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Home My WebLink AboutIMPV-05-2023-196661.TIFR NNW catawba county public health January 3,2025 Conrad Moss 2649 Brekonridge Centre Dr Monroe, NC 28110 Subject: Notice of Intent to REVOKE the Improvement Permit for 2969 Bass Dr,Sherrills Ford NC 28673; PIN:369804801289. Catawba County Permit IMPV-05-2023-196661. Dear Mr. Moss: The Environmental Health Division of Catawba County Public Health intends to revoke your Improvement Permit 30 days from the date of this notice. This is due to a new site plan for the property. You must apply for a new Improvement Permit (which you have already done) and meet the requirements of the current laws and rules necessary to obtain a new Improvement 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 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 General Statutes 130A- 24and 150B-23 and all other applicable provisions of Chapter 150B. General Statute 130A-335(g) provides that your hearing will be held in the county where your property is located. 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 January 3, 2025. 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 General Statute 150E-23 to serve a copy of your petition on the Registered Agent for the 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. Department of Health and Human Services:Julie Cronin, Office of General Counsel, Department of Health and Human Services,2001 Mail Service Center, Raleigh, N.C. 27699-2001. Do not serve the petition on your local health department.Sending a copy of your petition to the local health department will not satisfy the legal requirement in General Statute 150B-23 that you send a copy to the Office of General Counsel,2001 Mail Service Center, Department of Health and Human Services. Respectfully, .2::)41 . ini/L Steven Price, REHS Environmental Health Specialist Catawba County Public Health r catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: January 3,2025 Owner(s): Conrad Moss Mailing Address: 2649 Brekonridge Centre Dr Monroe,NC 28110 Property location/site legal description: 2969 Bass Dr 369804801289 Improvement Permit(IP) IMPV-05-2023-196661 Date Issued: 05/24/2023 con rad Moss ,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 in order for the authorized agent/local health department to issue the applicable permit(new IP)for the site. I understand by completing this form that the permit for a IIb (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 that the current IP must be revoked. I understand that the local health department's revocation of an IP 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. "—Signed by. Signature of Property Owner: /L- 1/15/2025 '-44FAE7336DDF402... Date Signed: NCDHHS/DPH/EHS/OSWP Revised May 2015 catawbacouniync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. r 0 docusign. Certificate Of Completion Envelope Id:8794BB0A-42CF-43C9-A42E-96DBF2D05C4C Status:Completed Subject:Complete with Docusign:IMPV-05-2023-196661.TIF.pdf Source Envelope: Document Pages:3 Signatures:1 Envelope Originator: Certificate Pages:5 Initials:0 Brelle Daniel AutoNav:Enabled 2649 BREKONRIDGE CENTRE DRIVE SUITE 104 Envelopeld Stamping:Disabled Monroe,NC 28110 Time Zone:(UTC-05:00)Eastern Time(US&Canada) bdaniel@truehomesusa.com IP Address:66.193.215.242 Record Tracking Status:Original Holder:Brelle Daniel Location:DocuSign 1/15/2025 4:30:15 PM bdaniel@truehomesusa.com Signer Events Signature Timestamp Conrad Moss S1pnod1 Sent:1/15/2025 4:43:47 PM conradwmoss@gmail.com [�/ /L_ Viewed:1/15/2025 5:16:47 PM 44FAE7338DDF402... SI ned:1/15/2025 5:18:05 PM Security Level:Email,Account Authentication 9 (None) Signature Adoption:Drawn on Device Using IP Address:174.216.12.84 Signed using mobile Electronic Record and Signature Disclosure: Accepted:1/15/2025 5:16:47 PM ID:4a3b3ebf-a060-4918-aac9-32d66b36a3fe In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Keshia Parris COPIED Sent:1/15/2025 4:43:47 PM KParris@CatawbaCountyNC.gov Security Level:Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature - Timestamp — — 1 Notary Events Signature Timestamp I — Envelope Summary Events Status Timestamps _ J Envelope Sent Hashed/Encrypted 1/15/2025 4:43:47 PM Certified Delivered Security Checked 1/15/2025 5:16:47 PM Signing Complete Security Checked 1/15/2025 5:18:05 PM Completed Security Checked 1/15/2025 5:18:05 PM Payment Events _ _ Status — _ �,_ —Timestamps 44 ja CATAWBA COUNTY Case# IMPV OS 2023 196661 to. .a. Public Health Department Subdivision FOREST SHORES Environmental Health Division PIN# 369804801289 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 15 9A Site Address: 2969 BASS DR, SHERRILLS FORD NC 28673 Name on Permit: CONRAD MOSS Property Size: Acres 0.99 Directions: Hwy 150 W, right on Little Rd, right on Ingleside, left on Bass Drive Owner/Authorized Representative Acknowledgement of Permit Receipt `, I 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-03-2023-43642, by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) J Electronic Image Transmittal/ E-mail (Return receipt required) F 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: 05/24/2023 Owner/Authorized Representative Signature Date Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) ciESignature Date/Time f I)3 _ Method: Fax 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 compiette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService ( rrdtu /MCC0gAkta. () n 615' ( 13 ehvemmit 05/26/2023 05:27