HomeMy WebLinkAboutIMPV-04-2023-194478.TIF catawba county
public health
VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS
Date prepared: 8/17/2023
Owner(s): Kou Yank
Mailing Address: 3915 Dover St
Claremont,NC 28610
Property location/site legal description: 2699 Yount Rd Claremont,NC 28610
PIN: 375020917119
Improvement Permit(IP) IMPV-04-2023-194478 Date Issued: 4/27/2028
Author' tion to Cons t(AC) Date Issued
I, ,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 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. 1 understand by completing this form
that the permit(s)for a
50%Reduction
(System description)
will be revoked immediately by the authorized agent/local health department.
1 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 eff .
Signature of Property wner:
Date Signed:
NCDH1-1S/DPH/EHS/0 WP Revised May 2015
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465,8270
MAKING. LIVING. BETTER.
catawba county
public health
August 17, 2023
Kou Yang
3915 Dover St
Claremont, NC 28610
Subject: Notice of Intent to REVOKE the Improvement Permit for 2966 Yount Rd,Claremont, NC
PIN 375020917119 Catawba County Permit IMPV-04-2023-194478
Dear Kou Yang:
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 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
Catawba County Government Center
25 Government Drive I PO Box 389 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 8/17/23. 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.
Res fully, D
ile(ri.„...„,„-- --
Evans, REHS
Environmental Health Specialist
Catawba County Public Health
, "
,.,„ti COUNTY Case# IMPV-04-2023-194478
Public Health Department Subdivision
d „ Environmental Health Division PIN# 375020917119
PO Box 389,25 Government Drive,Newton.NC 28658 LOT# 1
1.4 w
Site Address: 2966 YOUNT RD, CLAREMONT NC 28610
Name on Permit: KOU YANG
Property Size: Acres 3.33
Directions: S NC 16 business Hwy left Claremont Rd, right Yount Rd, property on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
XII certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-02-2023-43409, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
' Electronic Image Transmittal/E-mail (Return receipt required)
,,,/.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 p:rmitted.
Permit Issue Date: 04/27/2023
Owner/Authorized Representative Signature �y/,
4
Date 74,. . /11 :efiSS
a
Documentation of Permit(s) Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
(ifSignature _ Date/Time slit ,j
Method: Fax V Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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