N5s- Aj•-(J‘.,
Steven Price, REHS
Environmental Health Specialist, OSWP Division
Catawba County Public Health
i
,T CATAWBA COUNTY� '
t .�.� a Public health Deportment Subdivision
2 , - * Environmental Health Division PINT 462801469069
Apt � PO Box 389.25 Government Drive.Newton,NC 28658 LOT# 1
Site Address: 9685 ISLAND POINT RD, SHERRILLS FORD NC 28673
Name on Permit: •BLUEFIELD BUILDERS, LLC
Property Size: Acres 0.91
Directions: Take Island Point Rd all the way to end past Riviera Dr.Empty lot to right,next to 9667 Island Point Rd.
Owner/Authorized Representative Acknowledgement of Permit Receipt
0\ certify
that I am the owner or authorized agent(owner's authorization required)representing the owner of
the pl foperty described above.
A(s the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2022-40885,by the following method(s):
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required) _...
PofAs the property owner or authorized representative I have reviewed and understand the specific conditions
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(15A NCAC 18A.1900),
and/or Well Construction Standards(ISA 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: 10/17/2022
Owner/Authorized Representative Signature , I ...I AL
.k'°.1Date IQ dt Q IA3\
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time 44)3
Method: Fax Nimail 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/ENCusttomerService
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etiptrms1 10/18/2022 15:02