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Home My WebLink AboutAUTH-01-2023-187393.tif catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared 300023 Owner(s): _-S2eva.rtiMome.__ Mailing Address 128 am c ir_Rd_ Maiden,NC 28650 Property location/site legal description: 134 Gibbs Cir Maiden.,NC PIN 363611764749 improvement Permit(IP) IMPV-Q1-2023-187390 Date Issued 1/10/2023 Authorization to Construct(AC) AUTH-01.2023.187393 Date Issued 1/10/2023 - I ��,iQQ I, -DQ v r 0 Y1 vorimtarily 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 1508-23 and all other applicable provisions of Chapter 15C8 for the above referenced permit(s)(which includes the IPs 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 IIIY—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 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 effe Signature of Property Owner:Date signed: J 1 6, 2 0 z3 NCDHHS/OPH/EHS/OSWP Revised May 2015 catawbacountync.gov Environmental health (c'cr+hc (ounty Govelninenl (eniei 25 Govcln:lent Olive I PO Box 389 ! Newloi N( 28658 182E 465 )) MAUI?I!, IIVlki( 141"T)14 NOW catawba county public health 3/7/2023 Devarta Monroe 128 Ramseur Rd Maiden, NC 28650 Subject: Notice of Intent to REVOKE the Improvement Permit and Authorization to Construct for 134 Gibbs Cir, Maiden, NC PIN 363611764749 Catawba County Permits IMPV-01-2023-187390 AUTH-01-2023-187393 To Whom It May Concern: 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 for a new Improvement Permit and Authorization to Construct(IP/AC)and meet the requirements of the current laws and rules necessary to obtain a new I P/AC. 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 Church 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 Cctcwbo 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 3/7/2023. 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 1S0B-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/64 - 11)7-N Cheyanne Morgan, REHS Environmental Health Specialist Catawba County Public Health 1 . CATAM 1A CM!n T tO t�e1 P the Iies,*Depwnmsrt Soh:Imaumto • t;MYmwawrl I kel th It,.men MPH 363611764749 .jj Pe Boa 119 .-r,,2%Covenwnere th, Newton.NC 2V S1 U)Ta aes kooenree: 134 GIf 1 S CIR,MAIDEN NC 20650 Mt ,.on Permit DEVARTA MONROE Property aase• Aces 1 76 t3'•redlorle: From sokrmchord)id you would need to make turn on Giles circle and&Me to the home it theism!on the left Owner/A satborized ! epreseatstive Ae usow cdgentett of Perini Receipt DMi certify that I am the owner or suthorized agent(owner's authorization required)representing the owner of / the property described above. XAs the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service R3a R-10-2021-39140,by the following mcthod(s): Received in Person Facsimile Transmittal(Return form with signature required) 1 Electronic Image Transmittal/E-mail (Return receipt required) u As the property owner or authorized representative I have reviewed and understand the specific conditions IV) of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage'Treatment and Dispesai Systems(ISA NCAC IBA.1900), sad/or Well Constriction 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:01/102023 1410OwrurlAuthori�z7ad Representative Signature.__. , - -. ......._..._ I Date /2,3 /.�023 ------------------- Documentation of Permit(s)Ttsnsmlttat (permit transmitted by r1.ectroaIc or other mesas) Permit transmitted by ______.__..— (name of person sending permit) Signature Date/lime � _�� Met tDJ: Fag 't,lEmelt US Meat Ct:,,z Owner's request to send by the above indicated method of erecsmittel in lieu of signature "— ---_.. We wantt tto hear from youPlease tytrhe a few momentts tto complete our custtomer service suet/aft trittp://www.starveymoney.corn/s/E14CuittoreedervIct deoiletinon(0663411 • lit sal 0 , OI/10,2021 16 16 elytesoent e CATAWBA COUNTY Case# AUTH-01-2023-187393 .t. , , Public Health Department Subdivision Q ,. `�l „"lc, Environmental Health Division PIN# 363611764749 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# Site Address: 134 GIBBS CIR, MAIDEN NC 28650 Name on Permit: DEVARTA MONROE Property Size: Acres 1.76 Directions: From salem church rd you would need to make turn on Gibbs circle and drive to the home at the end on the left Authorization to Construct Permit Permit Category: New Septic Wastewater Flow: 360 g.p.d. Type of Facility: Primary Residence-New House Basement? No Basement Plumbing? No Bedrooms: 3 Water Supply: Private Well Maximum Occupants: 6 Soil LTAR: 0.3 g.p.d.1ft2 WASTEWATER SYSTEM REQUIREMENTS Proposed Wastewater System: 25% REDUCTION System Classification: IIIG-OTHER NON-CONV TRENCH SYSTEMS Septic Tank: New Tank: 1,000 gal Pump Tank _gal Grease Trap_gal Dosing Volume gal Pump Specs: GPM @ TDH Pressure Head ft Draw Down in Drainfield: Total Area: 912 sq ft Total Trench Length: 304 ft Aggregate Depth: in Maximum Trench Depth on Downhill Sidewall: 30 in Minimum Soil Cover: 6 in Minimum Trench Separation: 9 ft on center Number of Drain Lines: 4 Trench Width: 3 ft Distribution: Serial Pre Treatment: NONE Additional Specifications: *Do not drive,grade, cut or fill over any part of the initial or repair septic areas. *Existing septic tank may be used IF it meets the current rules, is in good condition, and placement allows for proper gravity distribution of effluent. *If existing septic tank is not used, it MUST be properly abandoned (pumped, crushed and filled). *Install 304 feet of 25%reduction product according to manufacturer specifications. *All parts of the septic system area MUST remain 5 feet from building structure, 10 feet from property lines, and 50 feet from wells. See also attached site plan. 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. >>>>> Do not install system under wet conditions <<<<< PROPOSED REPAIR Repair System Required? Required Soil LTAR: 0.3 d.lft2 g.p. Proposed System: 50%REDUCTION VERTICAL System Classification: IVA-ANY SYSTEM WITH LPP DISTRIBUTION Pump Required ***** Operator Required p:,,,,,n 0 1/10/2023 16:16 a CATAWBA COUNTY Case# AUTH-0 1-2023-1 87393 r Public Health Department Subdivision , Environmental Health Division PIN# 363611764749 .0.) PO Box 389,25 Government Drive,Newton,NC 28658 LOT# /H. ski Site Address: 134 GIBBS CIR, MAIDEN NC 28650 Name on Permit: DEVARTA MONROE Property Size: Acres 1.76 Directions: From salem church rd you would need to make turn on Gibbs circle and drive to the home at the end on the left 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 Authorization to Construct Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Authorization to Construct 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'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC I 8A.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. 371V4L- (1/ 01/10/2023 Authorized State Agent Permit Issuance Date 1/10/2028 Permit Expiration Date No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. ehpennit 01/10/2023 16:16 Catawba County Environmental Health f ap2- 10-zcz!— 35 I4o 0 I- 7,373 - 184-31 D 41,tkL,-o) -1073 -1i 343 well-of -Z.z3 - 1$731I (297) cep c/R hi` �e e 108.01 4s' 415 (102) Z0 r 15' •t Drop B2 50f HoulL DON' r' e134 EXSt .128 BeJ 11 gi-r] ; 5' l \ d �a- fo' , Q. v Nts S ,�V V1/4L • Parcel: 363611764749, 134 GIBBS CIR MAIDEN, 1in=50ft 28650 This map/report product was prepared from the Catewbe County,NC Geoapetlel Information Services. Catawba County has made substantial efforts to ensure the accuracy of location end labeling Information contained on this map or data on this report,Catawba County promotes end recommends the Independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents.and personnel,disclaim,and shell not be hold liable for tiny end all damages,loss or liability,whether direct,Indirect or consequential which arises or may arise from this map/report product or the use thereof by any parson or entity. Copyright 2021 Catawba County NC 01/10/2023