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Home My WebLink AboutIMPV-11-2023-208508.TIF 1/25/24, 10:47 AM IMG_7624.jpg (f.h ) catawba county public health VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS Date prepared: 1/18/2024 Owner(s): Joseph Carter Mailing Address: 2780 E NC 10 Hwy Conover, NC 28613 Property location/site legal description: 3017 E NC 10 Hwy PIN: 375012767286 Improvement Permit(IP) IMPV-11-2023-208508 Date Issued 11/15/2023 Authorization toConstruct(AC) Date Issued 1,3°y `�' 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 3g-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 re ' q sh my rights but that this is an option available to me so I do not have to wait 30 days for the revocatlo of t pern o ke effect. Signature of Property Owner: Date Signed: NCDHHS/DPH/ENS/OSWP Revised May 2015 catawbacountync.gov Environmental Health Cctowbo County Government (enter 25 Government Diive I PO Box 389 I Newton NC 28658 1828.465,8210 MAKING. LIVING. BETTER. https://mail.google.com/mail/u/0/?tab=mm#inbox?projector=1 1/1 catawba county public health January 18, 2024 Joseph Carter 2780 E NC 10 Hwy Conover, NC 28613 Subject: Notice of Intent to REVOKE the Improvement Permit and Authorization to Construct for 3017 Emmanuel Church Rd,Conover PIN 375012767286 Catawba County Permits IMPV-11-2023-208508 Dear Sir: 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 Catawba County Government Center 25 Government Drive PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. t Imo iii• CATAWBA COUNTY Case# I MPV-I I-2023-208508 �Q' .�. ,y Public Health Department Subdivision d „� 'I Environmental Health Division PIN# 375012767286 PO Box 389,25 Government Drive,Newton,NC 28658 LO # 2 Site Address: 3017 EMMANUEL CHURCH RD, CONOVER NC 28613 Name on Permit: *CLAYTON HOMES OF CONOVER#81 (UNLICENSED GC-BILLING ACCT) Property Size: Acres 9.98 Directions: Corner of E NC 10 and Emmanuel Church Rd Owner/Authorized Representative Acknowledgement of Permit Receipt Y. ____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-09-2023-45618, by the following method(s): Received in Person / Facsimile Transmittal (Return form with signature required) 4 Electronic Image Transmittal/E-mail (Return receipt required) _ As the property owner or authorized representative I have reviewed and understand the specific conditions r 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: 11/15/2023 Owner/Authorized Representative Signature -- ate Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by n (name of person sending permit) LteSignature _Date/Time tv171✓3 Method: Fax 1 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 yod'Iease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService tikthg. 4 cut5kyl 6 C(a( 61 A-ems C0 el'pernui 11/17/2023 06.48 (2-P II Catawba County Environmental Health I62.&( I \ rr a. o 14 cNt � •a •3017 dcr Had cis _ _ t� OvA- 01 � 14 oc �6�51 r6vl (.A hint, r� Ap� 1(- 1in=6QR CONOVER, 28613 a U),> - �,046 5'pg • m meplreport product was prepared from the Cato+wbo .ou NC p�p�information Services. Catawba has made substantial efforts • to ensue the accuracy of location and information C coot ned on this map or data on this report.Catawba County promotes and recommends the Independent verMralion d any data contained on This map/report product by the user.The C outy of Catawba,b employees,events,and personnel,disdain,and shell not be held liable for any and al damages,loss ar tabilty,whether direct,Indirect or consequential wArlch aflame or may arias from this map/report product or the use thereof by any parson or entity. Copyright 2023 Catawba County NC 11/15f2023