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Home My WebLink AboutIMPV-04-2023-193945.TIF ( ) catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 8/17/2023 Owner(s): Dustin Dellinger Mailing Address: Ar Gnndtnn Rd Malden,NC 28650 Property location/site legal description: 5785 W NC 10 Hwy,Hickory PIN: 269918305777 Improvement Permit(IP) IMPV-04-2023-193945 Date Issued 4/19/2023 Authorization to Construct(AC) Date Issued Dustin Dellinger t, ,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 150E-23 and all other applicable provisions of Chapter 1508 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 Illg;—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 effect. //,�� y� Signature of Property Owner: Dustin !-t. Dellinger Date Signed: 8/18/23 NCDHHS/DPH/EH5/OSWP Revised May 2015 catawbacountync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. (.44 catawba county public health August 17, 2023 Dustin Dellinger 3603 Goodson Rd Maiden, NC 28650 Subject: Notice of Intent to REVOKE the Improvement Permit for 5785 W NC 10 Hwy, Hickory PIN 269918305777 Catawba County Permits IMPV-04-2023-193945 Dear Mr. Dellinger: 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 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 PO Box 389 I 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 8/17/2023. 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, Ogg- % _.4biee Pe r;4.3) Blake Perkins, REHS Environmental Health Specialist Catawba County Public Health t �. CATAW'BACOUNTY Casek IMPV-04-2023-193945 (7.11.). Public health Department Subdivision Environmental Health Division PINK269918305777 'Evv. PO Box 389,25 Government Drivc,Newton,NC 28658 LOD/ Site Address: 5785 W NC 10 HWY, HICKORY NC 28602 Name on Permit: DUSTIN DELLINGER Property Size: Acres 3.55 Directions: Hwy 10 Won left just past Plateau Rd Owner/Authorized Representative Acknowledgement of Permit Receipt KI 'certify that I am the owner or authorized agent(owner's authorization required)representing the owner of J the property described above. r • As the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service EIIPR-03-2023-43787, by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) ,/J Electronic Image Transmittal/E-mail (Return receipt required) 4.1-) 1) As the property owner or authorized representative I have reviewed and understand the specific conditions of 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(15A 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:04/19/2023 • Owner/Authorized Representative Signature ( Date 5 3 - -2 3 Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name c f person sending permit) Signature ----Qt E ____- _- Date/Time 5/3))„..3 Method: Fax v 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 yoiPlease ttake a few momentts tto complette our custtomer service survey aft http://www.surveymonkey.com/s/EHCusttomerService ci e 1 I; (my( . (liks,A40./4100. 6011 1_1 hp.I'.' (Id/26/2023 12.55 ..03 i , CATAWBA COUNTY Case# IMPV-04-2023-I93945 t Public Health Department Subdivision l� '? Environmental Health DivGovernmentisionDrive, PIN# 269918305777 LO'f# (....... Newton,NC 28658 U. Site Address: 5785 W NC 10 HWY, HICKORY NC 28602 Name on Permit: DUSTIN DELLINGER Property Size: Acres 3.55 Directions: Hwy 10 Won left just past Plateau Rd 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 480 g.p.d Type of Facility: Primary Residence-New house Basement? No Basement Plumbing? No Bedrooms: 4 Water Supply: Public Water Maximum Occupants: 8 INITIAL SYSTEM SPECIFICATIONS Proposed Wastewater System: 25% REDUCTION System Classification: IIIG-OTHER NON-CONV TRENCH SYSTEMS REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25%REDUCTION System Classification: IIIB-SYSTEM W/SINGLE EFFLUENT PUMP Pump Required Permit Conditions: 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 I lealth 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'Laws and Rules for Sewage Treatment and Disposal Systems' (I5A NCAC I8A.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. ke,/ - lette Pe:kt 4i 04/19/2023 Authorized State Agent Permit Issuance Date 4/19/2028 Permit Expiration Date No grading or construction activity is allowed in areas designated for system and repair without approval of the Health Department. chp,,, h 04/26/2023 12:55 Catawba County Environmental Health EftPg- 03- 2.023- 43 -7Si \\* �aJ IMPV- O1-2-023 - 3"5. 0 G \� 1 �(\Y 14. 3' \1":41-':, , \kegs g bscc� C v--.\--) .. AA' Q'14 .5801 \3‘ \4' se a';'11%IA' PkreP�,r o. Nfetr O o. Igo 13i' <<1 +Ne 2.c, Q4 05( qs 1 c'� •§1.' ) ajott; r Parcel: 269918305777, W NC 10 HWY tin=60ft HICKORY, 28602 This map/roport product was proparod from tho Catawba Courtly,NC Ooospnlini Information Services, Catawba County has made substantial efforts to ensure the accuracy of location and labeling Information contained on this map or data on this report,Catawba County promotes and recommends the Independent verification of any data contained on this maphoport product by ttru usur,Thu County of Catawba,its employees,agents,and personnel,disclaim,and shall not bo hold'labia for any and ail damngos,lose or liability,whothor direct,Indirect or consequential which arises or may arise from this map/report product or the use thereof by any parson or onlity. Copyright 2023 Catawba County NC 04/19/2023 DEPARTMENT OP EmIntoNmENT AND NATURAL RESOURCES Shed. I. of DIVISION OP ENV1R,ONMENTAL HEALTH PROPERTY ID#: _o `3az`t77 .Ol4.SLTE WASTEWATER SECTION COUNTY: SOELISri'E EVALUATION • for ON—St1'E WASTEWATER SYSTEM OWNER: )L S-K►1 PO;it4 c►- APPLICATION DATE 3 a;2 7 3 ADDRESS: '3 G 0? (: s 4 ss N`'(I41, M r:4i w N r, J i50 DATE EVALUATED: PROPOSED FACILITY: Airy,' In a t+fl PROPOSED DESIGN FLAW(.1949):4 RD 5()i. - PROPERTY SIZE: 3.. r a c-'I LOCATION OF SITE; W.nIG iJ Hwy f b�.'rao rgftl atrva 3) l.4-0. . PROPERTY RECORDED: Sj WATER SUPPLY: 0 Private i Public 0 Well CI Sig 0 Other — EVALUATLON METHOD: ....6.uger Bating VPii D Cut • TYPE OF WASTEWATER: if Sewage 0 Industrial Proms 0 1vMFxed • . rx"'i^ :....0 i#u K^is - =>"-" ::nnii :u w :i": sl:i i:r i:i: '�•ial I%1EV( ' r.«:f•ii:i? iiis:i aaFi»i�•:a : ` . �i��- isaiii:r•u�•i, i»^iv .n::..ii;. .'�,a.!.:_: �i�i � �:s '"i• : "p•g� aiiiiiii sritiu russta,Mift- ,»aci �' '.:iiii .phi cii.a::� 5._au^..• .s•� ..�::si.;;:•r« ::: tgli.,s �� .i•.r igi :igsi�i �;� _ : � ' : "r�: usa.:.iiusxii n .c � S�tills:«»N�t•4i:I•"•u diii.i'siyu,;tUiit: « 7i y.s_.-i usn:« a: iyi.s ' i� i„ t +i: r?g.F. gi sal ( �= r : s%i::: _".'__a_'y ..t::s::i ii•: i1� �' � �ni«.:_s �. ues"ttr� » acs;:s14: : - *it g e ir• ttir a: R: 3 s» ! u i:� ~':ia:.:c.•i:.i.:....w:ar mo:ar.T«`.i^i"'i:iii, ...•....t... ...ii. r4...4u te .:::'s:si.::z: rtt i;. E�r :r :�r r i b . : � s •j� 1C1, tiir., tt ip =rii"3„i ii:s a:::::Yiisi i -ii «i-i:tstt::` x:''3ira:nn. itu rtt iti-r ' .s$..i?f:: nn: sii;sigs 3»:;te •st:p:r, ��r»zt;u^.1 a,A» • " t:a. uii- s•i.tsi :K.:::ns ' •s » iiii^-•�i : Fsi..ia.iu: 7-:-q4k»: .:: :::r ,s •i i: •is4_1- rssiro ti3iii.:; -s: .•a " ^«0,»i.i ! s�i�WgaNgarii?i": �I:� :y '�� ._--^4.1 �.....�..: ;:: iiai4". :::`» : '.. Np. •HL; • tt 0.0415 o i .. ~fxi r 'SL,V .!(• s� F h. '� . i;rii!ir::OI CrI V :w ns 3»: :- Itgif Ili.• . .. ": .s " zi» s. t t ..:,isiiiii::si + .::::::.ri )qg y :;;.... O81t:its ..i i «: , r`i,i, ! «ii s�• ::ili ,_-.._. :s. •• it: _F:al. •_. i •:xi: .a: i ^» ~ :riUF- :.i: »t, .: i= ° I CC (P(o...�) Ella. r j rr/c(f J P-5. 0,3 G ,z( r/ s/sP/f- I I, I 117, �3 -s"z C, tv.t'.re ;«i+8K r: /s „iii f� a 0 .13- ' o -f 1- ,..Cri f,PIC/yd) k i/VI'I k i 1 )qs 0 I 6 PS WV) C 5/t! if s..(-pi rt..; 2 bibi'„ , C):.,1. 4,wrv•.i; W,,,/( r; self/'/s. S� 0. $ • I I- q 2- C a,,, 1, ec ' , ------ (A •S 3 1,11-1 70 biZ-s3 ,cq(4.) . i E U 'I,L c.0 L(/61101,4o) 1,V 4&te .rf.ii,gfeirc., . . Ps • 4 t/ I Li'. 9_ - C + w.,'ttcir 3J#ry t _ci I r Ice I 1.6 0 15 - ' wtwirtrr -— DES tIPT1O1t INTIALSYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) s' S SiTE CLASSIFICATION(.1948): n Tyr) EVALUATEDBY;. g 1cke P. rklnl , 9 As o Pt"*V , OTHER(S)PRESENT: Slit LTAIZ 0, 5 0 ,x 5 Catawba County Environmental Health '' '' \\\,\INN\ \ \ • \•11" `Strk \..ret% ‘-,,,,,.. tri, \ t‘Or \t" KI:. Nett, \ -064c) a S� , `- Si, \ \ \ O U� 1/4\\\ -\\, NIOA._ • y' W64$ WIT / '''',.....,. hil AZ '"•,,,.„ elr '''"'''-''''''''"''''-'''''::N\\ \\:` D • %."...\''..\> o 0 c _i•-----; --------\\ \\0+1\:\ ._,.,if ..., \ . . �r � 111, ix vo "\k, \ \\\ \\:\ I) \.'� I\. y . Gy •56.36 Parcel: 269918305777, W NC 10 HWY 1 in=60ft HICKORY, 28602 This map/report product was prepared from the Catawba County,NC Geospatlal Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling Information contained on this map or dale on this report.Catawba County promotes and 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 shall not be held liable for any and 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 person or entity. Copyright 2023 Catawba County NC 04/19/2023