The URL can be used to link to this page

Home My WebLink AboutIMPV-10-2022-182712.TIF catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 8/7/2023 Owner(s): Jeffery Weeks Mailing Address: 6065 Little Mountain Rd Sherrills Ford,NC 28673 Property location/site legal description: 3964 Hoke St PIN: 376004936294 Improvement Permit(IP) IMPV-1 0-2022-1 827 1 2 Date Issued 10/21/2022 Authorization to Construct(AC) Date Issued I, 1{{ l de ,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 150B-23 and all other applicable provisions of Chapter 150B for the above referenced permit(s)(which includes the[Ps 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 IIIb-50%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 revocation. I understand that I am 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 Property Owner: 'lr Date Signed: crii 6/ - NCDHHS/DPH/EHS/OSWP Revised May 2015 catawbacountync.gov Environmental Health Cetcwho County Government Center 25 Government Drive I PO Box 389 Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. (i) Catawba county public health 8/9/2023 Jeffery Weeks 6065 Little Mountain Rd Sherrills Ford, NC 28673 Subject: Notice Of Intent To REVOKE The Improvement Permit for 3964 Hoke St, Claremont, NC PIN 376004936294 Catawba County Permits IMPV-10-2022-182712 Dear Mr.Weeks: 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 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 Catawba County Government Center 25 Government Drive 1 PO Box 389 1 Newton NC 28658 1828,465.8270 MAKING. LIVING. BETTER. I 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 8/9/2023. 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 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, l „ 5.4.+s can Evans, REHS Environmental Health Specialist Catawba County Public Health 4`r ('ATAWBA('MIN.l ('as q Z{• 1' ■ Public Ileulth f)epunmrnt Subdivision WOODLAND OAKS 's Envinauncntal Ilealih Division I'INil 376004936294 ��/� PO Bus. . Govcnunein Drive.Newton.N(' 2Nn58 ear 3IQ 251(�rs 36 Site Address: 3964 HOKE ST,CLAREMONT NC 28610 Name on Permit: TIM BERGHOFF Property Size: Acres 0.74 Directions: From Balls Creek Rd turn onto Hoke Street, lot is down the road near the end on the right Owner/Authorized Representative Acknowledgement of Permit Receipt I certify that I an)the owner ur authorized agent Imvner-s authorisation required)representing the owner of the property described above. I As the property owner or authorized representative. I have received the above referenced pertnit(s)as requested in the application for service EIIPR-O8-2022-421 I5, by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) /1/4l As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and d further understand that all applicahl(, regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A NCAC INA.1900), and/or Well Construction Standards(I5A NCAC 2C.0100), shall apply to the issuance of this permit and the construction ol•the wastewater system and/or water supply well permitted. Permit Issue Date: 10/21/2022 Owner/Authorized Representative Signature • Date i/( 1 raa I)ocurnentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by Warne a/person sending Signature Date/'Time 101)1 NZ Method: Fax J Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yo&Please ttake a few momentts tto complette our custtomer service survey at# http://www.surveymonkey.com/s/ENCusttomerServIce be,5hDife yahoo. &To 0 , CATAWBA COUNTY Case# IMPV-10-2022-182712 H t 111 is Public Health Department Subdivision WOODLAND OAKS d milli(7. f84 is Environmental Health Division PIN# 376004936294 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 36 Site Address: 3964 HOKE ST, CLAREMONT NC 28610 Name on Permit: TIM BERGHOFF Property Size: Acres 0.74 Directions: From Balls Creek Rd turn onto Hoke Street, lot is down the road near the end on the right Improvement Permit AN AUTHORIZATION TO CONSTRUCT MUST BE ISSUED PRIOR TO BUILDING PERMITS THIS PERMIT IS NOT FOR SEPTIC INSTALLATION Permit Category: New Septic Wastewater Flow 360 d 9•p• Type of Facility: Primary Residence-SFD Basement? No Basement Plumbing? No Bedrooms: 3 Water Supply: Private Well Maximum Occupants: 6 INITIAL SYSTEM SPECIFICATIONS Proposed Wastewater System: 50%REDUCTION HORIZONTAL System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP Pump Required _ REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 50%REDUCTION VERTICAL System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION Pump Required ***** Operator Required Permit Conditions: *DO NOT CUT OR FILL OVER ANY PART OF SEPTIC SYSTEM *DESIGNED FOR CRAWL SPACE FOUNDATION *WILL REQUIRE FILL TO BE BROUGHT IN FOR ADDITIONAL COVER OVER THE SEPTIC DRAIN FIELD. Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains,is not approved,and may result in failure to approve the initial system installation,or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant /property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina'Lmvs and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 18A.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Any permit issued for a conventional system may be used for an accepted system without Environmental Health authorization or permit modification.Please notify Environmental Health of this change prior to system installation. / 01044 E✓4M5. 10/21/2022 Authorized State Agent Permit Issuance Date 10/21/2027 Permit Expiration Dale No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. ehpcmiit 10/26/2022 09:39