NCG551766_Application_20191028 (2)

RECEIVED
OCT 2 8 2019
NCDEO/DWR/NPDES
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National Pollutant Discharge Elimination System
(NPDES)
Division of Water Resources
- Application for SURFACE DISCHARGE
rrti;'rt��rre�trrt? Certificate of Coverage (COC) Under
General Permit NCG550000
For Single -Family Residences and Similar Discharges
100%-domestic wastewater - < 1,000 gallons per day
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
9- 0tq
1(.
Certificate of Coverage (COC)
N
I C
I G
5
15
1 J-11
(�
Cheecky#
Amount
Assigned to:
The Division of Water Resources will not accept an application package unless all instructions are followed.
Failure to submit all required items may result in the application being returned. For more information, visit
the Water Quality Permitting Section's NPDES Permitting Unit website. (Press TAB to navigate form)
1. Regional Office Contact: Please contact your DWR Regional Office before submitting this
application. If you have not met with your appropriate DWR Regional Office Representative, the
application will be returned.
Please list the DWR Regional Office representative(s) with whom you have discussed this project:
Name(s): Jane Bernard Date: 10/25/2019
RECEIVED
2. Owner's Contact Information: OCT 2 8 2019
Applicant Type: ® Individual ❑ Corporation ❑ Partnership NCDEQ/DWR/NPDES
Owner Name and Title: Land Owner
Street Address: 1204 Goodwin Road
City: Durham State: NC Zip: 27712 -
Telephone #(H): Telephone # (W):
Cell/Mobile #: [phone] Email: smorganlla @yahoo.com
3. Location of Facility Producing the Discharge: Please list the address of the facility. If facility is not yet
constructed, give street address or lot number.
Street Address: 1204 Goodwin Road
City: Durham State: NC Zip: 27712 -
County: Durham
Telephone #: Cell/Mobile #: [phone]
Website:
4. Site -Location Narrative:
Please describe how to get to the facility from the nearest town, major highway or identifiable roadway
intersection (use street names, state road numbers, and/or distances and directions).
Click here to enter teat.
Page 1 of 7 Revised: A. Orlando NPDES 21Sept2077

Application for Certificate of Coverage (COC) and/or Authorization to Construct (ATC)
under General -Permit NCG550000
5. Describe the nature of the project. ["New" means has not yet been physically constructed, "existing"
means system already physically exists. Please see 15A NCAC 02H .0103(l1) for further clarification].
❑ Installation of a New Wastewater Treatment System (If yes, skip to Number 9.)
® Existing, unperrnitted Sandfilter Discharging System
❑ Expansion of an Existing Wastewater Treatment System (for example, adding bedrooms) (If yes,
skip to Number 9.)
❑ Replacement of an Existing Wastewater Treatment System (If yes, go to Number 6. )
6. Describe the Existing Wastewater Treatment System:
❑ Conventional Septic Tank/Leach-field — Discharge to Sub -Surface Soils. If previously permitted,
please attach a copy of the permit or enter the permit number
If you are not aware of an existing permit, check here. ❑
® Sandfilter — Discharge to Surface Waters [or other, as defined 15A NCAC 02H.0103(I1)J. If
previously permitted, please attach a copy of the permit or enter the permit number
If you are not aware of an existing permit, check here.
❑ Filter Media System ,Pod System- Discharge to Surface Waters [or other, as defined 15A NCAC
02H. 0103(11)]. If previously permitted, please attach a copy of the permit or the permit number.
If you are not aware of an existing permit, check here. ❑
❑ Other
❑ Check here if submitting proposal for a new system or if no treatment system exists.
7. Check all EXISTING wastewater treatment components:
® Septic tank ❑ Dosing tank
® Primary sand filter ❑ Secondary sand filter
® Chlorination ® Dechlorination
❑ Self -Contained POD system [describe]
❑ Leach Field
❑ Post Aeration (speck type)
❑ LTV disinfection
❑ Recirculating sand filter(s)
❑ Other components:
8. Provide Details of Single -Family Residence (SFR) or Similar Facility:
a) Type of facility:
®Residential
❑ Other:
❑ Commercial
b) Amount of wastewater discharged:
- Residential: Number of bedrooms 3 x 120 gallons per bedroom =
gallons per day (flow)
;An
- Commercial: How many employees? (25 gpd/person)
Page 2 of 7 Revised: A. Orlando NPDES 21Sept2017

9.
Application for Certificate of Coverage (COC) and/or Authorization to Construct (ATC)
under General -Permit NCG550000
c) Is your existing treatment system failing? Yes ❑ No
d) Has the Health Department formally condemned your existing system
"unsuitable for repair?" Yes ❑ No ❑
If yes, please name the Health Department [local, county, or state], and provide the site -
inspection date [attach Health Department's judgement letter, if available]: Click here to enter
text. Click here to enter a date.
X_ If previously permitted [local, county, or state], provide permit number and date issued [attach
copy, if available]: Durham County Permit # 4576
Check all PROPOSED new system components
❑ Septic tank ❑ Dosing tank ❑ UV disinfection:
❑ Primary sand filter ❑ Secondary sand filter ❑ Recirculating sand filter(s)
❑ Chlorination ❑ Dechlorination ❑ Other components:
❑ Self -Contained POD system [describe]
❑ Post Aeration (specify type)
❑ Proposed Modifications to Existing Treatment System - Explain in detail the nature of the
modification. Attach all site maps, plans and specifications, signed by an NC Certified Engineer.
If prepared by others, plans must conform to 15A NCAC 02H .0139.
Click here to enter text.
❑ Proposed New Treatment System for Surface Discharge (not constructed) - Attach all site maps,
plans and specifications, to be signed by an NC Certified Engineer. If prepared by others, plans
must conform to 15A NCAC 02H .0139.
Click here to enter text.
Expanding Flow? - Do you propose to increase permitted or existing flow? ❑ Yes ❑ No
Provide details of the Proposed NEW Discharge [Flow and Source Water]:
❑ Check if same as 6.
Existing: Amount of wastewater currently discharged: Number of bedrooms x 120
gallons per bedroom = gallons per day to be permitted (design flow)
Expanding: Amount of wastewater proposed to be discharged: Number of bedrooms x
120 gallons per bedroom = gallons per day to be permitted (design flow
10. Evaluate Alternatives to Discharge to Waters of the State. Please address the feasibility of
discharge alternatives as instructed in the NCDEQ Engineering Alternatives Analysis (EAA)
Guidance Document found here. (Note: Evaluation for endangered species is not required.)
Page 3 of 7 Revised: A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage (COC) and/or Authorization to Construct (ATC)
under General -Permit NCG550000
a) Connection to an Existing Wastewater Treatment System - Provide the distance
to the nearest connection, such as a regional or municipal sewer system, and the
estimated cost per foot to connect including fees. Click here to enter text.
b) Land Application —Assess the land application disposal alternatives such as spray
irrigation, drip irrigation, individual/community onsite subsurface systems, and/or
innovative ground -absorption. Questions to consider:
(1) Are on -site soils suitable for land application? Yes ❑
(2) Is there sufficient area on -site?
Yes ❑
c) Wastewater Reuse — Evaluate reusing all or a portion of the wastewater
generated, such as for golf course irrigation, crop irrigation (e.g., hardwood or
pine plantation, grasses), athletic field irrigation, landscape uses, and/or
commercial/industrial uses.
d) On -Site Soil Evaluation — Submit an evaluation of the soils on -site,
documented by a certified report from a NC Professional Soil Scientist, or by
your local or county health department report (if available). C I ick here to enter
text.
e) Cost of Alternatives — Provide an estimation of the cost of each discharge
alternative or combination of alternatives. Click here to enter text.
IL Provide Regional Information: Please provide the following information. If you need assistance in
obtaining this information, please contact your local DEQ regional office.
a) Stream Classification -Verify the stream classification for the nearest downgradient named
waterbody. The NC Surface Water Classification map can be found by clicking here.
b) Is it a Hi lg i-Quality Water? If so, check if it is by definition or by designation? In order to check
this, ask the Planning.
Click here to enter text.
c) Map - Provide a map locating the nearest downstream waters -of -the -State (i.e. where the effluent
reaches an unnamed tributary, creek, stream, river, or lake via any surface -water conveyance).
Click here to enter text.
d) Site Evaluation - Contact DEQ's local Regional Office for a site evaluation to confirm the
proposed discharge flow path to the nearest waters -of -the -State. The wastewater/stream
confluence and stream class must be verified in the field by DEQ's Regional Staff. Please list the
Regional Office staff member you contacted for the inspection. Jane Bernard
e) Flow Path - Display graphically the flow path of the discharge to the nearest surface Waters of
the State. Document any potential hydrologic trespass or right-of-way infringement on any
neighboring property (i.e. note all properties encountered prior to reaching waters -of -the -State).
No potential hydrologic trespass
Page 4 of 7 Revised. A. Orlando NPDES 2lSept2017

Application for Certificate of Coverage (COC) and/or Authorization to Construct (ATC)
under General -Permit NCG550000
f) 7Q10/30Q2 Estimate- Contact USGS J. Curtis Weaver (919-571-4043) to provide the estimated
7Q10 and 30Q2 stream -flow estimates for the first downstream point -of -contact with waters -of -
the -State.
11. Certificates of Coverage/Notices of Intent to Discharge/Authorizations to Construct - Check ALL of
the following information has been provided. Incomplete Applications will be returned.
Z An original letter [two (2) copies] requesting coverage under NCG550000.
This application [two (2) copies]. Your signature on this application, certifies that you are le ally
responsible for the proposed treatment system (see page 6 of 6) for the COC/NOU ATC.
® A check or money order for $60.00 permit fee made payable to NCDEQ.
12. Additional Application Requirements
a) Narrative Description of the treatment system. This narrative should present treatment components
in order of flow — influent to outfall, including anti -erosion structures and sample -port location(s).
b) Final Plans and Specifications for a wastewater treatment system shall be signed by a North
Carolina -registered Professional Engineer, or if prepared by others, must conform to 15A NCAC
02H .0139. All documents are to be stamped "Final Design - Not Released for Construction."
Submittal shall include a site map showing the proposed outfall and the effluent proposed path to
surface waters -of -the -State. (see Item ]for location verification by DWR Regional Office staff.)
c) Submittals by a Consulting Engineer or Engineering Firm shall include:
1. A copy of your written authorization to represent, signed by the legal
permit Applicant; and
2. Upon completion of proposed work, a signed copy of DWRs Engineer's
Certification form attesting that the project was completed in accord
with the DWR approved COC/ATC, as issued.
CERTIFICATION
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing:
Title:
for definition ofauthorizedsigning officials)
�� 1IA,A Click here to enter a date.
(Signature oj'�fpplicant) I ' (Date Signed)
Page 5 of 7 Revised: A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage (COC) and/or Authorization to Construct (ATC)
under General -Permit NCG550000
Page 6 of 7 Revised: A. Orlando NPDES 21Sept2017

Application for Certificate of Coverage (COC) and/or Authorization to Construct (ATC)
under General -Permit NCG550000
NOTE: Treatment System Maintenance is Required - Upon receiving a Certificate of
Coverage/Authorization to Construct (COC/ATC), the Division recommends that the Permittee solicit
manufacturer -certified training, or solicit a qualified contractor or service to regularly inspect and
maintain this treatment system. The Permittee is responsible under this COC/ATC to maintain all
components of the approved treatment system, designed to meet Surface Water Quality Standards [see
attached Operation and Maintenance Agreement].
Compliance duties include:
• paying your annual fee [due on the anniversary of COC/ATC effective date],
• following the manufacturer's guidelines,
• conducting and documenting inspections, in compliance with General Permit NCG550000,
• establishing sources for OEM spare parts and supplies,
• taking discharge samples for analysis, and logging the results,
• making necessary repairs, documenting said maintenance in logs, and
• keeping logs onsite for the life of the permit, available for DWR inspection.
North Carolina General Statute § 143-215.6B provides that:
Any person who knowingly makes any false statement representation, or certification in any application, record,
report, plan, or other document filed or required to be maintained under this Article or a rule implementing this
Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested
case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or
monitoring device or method required to be operated or maintained under this Article or rules of the Commission
implementing. this Article, shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten
thousand dollars ($10,000). 18 U.S.C. Section 1001 provides a punishment by a fine or imprisonment not more
than 5 years, or both, for a similar offense.
Application must be accompanied by a check or money order for $60.00
made payable to:
NCDEQ
Mail this application and one copy of the entire package (with check) to:
NCDEQ / DWR / NPDES
Attention: John Hennessy, Supervisor
Compliance and Expedited Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Attn: John Hennessy
Note: Submission of this document insures DWR's consideration, but does not
guarantee issuance of a Certificate of Coverage/Authorization to Construct.
Page 7 of 7 Revised. A. Orlando NPDES 21Sept2017

N qmprl
410
70* Ne.
m

1204. Goodimin Roadi
Durham Counpf h
C
e
USGS Topographical Map ¢¢ , ,
Northwest Durham Quadrangle 2016 r�`AL'
Locations are approximate
rM. legend: and are provided for refer-
ence only::
-Project boundary. *•a� 1Uv1

ROY COOPER
c,': vex
MICHAEL S. REGAN
LINDA CULPEPPER
NORTH CAROLINA
Environmental Quality
October 21, 2019
Shannon Morgan
1204 Goodwin Road
Durham, NC 27712
50 ect: Buffer Determination Letter
RRfl 9 19-3 80
Durham County
Determination Type
t Buffer�����IntermittenfPerennial� --�
Meuse (I 5A NCAC 2B .0233) _
Tar -Pamlico (15A NCAC 2B .0259) ® Intermittent/Perennial Determination (where local
buffer ordinances apply)
Jordan 05A NCAC 2B .0267) (governmental
and/or interjurisdictional projects)
Project Name: 1204 Goodwin Road
Address/Location: 1204 Goodwin Road, Durham, NC 27712
Streams) Cabin Branch
Determination date: 10/2112019
Staff. Rick Trone
Feature E!?/P(t) Not
_ ®F Subject(-)
Sula .ctTStart
- - - - - - - - - - - - - - - -
Sto Soil USGS 1
p{� :Sarvev OFIo '
A 1
X
Throughout project area X
yal i. :c:t:V, , ini, iftnjucul, F rcrmawi 141, Not [resent, NE Not tvatuatcd
(?) FCfcrs to State r tarinn buffer rules only 5treatn, wetlwvl, or pond impacts are stiff' subject to appltcab"e wzlcr quality standards and pertnitting recjuiremett s
Explanation: The streams)/pond(s) listed above has been located on the most recent published NRCS Soil Survey
of Durham County, North Carolina and/or the most recent copy of the USGS Topographic reap at a 1: 24,000 scale
Each feature that is checked "Nat Subject" has been determined to not be an intermittent stream, perennial stream, a
pond connected to a stream feature, or the feature is determined not to be present. Stream features that are checked
"Subject" have been located on the property and possess characteristics that qualify them to be subject to the buffer
rules. There may be other streams located on the property, that are not depicted on the maps referenced above and
are therefore not subject to the buffer rules. However, if the stream Features are present on the tract they are subject
to all other applicable North Carolina stream standards and permitting requirements as outlined in I5A NCAC 0213,
and may be considered jurisdictional according to the US Army Corps of Engineers.
�QE
=.orth Carolina Depinment of Environmental Quality :7L1vision of WatW r ,isources Ra's+#h Regionai Office
:3804 F-Trott Drive 1628 Mail Service Cel'.er Raleigh, s;xth Cnichna 2 699-1628
919,791.4200

1204 Goodwin Road
Durham County
I 0. 212019
Page 2 of 2
This on -site determination shall expire five (5) years from the date of this letter. Landow.-jers or affected
parties that dispute a determination made by the DWR may request a determination by the Director. An
appeni request must be trade within sixty (60) days of date of this letter. A request for a determination by the
Director shall be referred to the Director in writing. If sending via US Postal Service: c/o Karen Higgins,
D IVR — Vl & Buffer Permitting Unit, 1617 Mall Service Center, Raleigh, NC 2 7699-1617. If sending via
delivery service (UPS, FedF-v, etc.). Karen Higgins, DIVR - 401 & Buffer Permitting 00; 512 N. Salisbury
Street; Raleigh, IVC 27604.
This determination is final and binding unless, as detailed above, an appeal is requested within sixty (60)
days.
This project may require a Section 404 401 Permit for the proposed activity. Any inquiries should be
directed to the US A ",y Corp of Engineers (Raleigh Regulatory Field Office) at (919)-554-488-1.
If you have questions regarding this determination, plea-,e feel free to contact Rick Trone at [phone]
ZSincere
y,
lich, L.G.
Assistant Regional Supervisor
Water Quality Regional Operatkir-,
Raleigh Regional Office
cc: RRO DWR File Cop)
D_ E Q
North Carolina Department of Emironmentai Qua,ity Dvisonof Water Resources Raleigh Regional Office
3800 Barrett Drive 1628 Mail Serv''e Center Raelgh, North Caro i-a 27599 1628
9197914200

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Cassandra "Casey" Champion, Inspector 46761
1096 US Highway 158, Rougemont, NC 27572
335-5.98-2054 c}champion323ftmail.com
On -site Wastewater Inspection
_X Pre -Inspection Contract, signed by Client is attached to Inspection
-Property Address:1204 Goodwin Road, Durham, NC 27712 DURHAM County
Client Name: Shannon Morgan
Current owner of Record: Shannon Morgan Parcel ID # 183417
Date of Inspection: August 2, 2019
3 - Advertised number of bedrooms as stated in MLS or as stated in attached sworn statement by owner or
owner's representative
6 - Gallons per day for designed system size or number of bedrooms as stated in available local health
department information
*** Inspection shall include any part of the system located more than 5 feet from the primary structure that is a part of
the operations permit.
Attached - Copy of Operations permit from DURHAM County Environmental Health
YES - System requires a certified subsurface water pollution control system operator pursuant to G.S_ 9OA-44
Current Operators Name — UNKNOWN
Type of water supply X Well _ Public Water Community Water Spring
Location of Septic Tara and septic tank details:
5 ft - from house or structure
100 + ft - from water line if applicable and readily visible — WATER LINE NOT VISIBLE
10+ ft. - from property lime if said property lines are known — PROPERTY LINES NOT MARKED — ASSUMED
PROPERTY LINE IS GREATER THEN 10 FEET
NO - Access riser(s) - Describe cement lids at grade
YES — Interior Tank lids intact —
YES -Tank has baffle wall
YES - Inflow to tank is noted as sufficient
Inflow to tank is noted as insufficient or blocked
YES- Water level in tank is relative -to tank outlet
YES - Outlet T is present
YES - Outlet has filter
YES - Effluent Jeames the diet

NO - Roots present in tank
NO - Evidence of tank leakage
NO - Evidence of non -permitted connections, such as downspouts or sump pumps
YES Connection present from house to tank
YES - Connection present from tank to next component
SCUM LEVEL — 2" SLUDGE LEVEL —12"
Unable to locate tank.
Date tank was last .pumped — TANK PUMPED on August 2, 2019
Does system have pump tank? NO
Dispersal field: Type of system: Gravity to Sand Filter — Chlorinator and De -chlorinator installed on August 2, 2019
ORGINAL INSTALLED IN 1959
6 ft - from septWpump tank 900 gal tank — 3' by 9' by 4'
Sand Filter Trench — 3' x 67" to open discharge
Chlorinator anti De -chlorinator installed on August 2, 2019
NO - Evidence of past or current surfacing at time of inspection
Briefly describe:
NO - Evidence of traffic over the dispersal field
NO - Vegetation, grading and drainage noted that may affect the condition of the system or system components
NO- Effluent is reaching the dispersal field
NO Conditions present that prevented or hindered the inspection
Client should contact DURHAM County Environmental Health and/or a certified on -site wastewater contractor with
questions.
***Pertinent facts noted during inspection:
Chlorinator and De -chlorinator installed on August 2. 2019 — Operational at this time and property discharges
The system was Inspected with the aid of the originally issued permit The permit states the number of
bedrooms for the system design and the location of components _
No sign of failure in septic field at this time.
Septic t w* new to be pugged every 3-5 "_

Do not flush fernirdne gVq*jq& condoms cigarettes grease or wipes into septic tank
Do not ddw over septic tank or drain field
Inspector Name: CASSANDRA J. CHAMPION Certification # 46761
Address 1096 US HIGHWAY 15$ Rau emont NC 27572
Phone: [phone]
No representation, warranties or opinions are hereby given, written or expressed otherwise. as to the future
performance of onsite wastewater system described herein. This onsite wastewater system inspection is a presentation
of system facts in place on date of inspection.
Inspector Signature: Date: August 2, 2019
PICTURES:
f
House
Septic Tank — Tee and filter
Chlorinator — De -Chlorinator

QPen Chlorinator 0 De-chfori nator
Installed
Covered Discharge

DEPARTI+ tN t Ut HEAL I H ANU HUMAN b" ti tC tib
DIVISION OF PL+SUC HEALTH, ENVIRONMENTAL HEALTH SECTION
ON -SITE WATER PROTECTION BRANCH
SOIIJSITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
(Camplde SD fields in full)
OWNER: .ly''I 4AA n t .
ADDRESS. t
PROPOSER FACTLLITY:F)e sn
LOCATION OF SITE:
WATER SUPPLY: Private
EVALUATION METHOD:A
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SOIL MORPHOLOGY
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DEVELOPMENT INFORMATION RESIDEN•I'IALSPECIFICATIt NS
13 New Single Family Residence M x nundw of bedroo=
0 &pansion of Existing System Max utunber of occupsats:
�NItepair to Existing Subsurface Sewage Disposal System If expansion: Cumnt a mdw of bodroonw-
Is a Saflnge dOap W p 13 yes Xm
Will theca be any p1unhing domed into Ur&6s W areas of the house (suEh as an attic or basez ? CI yes no
If yes, describc location -- —
WAITR. SUPPLY
12 New well Existing Welt ❑ Conunnnity well 0 } ublic Water
Please bidicate Desired System Type(s): (system Cali be ranked In order of wur preference) w
Coaveuttoanl: Amsted We L _ maadir'ud Couventio" (id 4rpe D:
_ Ittnovsstive (list Lypc ): _ Atternarive (iist type ;: - _Other just type N
6121120I 5 PW 1 of 2
Environmental Health Division
Human Services Building ) 414 East Main Street, Durham, North Carolina 27701
(91 s) 560-7800 1 Fax [phone] j doom.gov
Equal Employment/Affirmative Action Employer

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7+EB,l;I OR AT'flfit'1'IM& OF APPJACATiON FOR IMPROVFMRM P3+RMT SUMMON.
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SURMMNOT A CEERfF�IEot COPY

Public Health
c
Re: Application for iimprovemnt permit for Shannon Morgan
Property site: 1204 Goodwin Rd, Durham, NC 27712
Environmental Health Division file number: 280534
Dear Shannon Morgan,
The Durham County Department of Public Health, Environmental Health Division on July 29,
2019 evaluated the above referenced property at the site designated on the plattsite plan that
accompanied your improvement permit application. According to your application the site is
to serve a 3 bedroom residence with a design wastewater flow of 360 gallons per day. The
evaluation was done in accordance with the laws and rules governing wastewater systems in
North Carolina General Statute 130A-333 including related statutes and Title 15A,
Subchapter 18A, of the North Carolina Administrative Code, Rule .1900 and related rules.
Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina. Administrative
Code, Rule .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a
sanitary system of sewage treatment and disposal. Therefore, we must deny your request for
an improvement permit A copy of the site evaluation is enclosed. The site is unsuitable based
on the following:
nsuitable soil topography and/or landscape position (Rule .1940)
nsuitable soil characteristics (structure or clay mineralogy) (Rule
nsuitable soil wetness condition (Rule .1942)
nsuitable soil depth (Rule .1943)
resence of restrictive horizon (Rule .1944)
nsufficient space for septic system and repair area (Rule .1945)
nsuitable for meeting required setbacks (Rule .1950)
ther (Rule .1946)
1941)
These severe soil or site limitations could cause premature system failure, leading to the
discharge of untreated sewage on the ground surface, into surface waters, directly to ground
water or inside your structure.
The site evaluation included consideration of possible site modifications, as well as use of
modified, innovative, or alternative systems. However, the Health Department has determined
that none of the above options will overcome the severe conditions on this site. A possible
option might be a system designed to dispose of sewage to another area of suitable soil or off -
site to additional property.
For the reasons set out above, the property is currently classified UNSUITABLE, and no
improvement permit shall be issued for this site in accordance with Rule .1948(c).
Environmental Health Division
Human Services BukkV 1 414 East Main Street, Durham, North Carolina 27701
[phone] 1 Fax [phone] dconc.gov/publichea#th
Equal EmploymentlAtTirmative Action Employer

Note that a site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if
written documentation is provided that meets the requirements of Rule .1948(d). A copy of this
rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan
under which your site could be reclassified as PROVISIONALLY SUITABLE.
You have a right to an infoonal review of this decision. You may request an informal review by
the soil scientist or environmental health supervisor at the local health department. You may
also request an informal review by the North Carolina 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, 6714 Mail
Service Center, Raleigh, NC 27699-6714. To get a copy of a petition form, you may write the
Office of Administrative Hearings or call the office at [phone] or download it from the
OAH web site at hfp:tlwww.ncoah.com/forms.html . The petition for a contested case hearing
must be filed in acWWarlice with the provision of North Carolina General Statutes 13OA-24 and
1508-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 13OA-335
(g) provides that your hearing would be held in the county where your property is located.
Please note: 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 Juty 29, 2019- 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 (N.C. General Statute 15013-23) to serve a copy of your petition on the
Office of General Counsel, N.C. 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 N.C. General Statute 150E-23
that you send a copy to the Office of General Counsel, N. C. Department of Health and Human
Services.
You may call or write the local health department if you need any additional information or
assistance.
Sincerely,
Patrick C. Eaton, REHS
Onsite Water Protection Supervisor
End: Copy of site evaluation
Copy of Rule .1948

15A NCAC 18A .1949 SITE CLASSIFICATION
(a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system
consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the
operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily
overcome by proper design and installation.
(b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and
disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable
require some modifications and careful planning, design, and installation in order for a ground absorption sewage
treatment and disposal system to function satisfactorily.
(c) Sites classified UNSUITABLE have severe limitations for the installation and use of properly functioning ground
absorption sewage treatment and disposal system. An improvement permit shall not be issued for a site which is
classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY
SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with
Rules .1956 or .1957 of this Section.
(d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system
specifically identified in Rules _1955, -1956, or .1957 of this Section or a system approved under Rule .1969 if written
documentation, including engineering, hydrogeologic, geologic or soil studies. indicates to the local health department
that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as
PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that:
(1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious,
non -toxic, and non -hazardous;
(2) the efilueat will mat "Wainnude groundwater or surface water; and
(3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could
come in contact with people, animals, or vectors.
The State shall review the substantiating data if requested by the local health department.
History Note. Authority G. S. 130A-335(e)r-
Eff July 1, 1982.
Amended Eff April 1, 1993; January 1, 1990.

DEPART-MMI ur HtALIH AND HUM" sex.vx ra --- ---&— j �—
DIVISION OF PUBLIC HEALTH, E NVMONMENTAL HEALTH SECTION PROPERTY ID #.
ON -SITE WATEIL PROTECTION BRANCH COUNTY:
SOILISITE EVALUATION
for ON -SITE WASTEWATER SYSTEM
(Complete all fields in fuD) J
OWNER: ��� t! �� �r1 — - APPLICATION DATE
ADDRESS: tW 6W1>W1;,4 -- Z- % 4 DATE EVALUATED: 2 1
PROPOSED FACILITY: 1 S'F'W .c�RO ED DESIGN FLOW (.1949): 3t'on PROPERTY SIZE: � c -40 A c ce S
LOCATION OF SITE:— mi & lt1 D I�R O RIm c9 -4I � PROPERTY RECORDED:
WATER SUPPLY: Private Public ctI Spring Other
EVALUATION METHOD. n . Btuin Pit Cut TYPE OF WASTEWATER:-Re"vtage:�) Industrial Process Mixed
tJP41) I'A_ CTORS
L i,A 43 ,AVE HQRMN
pASUI'i! . I� PROFILE
•/. �) .194i .1941 SOIL CLASS
1! 3 2956 ,1944
SMUC tRkf CONSIS7ENCFJ WR'i'AtMSS/ ;IrAL S ©, RESIR & LTAR
TEILT JRE MINERALOGY COLOR D .CLASS IIORIZ
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DESCRIPTION
Available Space (.14+t5)
System Types)
Site LTAR
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opted Fcbnwy till#
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vry- 59
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BUTIAL SYSTEM REPAIR SYSTEM OTHER FACTORS (-1946)-
SITE CLASSIFICATION (1948): V N42 l TRBLF
EVALUATED BY: F- GQ- ., /si• 4eo oo T
OTHER(S) PRESENT:

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