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Home My WebLink AboutIMPV-08-2023-201687.tif (: ) catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 10/3/2023 Owner(s): Bradley Campbell Mailing Address: 2924 Buffalo Shoals Rd Newton, NC 28658 Property location/site legal description: 3681 E NC 10 Hwy, Claremont PIN: 376007678559 Improvement Permit(IP) IMPV-08-2023-201687 Date Issued 8/3/2023 Authorization to Construct (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 150E-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. I understand by completing this form that the permit(s)for a i 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. 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 require li uish my appeal rights but that this is an option available to me so I do not have to wait 30 days for the r ratio the emit to take effect. Signature of Prope Ow er: J Date Signed: 1 O C)q i�- NCDHHS/DPH/EHS/OSWP Revised May 2015 catawbacountync.gov Environmental Health Catcwbo County Government Center 25 Government Drive 1 PO Box 389 I Newton NC 28658 I 828.465 8270 MAKING. LIVING. BETTER. Catawba county public health October 3, 2023 Bradley Campbell 2924 Buffalo Shoals Rd Newton, NC 28658 Subject: Notice of Intent to REVOKE the Improvement Permit for 3681 E NC 10 Hwy, Claremont PIN 376007678559 Catawba County Permit IMPV-08-2023-201687 Dear Mr. Campbell: 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 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 Cctcwbc County Government Centel 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 10/3/2023. 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, h4,1 Fo.-tc C Bryan Forsee, REHSI Environmental Health Specialist Intern Catawba County Public Health dotloop signature verification:(: .... <, '::-.4vii.ot6s OciY( 4(6—'0 Permit#:PIPY-04102:5-10(b s 7 :-,,,tr xii:**. :•' ROY COOPER•Governor Fir"tfligthiit"4 NC DEPARTMENT OF k KODY H.KINSLEY•Secretary 1 ki i-0.1)- . HEALTH AND ) MARK BENTON•Deputy Secretary for Health SUSAN KANSAGRA•Assistant Secretary for Public Health . . .. Division of Public Health Submittal Includes; FX1 (a2)Improvement Permit El (a2)Construction Authorization El Fee$ IMPROVEMENT PERMIT FOR G.S. 130A-335(a2) County: Catawba PI N/Lot Identifier: 376007678559 Issued To: Bradley Campbell Property Location: Hwy 10 Claremont Subdivision: N/A Lot#: 2 Block: Section: LSS Report Provided: Yesn Non If yes,name and license number of LSS: Wendell Overby#1218 New 0 Expansions System Relocation n Change of UseD Proposed Structure: 3 bedroom house Number of bedrooms: 3 Number of Occupants. 6 Other Design Wastewater Strength: Odomestic El high strength [ ]industrial process Proposed Design Daily Flow: 360 GPD Proposed LTAR(Initial): 0.3 Proposed LTAR(Repair): 0.3 Proposed Wastewater System Type*: ACCEPTED GRAVITY (Initial) Pump Required: nYes FIND E May be required Proposed Wastewater System Type*: ACCEPTED GRAVITY (Repair) Pump Required: ElYes nNo El May be required 'Please include system classification for proposed wastewater system types in accordance with 15A NCAC 18A.1961 Table V(a) Saprolite System(Initial): TlYes 0 No Saprolite System(Repair): DYes EN° Fill System(Initial): E Yes 0No If yes,specify:DNew nExisting(when adding more than 6 inches of fill to system area provide a fill plan) Fill System(Repair): EYes z No If yes,specify:0 New EExisting(when adding more than 6 inches of fill to system area provide a fill plan) Usable Soil Depth(Initial): 66 Usable Soil Depth(Repair): 64 Max.Trench Depth(Initial)I: 30 Max.Trench Depth(Repair)I: 30 I Afeesured on the down l eide of the trench Artificial Drainage Required: El Yes [' ]No If yes,please specify details: Type of Water Supply. Private well 0 Public well EShared well EMunicipal Supply E]Spring DOther: Drainfield location meets requirements of Rule.1945: Yes El NoED Drainfield location meets requirements of Rule.1950: Yesn NoE Permit valid for: E Five years[site plan submitted pursuant to GS 130A-334(13a)] El No expiration[plat submitted pursuant to GS 130A-334(7a)) Permit conditions: See Design Licensed Soil Scientist Print Name: 1 e94010vela A Licensed Soil Scientist Signature: / 40 lOr Date: 7/27/2023 The LSS evaluation is being submitted pursuant to and I-ets the requirements of G.S.130A-335(a2). *See attached site sketch* NC DEPARTMENT OF HEALTH AND HUMAN SERVICES•DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Building 3,Raleigh,NC 27609 MAILING ADDRESS: 1632 Mail Service Center,Raleigh,NC 27699-1632 www.ncdhhs.gov•TEL:919-707-5854•FAX:919-845-3972 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER ,ly) ' Permit#: IMPV-08-2023-201687 3681E NC 10 HWY This Section for Local Health Department Use Only Initial submittal received: 7/28/2023 by RP Date Initials G.S. 130A-335(a3)states the following: When an applicant for an Improvement Permit submits to a focal health department an Improvement Permit application,the permit fee charged by the local health department,the common form developed by the Deportment,and a soil evaluation pursuant to subsection(a2)of this section,the local health department shall, within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the Improvement Permit includes all of the required components.if the local health department determines that the Improvement Permit is incomplete,the local health department shall notify the applicant of the components needed to complete the improvement Permit.The applicant may submit additional information to the local health department to cure the deficiencies in the improvement Permit.The local health department shall make a final determination as to whether the Improvement Permit is complete within five business days after the local health department receives the additional information from the applicant.If the local health deportment fails to act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The Department shall develop a common form for use as the improvement Permit. The review for completeness of this Improvement Permit was conducted in accordance with G.S. 130A-335(a3). This Improvement Permit is determined to be: ❑ Incomplete(If box is checked,information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Applicant on Date State Authorized Agent: Date: E Complete State Authorized Agent: t1� �� Date: 8/3/2023 This Improvement Permit is issued pursuant to G.S. 130A-33S(a2)and(a3)using the signed and sealed LSS/LG evaluation(s) attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject to revocation if the site plan,plat,or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2). Improvement Permit Expiration Date: 8/3/2028 *See attached site sketch* G.S. 130A-335(a2)Common Form 2 V.2023.07 dotloop signature verification.c, •.'s;:'t }.>r:•;I':1,S VIIIF SERVICES OF THE CAROLINAS. PA July 27, 2023 Catawba County Environmental Health Attn: Robbie Phelps 25 Government Drive Newton,NC 28658 Re: Improvement Permit Submittal for Lot 2 Hwy 10 Claremont Mr. Phelps, Attached please find sealed soil notes as well as site plans and design related data for a 3- bedroom accepted (25%reduction)system using gravity distribution. "The LSS evaluation attached to this application is to be used to issue an Improvement Permit in accordance with GS 130A-335(a2) and (a3)." Owner/Buyer: Bradley Campbell i /1 do/oop verified Vitt-,.('W" 07/27/23 5:54 PM EDT 1 NM F-QUZX-TIYN-1 SJC Signature: Date: "The LSS Evaluation is being submitted pursuant to and meets requirements of GS 130A-335(a2)." This Improvement Permit is issued pursuant to G.S. 130A-335(a2), (a3) and (a4) using the signed and sealed LSS evaluation attached here". "This AOWE submittal is pursuant to and meets the requirements of G.S. 130A-335(a2), and (a5)". Wendell Overby, LSS Signature: 624.,MI 9. Date: 7/27/23 Seal: 41111,11 ; p SOIL sc�;t,. c (4•+441. w rtre, dotloop signature verification:tltip.uspYQf3.elvjI-D1 GS VIr usablesoil@gmail.corn 980-439-5007 SOIL & FORESTRY 813 Davidson Dr NW Concord NC 28025 SERVICESSoilAndForestryServices.com of 7 h1E C:ARtJ L.INA:S, f'A Project#23-1092 Septic System Design for a 3 Bedroom House ACCEPTED using GRAVITY distribution Site location: Hwy 10 Claremont, Lot#2 Contents Page Information for the Installer 1 Design Specifications • 2 Layout Specifications 3 Site Plan 4 Calculations-------------------------------------------------------------------------------------------- 5 SoilDescriptions------------------------------------------------------------------- 6 Jul 2023 Design By: Overby dotloop signature verification; tip.sn< O. Page 1 INFORMATION FOR THE INSTALLER Project#23-1092 ACCEPTED using GRAVITY distribution Site location: Hwy 10 Claremont,Lot#2 * CALL 811 BEFORE DIGGING * The permit should be read very carefully prior to bidding. The following are details that must be considered along with all other considerations. * Tanks shall be approved by DHHS, and certification supplied by the that must be considered along with all other considerations. * The installer shall be responsible to the owner for placement of the tanks and to insure that final grades are returned to the original natural grade, with exception of added structural features. * The supply trench shall be compacted to eliminate cavities left during initial fill placement. * Installation of the system shall be during dry conditions in order to protect the soil * All fittings shall be pressure rated fittings. * All joints shall be cleaned with PVC pipe cleaner and a heavy bodied glue applied to weld all joints. * Where required by the county health department, post installation inspections by the designer must be scheduled 5 week days in advance. Trenches shall be carefully excavated so the bottom is within 2"from the highest to the lowest points of elevation within the trench. If the bottom elevation needs adjusting after it has been * trenched, it will be done by removing high points rather than filling low points. It is extremely important to insure that trenches are not over excavated during initial trenching. All fine grading within the trench will be hand done with a shovel. No loose material will be left in the trench * All pipe openings in the tanks shall be properly grouted. This also applies to the joints around the riser. * All tanks shall be properly back filled and compacted to prevent slump at a later date. * Earth dams, constructed of relatively impervious material, shall be installed at the beginning and end of each lateral. * No heavy equipment shall be used on the field during or after installation. The use of a small loader(i.e. Bobcat) or a trencher(i.e. Ditch Witch 2300/2310) may be used. * Elevations at pinflag locations should be checked by the installer prior to beginning * Septic tank riser shall be a minimum of 6"above finished grade. * System specified as ACCEPTED type using GRAVITY distribution * Repair specified as ACCEPTED type using GRAVITY distribution * System trench depth specified at 30" * System trenches installed on 9' minimum; 36"wide trenches * Installation does not require a soil cap dotloop signature verification:t;tip.us)'<Q(;.NvJl.pt(;S Page 2 DESIGN SPECIFICATIONS Project#23-1092 ACCEPTED using GRAVITY distribution Site location:-Hwy 10 Claremont, Lot#2 Business (if applicable): N/A Contact: Bradley Campbell Phone: 0 Email: bcam2006@yahoo.com County: Catawba Location: Hwy 10 Claremont Source of Wastewater Flow: 3 bedroom home Estimated Daily Wastewater Production: 360 gpd Drain field Size: 300 If Loading Rate: 0.3 gpd/ft.2 Trench Depth: 30 in Trench Width: 36 in Soil Cap: 0 in Septic Tank Size: 1000 gal dotloop signature verification:c:t.:•,.'u.)().P;,jid;ivS Page 3 LAYOUT SPECIFICATIONS Project#23-1092 ACCEPTED using GRAVITY distribution Site locatipn*;;Hwy 10 Claremont, Lot#2 Daily Flow(gpd) 360 Jul 2023 LINE# FLAG BS HI FS ELEV FLAGGED DESIGN COLOR — — — LENGTH LENGTH TBM 0.0 100.0 INSTR. 1 100.0 REPAIR 1 PINK 5.5 94.5 100 100 2 RED 6.7 93.3 100 100 3 ORANGE 7.8 92.2 100 100 SYSTEM 4 YELLOW 8.6 91.4 100 100 5 BLUE 9,6 90.4 100 100 6 PINK 11.3 88.7 100 100 LINE LTAR SYSTEM REDUCTION TRENCH SOIL LENGTH GPD/FT2 TYPE TYPE DIST DEPTH CAP SYSTEM 300 0.300 ACCEPTED 25% GRAVITY 30 0 REPAIR 300 0.300 ACCEPTED 25% GRAVITY 30 0 Notes: **TBM is assumed to be 100' **AII measures in feet **Nitrification lines are demonstrated on contour via colored pin flags **BS and FS indicate rod readings dotloop signature verification:iii,:' ..is;,c,.7.•,.:Cii E Ain R/ge . 4 T 1, Inry 1 0 , .611n 1 ,-44.....zz&o.:-'....;:l.'4,...',.:,-......-7,>•.-...--,N 73-, 7 -'-'4'.-'1....1.:•:','.:...,A.:.:..,..-....:1..-F::*::;: -:-.:,7"..,,,$),8'4 u) pt-7,-------,,, .8641<4.: e1;:i 0 —' LA • (..,4 tv 4' m \ ...44. c 4 . , P--'4,4•1••'.• .-- , ^ 4.'! • -,41111° RCP ,..... ri 4 . ....--_4 ,,„....00sllo( 000000.000 I R •. 6 os" f Sil - TRACT 1A s R3 5.329 ACRES TOTAL 0.573 AC. IN 45 R/YI ,r 0.146 AC. IN 60' R/W • ' -23 4.610 AC. REMAINING , .., --- <, \t"..., in FLOOD ZONE AE [ LOT 2 .._...._............_ . . ".t - -- .) -, cre'-.. • . . 1 0 4 '•8 • z „<.).„. (21-...'• , .. ca ,../ n A.I.4t.... . 0.2%ANNUAL CHANCE FLOOD HAZARD . • •.. ::.• al-' .... , 70 .. ...c.,:,. 4 HOUSEBOX P. 4 ** * 0 .‘, -.. ,-• •„5.., 5 O.00' ---------* -9 ' -E 407-- 43 7.I 4' S 843 '4 9 4271f._ c-) GRAPHIC SCALE i 1" = 80' c-, 70 80 0 80 160 . mil imilmoml dotloop signature verification:::ilp,usr.;•'riv i•D7GS Page 8 CALCULATIONS Project#23-1092 ACCEPTED using GRAVITY distribution Site location: Hwy 10 Claremont, Lot#2 Designer Overby Project# 23-1092 Project MM YYYY Jul 2023 Project Location Hwy 10 Claremont Lot#(if applicable) 2 o Subdivision (if applicable) N/A u_ Z Parcel# 376007678559 ►— Lot size (acres) 5.329 wContact(Owner) Bradley Campbell Business (if applicable) N/A a Phone Email bcam2006(cr�.vahoo.com County Catawba Bedrooms 3 Water Source Municipal Daily Flow 360 System LIAR 0.3 System Type ACCEPTED System Distribution GRAVITY 2 System Trench Center Distance (feet) 9 Lu System Trench Width (inches) 36 System Trench Depth (inches) 30 co Soil Cap (inches) 0 Tank Size 1000 Required Feet of Line (system) 300 Designed Feet of Line(system) 300 Repair LTAR 0.3 Repair Type ACCEPTED Repair Distribution GRAVITY Repair Trench Center Distance (feet) 9 a Repair Trench Width (inches) 36 w� Repair Trench Depth (inches) 30 Soil Cap (inches) 0 Tank Size 1000 Required Feet of Line (repair) 300 Designed Feet of Line (repair) 300 dotloop signature verification:dtlp.us;IKQO•Nvjl.01 i 5 Sheet 1 of 1 PROPERTY ID It: 376007678559 COUNTY: Catawba SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM (complete all fields In full) OWNER: Bradley Campbell APPLICATION DATE: ADDRESS: DATE EVALUATED: 7/26/2023 PROPOSED FACILITY: 3 bedroom house PROPERTY SIZE: 5.329 acres LOCATION OF SITE: Hwy 10 Claremont PROPERTY RECORDED: WATER SUPPLY: L Private Ll Well ❑ Spring 0 Other EVALUATION METHOD: L Auger Boring E Pit C Cut TYPE OF WASTEWATER: O Sewage 0 Industrial Process ❑ Mixed P R 0 SOIL MORPHOLOGY OTHER .1940 (.1941) PROFILE FACTORS PROFILE F LANDSCAPE HORIZON DEPTH CLASS POSITION/ L SLOPE% (IN.) .194Z &LTAR E .1941 .1941 SOIL .1943 .1956 .1944 STRUCTURE/ CONSISTENCE/ SOIL SAPR RESTR TEXTURE MINERALOGY WETNESS/ DEPTH CLASS HORIZ # COLOR 0- 10 YBSLWFG FRSSSP 10- 24 BRSCLWMSCSAP FRSSSP 5 L/12 24- 64 VAR SL MASS ROCK INC FR SS SP N/A 24 N/A N/A 0.3 0- 10 YBSLWFG FRS55P 10- 3D RB SCL WFS F/C SAP FRSSSP 6 L/18 30- 42 RB CL WMA Fl SS SF' N/A 42 N/A N/A 0.4 42- 66 VAR SL MASS VFR NS NP 0- 9 YBSLWFG FRSSSP 9- 64 VAR SL MASS VFR NS NP 7 L/13 N/A 9 N/A N/A 0.4 0- 12 YBSLWFG FRSSSP 12- 42 BR SCL WMS C SAP FR SS SP 8 L/11 42- 66 VAR SL MASS VFR NS NI, N/A 42 N/A N/A 0.4 0- 3 DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): ITE SIFICATION(.1948): PS Available Space(.1945) 300 300 sort.5Cit,`• EVALUATED BY: OVERBY System Types(s) ACCEPTED ACCEPTED p� E,NAF,c� Y ,N,.,.q�., p RESENT: Site LTAR 0.3 0.3 "z,f e*, COMMENTS: 41al " 5.•1.i'l _,fit 1