Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
A31 127
Appiication Date: U � Q-3 Amount Paid: UO _ Receipt #: Taz Man #: � 3 I Parcel #: �v� � ����.�� ���� �� - - _ --,_ � � �� � � � � aa�vaa-�+aa�•.^^• ma-a_�a.I1 ����.7L�I�.a APPLICATION FOR SERVICES IF THE IMFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS INCORRECT. FALSIFIED, CHANGED OR THE SITE IS ALTERED THEN THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. 1) Permit requesied by: (Owner/agen ros ective owne : BRUGE ED WARD GORDON Home Phone: 32- 6332 Address: 123 OAKDAI� DR�V� BusinessPhone:�919 - fo332 NILLSBOROU61-� NG 27278 2) IVame and address of.current owner: LYNN S. W tIS�rJ w�o pAUL M.� K11.1..oUE,!-! 744 MYRTLE_ T. DTtIVF � N LUtZDL£ M I LLS NG � 75ri 1 Bust+Y wiu� s�wsFR�zY 3) Property Description: Lot size: ,3 � acTownship: FoRK Subdivision: FI ELDS Lot #� Directions to the property (including road names and numbers): FRor1 RoXBORo 1 57 T� 6. 4) Proposesi Use and Structure Description: answer each of the following questions:, � � a) Proposed �, Exisfing _, Type of Structure: RES�DE�si'IAIr Width: 48 Depth: Z$ b) Number of Bedrooms: �_ Number of occupants or people to be served: 4 c) Basement: Yes_, No � Will there be plumbing in the basement? N�A d) Garbage Disposat: Yes . No � 5) Water Supply Type: Private �(new �, or existing�, Public , Community_, Spring _ . Are any wells on adjoining property? Yes�[ No _ If yes, please indicate a�proximate location on the site plan. 6) Does your property contain previously identified jurisdictional wetlands? Yes_ Mo� PLEASE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED W1TH THIS APPLICATIOM. ➢ PROPERTY LINES AND CORNERS MUST BE CLEARLY MARI4ED. ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAKED OR FLAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATIOPI BY THE HEALTH DEPARTNiEWT STAFF. I hereby make application to the Person County Health Department for a site evaluafion for the on-site sewage disposal system for.the above-described property. I agree that the contents�of this appfication are true and represent the maximum facilities to be placed on the property. 1 understand if the site is altered or the intended use changes, the permit shall become invalid. , aLlr�... Owner or Legal Representative 5 Date PCHD, rev. 06/27/02 ,. � ���� �. "✓ � �� fr ,�� ,f , � , � w� � ���� ��d , .a� : �� s f�� . �`✓� : . � �. ✓. €� �. ;�' � <:�3r : � > ; . . > � :.�3 �� ��������� . �; ; fi� ��� �� � fi� �: � ;; � • Y: < h ; ..,. ! .. � . . - .:_ : . �n . .. . r ,. .� . '. - .' .� � • � f '' • f } ' . � : ,: � : ' � e� ,. , , .. �'� , } : � � Y , � ' .� { . � �€�'� ��` � .. >' � � ��': :- �. ���#3$ �: ,,�, , , , ,: , ,: , ,. . . f �� �. %i� {�` y . ; � � f �i���� `, �i ,,3Y. . �< . � S `�f� ,�a : ; ;>�!;'f? ,r,�"�,`s � �x�� �� A .'' �. . , . . . '_ �. � � � . f� .. . �� �� . 1 < �{ ��� ��,.�` �� . ��� � ' � r # , �. > : : ` , _ t .'�� �` � � . •;� � < r � . '�'` � ` ,� � � :' �. . � h ��� �� � �at � : . � . .,. ...:. < >y . s�, .... : � �: ; ..: ,: � �; ; > �: :. , ,;. , : � k;� � '`� _ ���. �' � �' , M{ �: .� . , . �� �:� � � � � � d� .. . ; � O � . . . . `. . 4 . `..'" �c �`i J 2 .y �t'S { . � � l� � �� J �,,> �. r� y�t ` ` :., v�tic.<k.` §7� �w t i f • �� .. 4�� :' �T: �< �,�, �. � : : . �- � � � „j � . �' - , ' i. ,. : ;: _ �:'� . .. -. �,�`T�� _ ; ., . ,�� - . . . � . . . - . .. . � � ', � �'. .� . }: . �, � ��; . �( � � ' : . .. :.. t . . �. .... .: ._ _ : a`� � : f ' ; o ; # : : : �; {�� � � � � � � � ,� �131,� ' , . R .:� �. ; , . '� .� S : r. '� ¢yt,y�; � �� � � �i R � � �'r � �,, f � '�JOr• Y s :� � , P. :: sn�'` >fi .. ��>�, � r�` � . N � , 4,. � � � � ��~ � � # ` ` N gb . '� � ! � �~ � ; s �' ��..:� E-', � 6 �� ` ,: � �: � > ,.> 4 t . o . o ^� d � , f : i �` : `. � , .. , . 3t� : ,. o a .. • o . . > ` �•�, �`: '� � W, -'`�-'`'J � < : ,�'`'�� ' � .� . c� �� c r �w, t � � t!t 'i d M , . • ^'t �'r � ........; : � �7 � �. ; : : �x `�'�oe� �E �;� ° r � �� �� '� � � � , �' ��4� t -�� � . �. �� ,. .,�, � . N _ f �f � ' y 3' •' v! f � ' S ., ,, • '. > �' y�: . � � . .. . -. . r � ���?�oow�ow,d, � . �r3,.� j�t3' �li� ��`'�.i '� fi� �3' �:.c ^v .�`ii�. �ir'i� . �,,,, �'�j ' : �'::: �,v:. �� �������ts / , .. , � : y. • : > _ �` ' .' �i � i : `: , . �i ` j .� }� ;.� �� �' . > . ,: : .. •: , : : . ,� < Q�,�'/ ... .' , l �1 � J S � S � 4 '�4.' � ' ~�f �f lN � .�� f:� ) .� �.� . ♦�' � ..! ' .. . .. . ... . � X :•S � i•��. � . , �. h � #.,; fi �' � � �r ��` S.t'iL PLAtJ }, ��:�:t�: <�{� '.sM�`�; . ''�;� � � f � :: � � . f �.� ��. , �� .: � � �o► 6 �� W�u� �TRAwBER�y: F��s : � �� — z: , > NoUsE .�iTt c>a�! 3� a�ss�o . f , :. ,: ;;... >'' ,` , TNROU�,�f. �-'toWtb: P�'r"1""!-F A'4' �: . .. . . _ ,. , >. - z. . ; � > : _. .. , .. � TREtU �fE ,. . : _ ; � ; . GHtGK. #- ,Z17�% . , , :. , .. � x. , ' ,€ � ' �.�uc� E�wa�� �o`R aoN : : �.:. ;.. <:,. :> , p���Llf�Tior� . FOZ . . . ... ; t MPRoVEMQ�S PEKM �7' � j� � �� �p � i p�0 � �� � �—��'?, �� J.! ���� ��� o , � ' ; ��� �--�-- "— � � �T� 1'�C�� o I����-��,�-„-.� ��.��.Il. I���.Il¢Il� . ���� � � � Applicant: �UG� �%�d�n . Location: , : _ . , _ � .--�� i I -� - Pea�it `Valici for � Five Ye Type of Facility: `� # of Occupants�X # o Proposed Wastewater System: Proposed Repair: 1 'an .�. ..� , ,/'► / Owner or Legal�Represe Authorized Sta.te Agent: �proveffie�t �'ea�t I�To E�ar�tion IN��� New ��ddition �ater 5upply s Projected Daily Flow ��i g.p.d. � "c�✓tl�i Type: �A � `a'I�t,� Type: r�S. �- �D�,�e. ��1�'� � ��-2R5� � � ch�m'� Date: Date: � �� The. issuance of this pemiit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for Sewage Treatment and Disposal Svstems' (15A NCAC 1�A .1900). Neither Person County nor the Environmental �ealth Specialist warrants that the sephc tank system will continue to function satisfactorily in the future or that the water supply will remain potable. - Aaz�ao�a�on to Con��uct Waste�vater Syste� ��ter�uirecn for �nilding 1'ermit) * See site plan and additional attachments (_). . Proposed Wastewater System: �-U'e✓1.'����� Type��' Wastewater Flow�6�g.p.d. New �. Repair Expansion _ �oi1 I.,T�: ►� c� g.p.d./ ft 2 Type of Facility: 3� -* Basement Yes � No i�astewate� ��stem ltequirements Tank Size: Septic'Tank: ��gal Psamp T�: gal Grease Trap: ga1 Drainfield: Tota1 Area:1 �- O O sq ft �'otal Y,ength �� ft NYa�meun Treaich IDept�a �� Treaach dVidth � ft l0�anamuffi �oil Cover: �_ aai Minimum Trench Sepazation: �� ftO�G' Distrit��hon: � Distribution Box �.. Aaatlaorized State Agent: � Permit Expiration Date: %C Serial Distribution Pressure Manifold � - �e�: �; ( The type of system permitted is � Gonventional thz permi� d��aer/�e�a.l ��p��sesat�tive: Date: �'���� � ,� Innovative Alterna�ave. I ace�pt the specifications of Date: PC�ID 1/17/2003 ,., � ` .� � : . 1� ` , �� . � C �� Y'� .�'� � � .; " ' � �,� ���� � - , � � U . �� .. .. , ;, y � ' r; - �� � �� � �V� % — % y � � � ��� � � & �} "'`�,,�- ' � .�� �' �- t��, � 1 �J I > � �, ��. � ��}�* � � � �Y�� ;� � ..� i)� '�. � � �. ��� �.� �� --��---����:� �� �:� � -a� ` `� �' '� '� :!'7 �r�.`. �'�� �. °` <� ^� � ' r• � '� I � � 4��1�' ` '��� £ t 3. � ✓��y'�,�s� � , � .} ���'� � ����� ''���(.�1, aj%fid}{� t � � �,� �, � ,�r� _ . �� f %� �� � �,1,12�.11� �(J' i����; 1 ��� `�. �f'� �, ,�r �.{f:'�t �� / ' ° �•?�;3�-3 t �` �',''�,. f� `,'i.,r� � ` %, . � f.� � �..,,�.�'��' r," �`� ,i �.,,� • 5 —�'''''lJ � �-�( � t , ' r,�/ � x _ �� , s t�, -s� ° �, _ � � . J'" ' �� `c3 f�° �.:��� � '�'�A�, . �f � . � � �" �...-. - � . � -�: . _ . �o� � �� � -.�� ` � , :, .r} � 3 i `t � � ��?�� . . "a� r i. e —� s�'1� Q _ '� �.�i ,� Z J` .:'� r,��,> � r � � -�t�� ����y : � . �SS 0 l S� � ,.{�. f ) �, rt- /A �,/ � L /� ° -°� ,� �.��� .� y� �� . ., rs, � F � ' ��1 � .. � �� . d � + + � � � � � �.:� s � �� _ C:> ',#� , S � � � �+r�As 1 � -� � /� � , �o. ��,.,��tY c� ,� � � � � K�o , �� ,� �. I � � ���� ��, � ,�� ,,�� �a,�v���� �,, ��� t�.� s� � :�q �•ti � �n: �- � i ?Z, ,��xos � � rU. /� u � ��� ��, ,� I � .�� ` � 1-� �,�, ze-i 2 �` C� � �� �� ' c� � �. } � � ���� �,� � � �� , , K � ,� �� . . �.. .� � �r � � � � �� �� � �� ;� ��a ��� �� � �� �,� �.. = ��, � ��. , �., �; �:�i �. �' ���? ` i ���, _ � r �—f � � �;�.' � f �a'`+ �� �'�'��'�'��a �j� ',� � ,`� ,�"� � j j ��� _�`,r T�.,,�f _ � ` 1���' , � J �C7� � f `�� j �f} �t�"�r., . m 'j�� � �1`iv1 Q�/ >/ _ �+ f �' � '�� . � 1 � � :' '`.�ti/ `''rr•� �; �. 3 �: ,; ;�- $ � �i� � ���.,,� � 1/ � _� L� '� � F ` �j � � � ,��� `°�""`_._.,,� � �- �. , ��,,, �,. .� � i�'`� -- t�, �� � ..�:�"°�'�� `�'�' � , ,����; � C' }� . .`_a,�` , a`. "'"' (�� _ . �.��,� C F,� '"*r- � � �.� ,�-u� F � J -� � �,K,�,.. �^�� l , , ,�,�-• -;� ' c � � � � � � � �� Ep : ' t � �.,,�r.�yu"'`"r""` #� . `��� �;. E .f rk. � ..,.����1,a�� � y���.7� �}ii� � 4 � N ,��\//////�����' W�J ' � � � �. �:._ .-�..�- � i(� : � ��� € � C./.�� � ' ) � � ��y� S r�.,/ `� � � � � xi �rTt' �r" i �� � ^� �` �4 V � %i � j 6 : , _ � • ! , � � t �. ���' � � ' ! ,� � "� ¢ � ��� @j �, �f_ �t, t (,� � �' � , : � _ � . i�r �'j� � { � ��! �v �7��" "�C ' �. _ _ . �j ��� i ' ��f �:� t � r�l ` ^"�� - �.�� .,`"„� _ _ ..��4 • ._.. .F�-�... . ..� , _ � � ; ; � �� c�.B � � �,. � � � . _ - . � . ... 4 . . � _.. _- . .ro`.. l '- ... . - -+._ ,-. . . .. . . �1�� �� ���� y���q� ��' � 1 � � �� �.� �7 1'L � �S�'ffi� ��!"Tt'w'�a's d; �� �L �CL.�.�'�J�- . . . � S�lLO1VJ1.� 1 . �'1.aS'amJ� J�rS.:r 11��� �l n��I i'V� W�n •n ' JL ° S_S �'1�fJ - ".�� I��p #: .�� $'arCel # `_ �ov�ash�gx — : :.:. , ,«•.� IPiII,([i'V.�:a�.«aa�■ ���,� - �:, �1 ` A ' �/ S�ti.on.: _� �.oiC � '1:� ._ � 1'�! .: :x - , , ,v. ,�, '; •, �� • � ,.� . ....., . � ' � ��7B.41E`.ffi�Ii$�: _....._... . .�.. • .. .•:.. ., �%�. �Og SR7eil T�g - Air Veat � Hose B� ' Concrebe Sla� _ _ , � R � S� �o �� � �j � Y ��� ����. � �-� - �; t . i; ; . .. ;�; . �:, :- r . . : . . �:. . , '�ee �acffaes� �i� Sket�a� We11s must be 10 feet from property liaes. ' �YTe1ts must be 100 feet from septic systems• . WelLs mvst be at least 25 feet from aap bv�mg founda�.on. o�� �aa��o�: PCf��, s�v. 09/07/01