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A31 18No. of persons tq be;servecL: ,Bedrooms 1,U3, 4. Additional :appliances to be used: Disposal, dishwasher, washing �� 's machine /.�.o�-� Recoxnmended: Septic tan ' � � _ � � � , : � I - r ; ` '� rI' i . Nitrification lin�: � � � ;� � �� L Above recommendation based ori information received and obseryed soil condition. S�ptic tank and nitrification line must be inspecfed pnd approved by s�ember di the Disfrict Health Departmeni staff before any portion of t�e installation is covered. ; , i � , I Date Approved' �-� 1��'-�� ; ; Si�e� ' . � i ,�^,�r� ; � i ( + � _.._ Saiutarian { E � By� `�i :1 / � _ ' , i. ' ' O. David Garvin, M.D., M.P.H. ! ' ! - ' District I�ealth Officer � f . . . � 1 . . - � _ - .. Countersigned ; : � , f � , ; (�ver) ; , ' � , _ i ' i NOTE: Make sketch of installation showing location of house, septic tanks, privies, water supplies on adjacent property, etc. Write in measurements in order that installations may be located at later date. SUGGESTED INSTALLATION (Date ) FINAL INSTALLATION (Date ) • (Road or Street) (�oad or street) �i'11 �u1:'��.�'��....�.. ■��-. :�■��r�� ■��\�� ■r■�r■r■■rr■r■.■��1 �■■�■'� ■��■�■�■O��lli%r�"I��J��■■■�i. ■��E�Ci��I�■■/%■■��■ �. ■■��■��0� �� I/,%■��■■ ■��■C��I/II ��■■� ■��■��OI/,��■�� ■��■o��/r��■��■i� ■��N��■■��■■��■11�■ ■��■��■��s��r■11�■ ■e�i��■■��■��■ ��r�■ ■��I■■■i�e��■�I� ■■��■ � � A?nount paid ldd� Receipt .!� � . e�'-�- � i �r � H 0 � � w v � a U� � � �� R� � � � 6� ` Date W � z _ Bacteria 1. Permit requested by: . owner/prospective owner Address: �aS pe ome Phone #: � usiness Phone #: � Chemical I Petroleum I _ Pesticide I _ Lead 7. Dimensions or Proposed Structure: lagent: Width: � � � j � �` X � � - r .� . 1 ;u n � ) �'r, Denth: _ 1� ��-aC� ec� �C �d I� � �nti.► �l`�U I�Iame and address of current owner: . � � � Description: Lot size: . Tax Ma� Parcel#: Directions to property: State Road #& Road �,� be�-�� -t � 8. What type (if any, additions, expansions, or' ` replacement is anticipated to the structure or facility that.this sewage disposal system is intended to serve? 9. Water s y tS pe: private public ❑ community ❑ spring ❑ Are any wells on adjoining property?Yes ❑ No [�. If so, identify location: 10. Type of structurelfacility: Proposed: �Existing: Q I Type of dwelling: House: ❑ Mobile Home: C] Business: ❑ Type of business: Number of Employees: Numbc.r of bedrooms: _ _ � Garbage Disposal? Yes ❑ No 0 Basement? Yes ❑ I�Io�I If so, # of basement fixtures: 6 Number of occupants or people to be served: � � CLEARLY STAKE ALL CORNERS OF THE PROPERTY AND THE CORNERS OF ALL PROPOSED ST�tUCTURES. I hereby make application to the Pet'SOn COUIlty Health Departmetti for a site evaluation for the on-site sewage disposal system for the above described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the propercy. I understand if the site is altered or the intended use changes, the permit shall become invalid. I understand that before an Improvements Permit can be issued, I must present a survey plat of the property to the Health Dept. I understand that in the event I have not delivered a survey plat of the property to the Health Dept. within 60 D S after the date of the evaluation of ttte site by the Health Dept., this appli�tio.� shall become void an�'all�s paid forfeited. Owner or Authgri�ed Agent �'erson County Health Department Existing Sewage System Report For: Mobile Home Keplacement ��ddition Requestee: ��-�Q-� l't ��X� n.�r. Home Phone#3�7y2 �� }�il,t..('G��L°..��i ��S �. Business# �-7�/�y � I � � � ( I (�%� �J-� ftax Map# �� t' 1 6 Location/Uirections: n Original Permit Located Septic System Uesigned r'or: Kesidential l3usiness Other (specify) _ # Bedrooms � # �mployees Other _ Uate lnstalled �"oZ4 "�o� Water supply �/�, V�C�'� `Pype of 5ystem �I� ��;�7�/��C� Nitrif ication Line �� d � k� � Tank Size - � v N� Certified Operator Required On site wasL-ewater disposal system showes no visually apparent malfunction on �l�s I q 0_ � c -� � Yermission is granted to: According to the attached site plan. Comments: Environmental 7� i�l � PA� R �e r�rn � t-� N COUNTY HEALTH DEPARTMENT PERSO WELL AND SEW�GE SITE, LOCATION IMPROVEMENT PERMIT Tax Map # 3� Parcel # �� Zoning Township � �.4 T �/t/� � Owner/Contractor Titill D 1 x� Date �-3 =,96 Location/Address �{w� �S''7 s ,yovs� n� Ri�� T g�Fo,z� ��v�� _ S.R.# Subdivision Name Lot# �- �� yo� �iJ 5 I A �L O/� � �� oN'cccR o�' � ay;n, meuc. T�e�d, �� . ;I�� As Installed a0 � �. 6�'�� '4 J 3 0 SEWAGE SY5TEM SPECIFICATIONS Repair Lot Area Size of Tank CX /S TiN � SFD � Mobile Home Size of Pump Tank 095� # of Bedrooms,T- Nitriiication Line�x is7�inl1� -►� �300' X. Max Depth Trenches Z"'� S� '' _ Permit Void after 60 months. Permit Void if not in compliance with zoning regulations. Permits may be voided if site is Well and Septic Layout by� Comments: . �oo ' x 3 ' c7 or intended use �t�r.lTDv� r Zz"—zy'� Date�-a'-96 Installed by L. � M�Ti�.! Approved by Date Installed by Approved by This report is based in part on information provided the homeowner or his/her representative in the application submitted for this permit. The environmental health specialist is not responsible for false or misleading information contained in the application. The environmental health specialist is also not responsible for concealed conditions on the property oc for statements in this repoR that may have resulted from false or misleading statements provided to him in the application. Neither Person County nor the environmental health specialist wairants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. c:\amipro\permit.sam 01/95 rev.1.0 fc �f ��` � � ACCESS • Scafiolding • Shoring & Wall Forming • Systems Scaffold • Suspended Piatforms • Altrex Modular Staging • Safety Equipment • Erection & Dismantle AERIAL WORK PLATFORMS • Boom Lifts to 100 ft. • Scissor Lifts • Personnel & Material Lifts �� : �� EQU/PMENT RENTAL & SALES AERIAL WORK PLATFORMS • SCAFFOLDING CONTRACTOREQUIPMENT COMBINING ABLE EOU/PMENT COMPANY • SAF-T-GREEN FLORIDA CONTRACTOR RENTAL 8 SALES _ F��,J BOOMS & SCISSORS • HEPLER HI-LIFT /� I'_ . i , .� . � . I _' � �� L{L� �,c'��'��, �•'' b:� 1 Vr�-�.€�— � CONTRACTOR EQUPMENT • Air Compressors • Air Tools • Compactors • Backhoes • Mini-Excavators • Generators/Welders • Mortar Mixers • Forklifts • Concrete Saws • Pressure Washers & Pumps • Suppiies o a e �z -- � AJ 1 . a � - ? � l �Z 5 ti �� B K � �� \ �, � � (� � 12 i5 � �� ` � " �t 16 0 J ' /' /y i � i zo t ! 2a za JACKSONVILLE ORLANDO NAPLES ATLANTA (904) 262-0066 (407) 889-5599 (813) 643-5000 (404) 525-1919 Lifts (404) 523-5962 Scaffold FORT MYERS MIAMI W. PALM BCH CHARLESTON (813) 768-3636 (305) 822-3022 (407) 640-5900 (803) 767-8500 RALEIGH NORFOLK WASHINGTON DC (919) 262-2664 (804) 543-2900 (703) 368-6248 CHARLOTTE RICHMOND (704) 377-4200 ($�4� �J�J�-2i$rJ BPS-MEMPD-S.A3 R�: North Carolina State Laboratory of Pubiic Health Department of Health and Human Services P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047 INORGANIC CHEMICAL ANALYSIS - PRIVATE WATER SYSTEM ; �, Name of System: Dixon, J.A. ,Source \ Water: Ground Address: 8850 Hurdle Mills Rd/PO Bx 280 '� J� ` ,Sour�e of Sample: Hurdle Mills, NC Zip: 27541 �j OC, � � j ��;T�pe o� ample: Raw �- � County: PERSON �\ ,Q,� "`Ty jj f Treatment: Report To: Person Co. Health Dept. ATTN: � 325 South Morgan Street (336) 597-2371 � 1�� Roxboro, NC 27523 \�'/ Courier: 02-33-15 Collected By: BH Date: 1/7/2008 Location of sampling point: Outside spigot Remarks: of Analysis Private Time: 11:30:00 AM Parameters Results Units Date Analyzed: Alkalinity as CaCO3 148 mg/I 1/8/2008 Arsenic <0.001 mg/I 1 /8/2008 Calcium <0.5 mg/I 1 /8/2008 Chloride IC 23 mg/I 1/8/2008 Copper <0.05 mg/I 1/8/2008 Fluoride <0.20 mg/I 1/8/2008 I ron <0.10 mg/I 1 /8/2008 Hardness as CaCO3 (Ca,Mg) <2 mg/I 1/8/2008 Magnesium <0.10 mg/I 1/8/2008 Manganese <0.03 mg/I 1/8/2008 Lead <0.005 mg/I - - 1/8/2008 pH 7.9 Std. units 1/8/2008 Zinc <0.05 mg/I 1 /8/2008 � - ��-t�ie� 21u��g Date Received: 1/8/2008 Report Date: 1/28/2008 Reported By: ��t�;..J`�n� Today's Date: 1/28/2008 Ref: 303 Login Batch: 08010011__,_._: Sample Number: A666878 Explanations Coliform Analysis: If coliform bacteria are Absent, the water is considered safe for drinking purposes. If coliform bacteria are Present, the water is considered unsafe for drinking purposes. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. r� - Inorganic Analysis: Recommended limits for drinking water. Sample should not exceed levels listed below. - - - Alkalinity Arsenic Calcium Chloride Copper Fluoride Hardness No established limits 0.01 mg/1 No established limits 250 mg/1 1.3 mg/1 4 mg/1 No established limits Iron Lead Magnesium Manganese Nitrate Nitrite pH Zinc 0.30 mg/1 0.015 mg/1 No established limits 0.05 mg/1 10 mg/1(as N) 1.0 mg/1(as N) Not less than 6.5 units 5.0 mg/1