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A29 292
AnAliaation Date: 3'�`c� i a� ��(an m Amourrt paid: �OO.Od � � Re�a� T :? �f � � � �ri�l �• ���G�� .��� � � �J-�� �. � � �4 S� ao1 _ _ - _� I���� �'°G � ��.-�.._—�—� ' c� � �T� ��. APf�L1CAT]ON F�R S�tVICE�� L�i�d5TFiUCT Si�ALL BE�i3ME IPIVAL.ID. . � • v 1) Permi� re�uested by; (Owmerla er�filpraspe�tiv� ownerj: _�_ Ir� C� ��� (� �-� . Home Phone: • Sq�•-S7 � . Address: � Business Pt�one: � 2) Nar►a� and address o�r cvrren4 owner: b rr G �� � i�Y� r l�s N� �-�5�1 3) Praq�eriy Description: Lot sizs:.' Township: Subdivisian: LDt #�� Dire�tions to the property (lnduding roa names and numbers): d) pro}�osed Lls�e�d Struucture �escri�ation: answer eaci� of the fallawing questions: � � �.. a) Propased _, Existing . Type af Struc�ure: �dth: � Depth: b) Number of Bedrooms: 3—y� Number c�f ocr,�parris flr people to be ser.ved: . c) Basamec� Yes , iVo " Wiil there be piumbing �n the basement? d) 6arbage Dispasal: Yes Na _ . � 5) 1lVat�r SuQgly Type Prnrate _(new _ or e�s#ina_ _), Pu��_, Cammuniiy_, Spring Are any. ad�oinin9 pro�erty� Yes�:w� i�lo•,�, tFYes, Please indic� approximate location on the ": 'siie pian_ � • � � �' 6) Does youe, prope�iy cantain �a�viousiy identiii�d jurisdictionai we�laa�ds? Yes,_ �!o � Pti�SE �1oTE �-tE F�LLOWIiVG• �:� P�AT OF THE PROP�3�'Y OR SaTEE �.i.s�A! iiflUS'T BIE SLiBiVtl'lTEi� W!'�'i-i ii-slS P+PQ�iCA'iiD�l. 'a PROP�TY Lll►IAE� At�D CaRAlE�ZS flflUST HE CLF'�1RLY 11�4R9CE�, . � y T}�iE PftflPOS� LDCATiOId �F ALL STRUCTUR`S 11�UST HE ST�i7 OR F�.AG�€i3. y i'NE SITE �flUST SE }�ADILY �C��SiBl� �aR �id EVAi.lJA37OM B�t T}iE l�3E�l.TI�] i�E��1RTM�T STAF�. • I here�yy malce appiication tfl the Persnn County Health .t]epartrnent far a siie evaivation for the on-site sewage disposal sys#em for the above-described properiy. I agre� that the cantents of this appli�tion are true and rzpresent the m�imum r�ci9iiies to be piacarl on the property. I understand R ihe site is �liered or the intende� us� ci�anges, the peamii s#�all be�am� ijtvaiii� �� , I ._ ,. . Cuvnef a� � �:�:� � � .� Da#e r'C: ID, a�:. �76iTi; 02 .:�. ``���� �� ���� �� ��4 ' � � ���� IE�-�.a-�� -�-� ��,�,.If. I����.1l.�I�. APPiicant ►LCt¢n � Locatinn: �IG 5' —7 '•• T��x P.�f:� E� � , ' �t r c :_.I '� , . S�u!I�.cfli v i.s�i c���1 •- - P f�r�;���.c; 5 e��� ti;o,n�:� L.� t� . rd � �C..J -a _ �pro��� P��� ; . . Pe�mat �Talad for � �e 'S�tears. l�i� �irai�on �� as 'I�ype of Fac�ii�: ` ' �N.:.\ �c..� eS�4,�' 1Vew ✓Additian ��t� �aPP�3' � �'` # of Occupants c�.k # of Bedro �� -�. Psoj� Da�y'Flow �_ g P•d- • Proposed Wast,�water S��tem: (�a •. ..�.�.a.4 � . Type: at Praposed Repeir: � =,� � ' C2�'S'/ �.�e�.�.-.� ' . '�YPe: : Pe�nii Co�aditions•�fe - C�n9'�n,.t�•l�. tr��s.�.,_r�r.�o.��. �o Nk �nr�a�. . U . - . �wner or Legal Repres e Si ,: �...� � Date: Authorized State Age,nt: . � � Date: 5-2 5/�os 'Iho issuauca nf ttiis permit by the � ' does noi gu�e the issaanca of othcr permits. Yt is tlua responsb�ity of the aPP�PTaP�Y owaer to in sure ti�at aIl Peison Cowsfiy T'l�ing and' Zoning and Hwlding InsPections requirements are met 'TLis Improveffient P.ermit is subjeet to revocation ii the site plan, plat or the in#ended ase ehanges. T�e �inprovesnent Permdt is not affected p� a'ch�ge nn ow�merahip of the prs4pertyf. �'hi�� permit was issued in romglianc� with the pruvisinns of the North Cmrolina 'Laws and �lea,for �erva�e Tre-�emt nred Disnasal S`a►ste�es' (15A NCAC.I8A .1900). NeitLex �'erson (:o0nty nor the Eavirnnmental Healtea Special3st �rmrranta that tbe sep�ic t�nDc syste�n �I cont6►us to f�c3ion s�tiafactnr�y an the future or tLat the v�ater sag�plg vn'II a�emam potsLle. • " � ' . �AII�b.���anII to �0�9�c�'���i�'V�a$e� � �j�steg9i ��ed %s �uiiding �.'er�nat) . * See site plan and additlonal r.�ttachmertts (✓�. � � Proposed Wastewater System: L. c� llXall�1, �� �Pe ..1�_ �7astewater Fluw ��.p.d. New � Repair Ea�ansion Sa1 I�TA�t: . a 7S g.p.d.l $ 2 , Type of Eacslity'_ �nc� �s��� ¢Q.�A+�. � �Baseme�xt �Yes �C No � �— �astew�#er Sysieffi Ytequirenmemts Siae: Septic T�nk: ���'SZ� g�l .. �P Taatd�: —" gai' . Gr�ase Trap: `� Sral fie1d: 'Total Area: 1 � �15 sq $ Tot� Len� .�_ �t . • 'T�ene� Depth �._ ffi e�t �#�t y�_ f� ��i�.,;�,� �0�1 Eove�: � ' �o � M�n�**�» Trench �epazation: �_ $ �#ion: � Distdbution Bna Sesi�1 Distabution .� ll A�aoa�a� S�ate Age�: Pe�mit �x�iration �ate' -2 _ pressure Ma�ifold ��ln �C1`�+�� Date: S - 2 �i-c�5 The type of system petmittesi is � Conveational Irmovafive Alterflative. I acr,�pt #lie specifications of the pe�it ' . ��erll.�g�i ��a�se�a�e: • . .. Date: . . � PG`�7/3012002 .����� �,,� ���.� �� ~ �- . c� �o �C��C`� ]� �.�a-�,�,� ,� ���.Il 7�7L��fl�fl�. ���• S���C�. I'�am.�e . Subdivisa.on 1'i��t1a�� d State Ag�nt ci�es�-`��- ��-��-►��, Ta� lY1a.p # Pascel # �ection/Lot# � '� --o'�c�/-Q�' Date `.Sjrs�s coaaa�iosaerats represe�et up�'ira�a�irr�ate �co�tnuss or�ly. Td�e con�atctar s�us�,�`Tag the sys°t�er�a pv�t° t� lregiazrei�ag td�e isastadlataara to i�asure tduat projierg�rde a�r srrera�ataisaed :: c�- a . 1 � /,.. � �,� I �--�-;� – ` • .� � �� - 1�1 ��-� �� �-e. �i.Q.�-Cl� Q__ .�(�-iC.� ' �-� 192-G� `_ � � —,-�_____ � � � �. � � ; � I � , � � � i� � , � � � I � c`�.. WUP�QC�- GYQQ , ' "� � � �� � �-- 1 N'_� 4g ''�_, ��5 �- L' onv�-h'o��Q 1 �' ` -�,•�..�-, c�-p�, '(�9�.��n+�.�� c��_ C��.�ar ��-�\; s}, � �;�cs� v�. :) cyQs- 21�1h�e. ��`� $��'`'`� � � QSpg�"9 n . Scal�: j „- a�O� VIOLET M. �RENN P.B. 12, P. t10 � � / /' / CONTROL i i CORNER i i �F14 589'S6'29•E / � _ _�_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 662.51 � 8 161 • \ / � � STEPHEN L. DUNEVANT �.j O� O.B. 311. P. 199 ryy � a N25'01'S4'E � tih ^ 48.42' � 59.5g� �6 = ryF �F 58�•37'OS�E �. J� A C. 507.87 T07A� 15 � 6 19 ;u I F / h� ♦ " / =�ry 0 F� _ _ _ _ _ PROPOSED 50_R�W ACCESS EASEMENT :e � ' / 21 �29 30 ' __' _ _� 2' __ _ . 185: " — " NS 1 N85•10�05•If182 Z � i � 5 �_ 1 - _ i I � '_ "�"_�„'-�-� 4� 185 3 NS � i � �s"__"__'___'—_ 22 }` ���35 .. i 188� � _ —� 72 i g �\/,� / V/ PATRICK �EE GOOM[N, JR /�� 24 / i / KAREN HOB6000 GOONIN - ` � ' � 2 �.B.SJ2. P. 91 . r � , , ,88 �F =,.:.� � _ / � � /. — ----- � ---- ------ ' ------- � / / ----- ----------� _ _ _� -�' / � i � �- ' � � SANORA BRAOSFIER DUNEVANT D.B. �95. P. 208 13 7 �ATED. THIS IS A 7 RECOROATION, SALES '7JEYORS ,�, IA 27573 _.—__- I i - . re � ._ �. � � ,-';���r �`� '� �,;,a✓�„�.._ . � � � t: — �`. -`� � �„ � , F ```' ` 3''� �:Q. ��`'._ � � �� ��i�+.. -- i � � � _ ,_, '— , y'—i IS .,.6, 9. � IF 86 173 27 6}5.31' . ,o PATftICK LEE GOOIIIN, J � KAREN HOBGOW CODIII D.B.512. P. 91 26 25 � .� : y�� J�� ��) .— i / �" / i . � � 1 \ � ��} .��_ i ._ �� � J l � .;�� �- fi�;:. ! � ��"` 1 �-' � ' � � ,`�._ � , � �1 ;� , �c. � t � }8 PATRICK LEE GOONtt1 JR ' � i KAREN HOBGOOD ,EOONIN D.8.512, P. 91 �S`, � \ S9 � � � \ -i `� \ , .� �=1 � \ � ' i 10 � � � i � I I \ 4� � i t i � 42 `` i i i �\ \ � 43 . � 84 �\\ 4\ ` ��81 `• a5 .. ` \ � 76 �6�� Q 5: 77 ` � � / � 81 _�� % i- � --j\���` i, 8z .. _ __ - J \'f ,� -- �� � F �:� a ` � ���. — _ � . 79 J •169 � 70 0 . i• .. . .. . .::'•�•��:::.:.....�.;.,.�.�. �. �1 . .. ..� v. � : .. ��. .':�'13 -•�. ����� �� .}••�i'•�C: J . . ... . . .. .:. .��+w1"._• ''•' � ..� l ���� :;�;Y;��• `m� �• .,_... . � ...,..... .. .. ....: .. . ... . . • . . . : � . •. ........,��.,.:;:..vs;•�,.;•.v� ::•:...,e•�.•r::,.,;.. : . . .... ...,: ,-,;-. . . . �]G71-;�`�,4A;'iC�—�n^r^�:�7�1,L"�'..it.lL':�`.:' �;�'�51.��7�:: ': ; ..,-; .. ... • •....• .:.. .. ".^.�.,-: „ ...... ... . ... .: .::.: � . ... ..:....: : WELL PERMIT � � . PI' + ASE S��+ � A�A�D PI.AN FOR WE�Y, � SI� ��IOIUT Tax Map Parcel # T�oovnship: Applicant: 1��n Cyn�c.a� Subdivision: �,+�r'.�.��•, Lat # � � Location �-iQ � � ^- � m�'1 2�3f- Noa6+ '�',,u's � a'- St�-bd•ur`+�• �Z 'iype of �Vater Supply: �Individuai _ Community $tes�nirements: Site Approved By: Grouting Approved By: � Well Log � Pump Tag: _ ' Well Tag � Air Vent: ' . IIase Bib: � Casing Heigh� . Concrete Slab: ' ' Well Driller: - Pnblic Liner. 7nstalled by: � Depth set: � Gmuted: Date: . - Water Sample: � Well Approved by: � Date•. ****Se� Attached Site Sketcli**** Wells must be 10 feet from property lines. � Wells must be 100 feet from septic systems. � Wells must be at least 25 fest from any building foundation. �' � Other conditions: �►�� � c3> S�� g��c.� PG`� rev 01/27/04