Loading...
A27 95_ _ _.. ,: _ -_ � � = ; r�G�� V�, ��- 5.�- ^ � ir � ` Person ounty Heaith Department Sewage System Improvements Perm�a,�,,, Date• � L is e i� Void t r 5 Years Owner: � SR# �� L.ocation/Direcdons: , . —�..�— Subdivision Name: ` � � v � Lot # � - Lot Size: Type of Dwelling: Q*�►1Q Water Supply: Privatc: Public: Community: Bedrooms: � Garbage Disposal Basement Basement Fixtures � INFORMA � E IFTTE Y `-�vo 4+zr � 5����: own r or rep�sentauve REPAIR: RE VALUATION: Size of Sepac Tank: �L Nitrificauon Line: ��j Depih of Stone: 12 inches Max Depth of Trenches:_ Altemative System: Conv, Remarks: i: ----------r--- �gallons Size of P�}mp Tank: — �1-z� . C��v��� 1.�n � �.9nd is,., Pump LPP Pump � Date Well g veci: ��� Well should be 100 fr� from any sewer system BY Sani 'an Date S e S te pproved• � C� BY Sani �' .TE OF COMPLETION Contractor. 1� � ��� ------------------------- � Sewage System location, installation, and protection must meet state and local '� regulations. Septic tank should be pumped out every 3 to 5 yeazs and shall be maintained � by owner in such manner as not to create a public health hazard. Septic tank and'd nitrif'ication line must be inspected and approved by a member of the Person County � Health Depaztrnent before any portion of the installation is covered and put into use. If the site plans or intended use change this peimit is subject to revocation. (G.S.13U A-335F) Location of sewage disposal sewage system sketched on back. (OVER) �' Pe`rson County Health Department • Well Permit � � � '� Subdivision Name: Lot # Drilling Contractor: �L$�—s �1 � WELL CONSTRUCTION b Distance fro Nearest Property Line�r f� Distance from Source of �' Polludon � U- ;�. Total Depth: Ft Yeld: �GPM Static Water I.evel .'�� Ft � Watet Bearing Zones: Depth /�� Ft �FG F� ' FG Casing: Depth: From � to �- FG Diame� � Inches TYPE: Sceel � Galvanized Steel ff Steel, does owner approve: Yes No Weight: ,.,��_ Thiclrn eight Above Ground: � Inches Drive Shce: Yes � o Were Problems Encountered in Setting the Casing? Yes No ' If "yes" give reason• - � GrouG Type: `Neat �~ Sand/Cement Concrete Annular Space Width � ' Inches Water in Armular Space: Yes No '�+ Method: Pumped Pressure Poured �— Depth: From (�_ to � FG Maten Used: No. Bags Portland Cement � Weight of 1 bag � lbs. If mixture (sand gavel uings) - Ratio: � to < ID Plates: Yes.� No 4 x 4 slab Yes No '�_i HEREBY CER'TIFY THAT THE ABOVE INFORMATION IS CORRECf AND THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH REGULATIONS SEf FORTH BY THE PERSONaCOUNTY HEALTH DEPARTMENT. ' �..� ture C ac � Date �`� � 3 �� anitarians it; a e ate Issued Sanitarians Signature Date Completed Sketch well location on reverse side. : . s 1�TOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located at later date. Note location of water supplies on adjacent lots. � x U O �Q The District Health Department � � Orange, Person, Caswell, Chatham, Lee Couniies Water Supply and Sewage Disposal Date�d ` � ' ? � �% . Owner: Lg' k-� � �� � as� �r Location: s•R. t3��� ----, p, Contractor: '�✓ �' � � ! -�- � `� � � Water Supply: Private � Public _ �/�i� Sewage Disposal Facilities: No. bedrooms Dishwasher, Disposal, washing machine, other automatic appliances Size of tank: -� Nitrification line: ` %�%/� �V �� �',�„�,% i-.' �Xo�- noY�!" n Other disposal facility: Water supply and sewage disposal facilities location, installation and protection must meet state and local regulations. Above recommendations based on information received and observed soil condition. Septic tank and nitrification line MUST BE INSPECTED AND APPROVED BY A MEMBER OF THE DISTRICT HEALTH DE- PARTMENT STAFF before any portion of the installation is covered and put into use. Date approved: (OVER) Location of well and sewage disposal facilities sketched on back. � NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located at later date. (Z) � A�pi[cadon Dete: � �6 �v Amount Pald: _� Recelnt #: � ._. -- -� �� ]E$� �1� ��...-��-o��..e� � .�e.n.� . ��� r�� =�- I � 1} Permit requ� Home Phone: � 8uslness Phone: ' � 1!yY: (awti agvRt/ spee�lw,arve�; • �f �� 3 s Adciress: � 3�i � o �,r ln a�w� S�- l 0 7 ' 7Jc�. l�' `t1�e%� � s r� 7� ,L?- 5 �3 .: ��:�....•.�) Ns�me and addrass of cun+ant owvnvr. ,�',� . � j'��j s % L � l . � oro Z757 3) F'roPectY Dascr�ptton: Lot size: ' S�- - Towttshtp: �Lrvc l�ilf 5ubdlvlaion:, �G Lot� �►re�lcns to th� Property (lndudtn� road names and numb�s�); 4) propased Use and 3tructure Desc�i�tton: anawer each of the foflawin ques�ons: � � � a) Preposed t�Exfsttn9 - Type of Stru�: '�, L� LJ ���, yVidth. �� pap�; (o �% �... b) Number of �edr�ooms: r� Number of occupents or people to ba served: � c) Basement Yes_,, Na e/ Will the�e be pwmbing fn the basement? N b d� �a9e Dis1�e1: Yes . No v � t. • 5) W�ef �pphl'1j►Re: Prlvats �(�aysr,_, or eoctsttn9..�,'p✓ !c_,,,, Canmunity . 3prfn9 _. Are anY we!!s on adjoining Prope�ty? Yea No ,_, If y�es� pteaae tndiCaba approodmste locatbn on the 'sfte plen. 8a Ooas ycar Proper�Y ccntain proWous#y Identffl�ed )wisdlctio�al w�etfands4 Yoa No � PLeSE NOTE THE �OLLONfINa,� ' ,• •, � _ � � � . ... ', . ➢ A PLAT OF THE PR�PEiZTY QR S17� pLAN Y�(gT BE 8UBMI7TED WITH TNIS Appl1CA170N. ➢ PROPERTY LJNES AND COR��ERS ��L1g-r gE C�,��Y MARl�p, ., • % THE PRQPOSED LOCATION OF ALL 8TRUCTURE9 lIt118T BE STAf�D OR FLAGGED. D THE 3RE aAUST BE READILYACCESSIBLE FORAN EYALUATiON 8Y'THE•HEAI,TH DEPARTMENT STAFF. I hereby make appl(catlon to the peraa� �auMy Health Department for a sfte evalustion icr the on-site sewage dlsposa! system ior thQ above-described property. t agree that the contenta of thta apppcsdon are true and represent the maximum facilitles to be piaced the propecty. 1 understand ff the sfta la altered or the inte�tded use changes� the' pertntt shaU ber.ome�trnalid. � . , owner or •12 � � D te PCND. rev. a8l2TJ�2 t/l 60RLL6C9EC 411soH I�au�wuo��nu3 •o� uos��d Wd Zl:tf1 Cnn7./nt/An �� � �, i � i � �� y � �`L..1 � �.d. �l � � �m1.�'9.7C'QD�9.3C�C��7L71..'�.� ��.ffi..�1¢� �uilding Additioas/ Mobile Home l�eplacements Tax Map #:� Parcel#: Q�.� Approval Requested for: ✓ Mobile Home Replacement Building Addition � Applicant Name: u hi-e Aaaress: . ., � � � d. .. ;axf�or � 275�� Phone #'s: Permit Located: � Yes No Installation Date: - 2r, A� Design flqw: �� . �, Current Contract with Certified Operator on file (if required): Water Supply: ��Well Public or Community (gpd) Wastewater system shows no visual evidence of failure on: �� �" U 7 (�.�) (Applicant's signature if site visit is not required) � � Addition/Iteplacem�nt Approved /- Z-07 Env` onmental Health Specialist Date J ��� ? �� ���� �� �v � , �� � � ���� , 1G�.�fla-oa�-+��e��o.71 7E3C�e.m.7L�71a STTE PLAN Name R G ��a � Tax Map # AZ7 Parcel #� Subdivision Secrion/Lot# /-Z-� 7 Authorized State Ageut Dau Syatem cvmpaaeatv rrpnseat app�am conmrus mly. T3e canua�o�muarflsg rhe s}strm pdor to beg.finarag r6einamil�oa ta Insurc r1�tPr°Pergrdde ia m�inmined . . � `J � � . � v, / �e � f� s�� ������ . � � ql �'�al � Q raP �► a�P . �i � / .. S���I�S �w� S� � . � S"ys-�el� � �e�� � Pc�m, r�. o���z�oi . • � T - � � w�s�s , - • ' • • ' � � � � �• F.�t.oa�...• � I'� . ' $ t . • • • ;, '- • ' ��'a���� � : . _ • - . �� �� 'Carr� ��3� - ' ' . . �i • �s S-$8 , • • ' �,` R: !4$l.�3` . • . '. • . - L �7��.Q�' � �"'� �� � � �' � "• ' • . O�, � C� �i� � • .� s lO-03 - ; .' . �a ��'� ' ' r?�• p�* T3' . . . Yi'� �� � i�r=«76�� ��.J /jS. � : . .. ���.�y - ' . •�� ' . - _ . d � . . �� 4�. � . . � 6S'_� o- a" � . . /�h ,�► . : \ � �<�r� • . . • .' . - . r- - . . . '' . • • ' ' • .. - . " . � �eer �.a� PraR. _ ' . . - • ' .