A31 2PERSON COUNTY ENVIRONMENTAL HEALTH
PLEASE SEE ATTACHED PLAN FOR SOIL AREA AND SYSTEM LAYOUT
Tax Map #: 'r � 1 Paroel # v'�
Zoning Townshlp �rJ�'1V �"O��
�� 1 T
Appiicant:
LocaUon:
Subdlvislon• Sectlon: Lot
New
Improvement Permit
# of Occupants ���— # of Bedrooms N
Basement? �Basement Fbctures?�
Other
Projected Daily Flow:,�, g.p.d. Permit Valid For. �,Fi�Years ❑ No Expiration
Proposed Wastewater System Type: ��P'TL —►'� I D,AQ o� Q n
Pump Required? Yes ✓No
Proposed Repair :�Op . 1��, OG,�__T.(Q,�
Permit Conditions__ � � �,p ��j� , ���
Owner or Legal Rep
Authorized State Ag
Date:
Date:J _ l r
The issuance of this permit by tlrie Health Department in no way guarantees the issuance of other permits. The permit
holder is responsible for chedcing with appropriate goveming bodies in meeting their requirements. This site is
subject to revocation if the site plan, plat, or the intended use changes. The Improvement Permit shall not be
affected by a change in ownership of the site. This permit is subject to compliance with the p�ovisions of the
Laws and Rules fo� Sewage Treatment and Disposal Systems of the North Carolina Administrative Code.
Authorization To Construct Wastewater Svstem (Required for Building Permitl
Type of Wastewater System � Wastewater Flow��.p.d.
Facility Type: �p� � 1�L(,� ('�— New ❑ Repair �cpansian 0
Basement? 0 Yes C�;Pdo Basement Fixtures? 0 Yes 0-P�t6
Wastewater Svstem Requirements
Septic Tank Size:1�� gallons Pump Tank Size: gallons ����� �� C i��
Total T�ench Length: �Q feet Maximum Trench Depth: a,Q inches Aggregate Depth:L in.
Maximum Soil Cover. � inches Trench Separation: � Feet on Center f
Other. � � �j� ��� �� �
Permit Expiration Date: � —c���� Cj
Authorized State Agent: �� Date: S_c� �_�
The type of system pertni ed 0 does ❑ does not differ from the type specified on the application. 1 accept
the specifications of this permit
OwnedLegal Representative Signature: Date:
PCHD, rev. 11/18/99
. .
• Application #: -
, Tax Map #: �_1_____
Parcel #:
• Person County Health Department
Environmental Health Section
SITE SKETCH
� �C'l �l ► /� f �`Ji`/1G��'� e tion/Lot#
Applicant s Name Subdivision/S c
� ����
Authorized State A nt Date
Svstem comAonents represent approzimate cvntours only. The contractor must flag the system
�
e nnin the insiaUation to insure hat ro er rade rs matnrainea.
�,r 2M � US
Scale:
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, ��k .
�.�,v T•-� vv-��.— i��l.S�-O�o � n�
v
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PCHD, rev.10/12199
Person County Health Department
Environmental Health Sectiona
Tax Map #: �3� Parcel #:
Zoning:
Township: �(-�.ShTi'"l�r �
Subdivision: Section: Lot:
Appiicant: �l� � � V� � �l(�.2�1i�-�
Location: `Ic7�� ��U (�f f2 %�� ��� �
Operation Permit
System Type (In Accordance With Table Va):
THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH
CAROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL,
AND ALL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION
AUTHORIZATION.
� I 11 �
Authorized Stat Agent Date
C�-T- �T
3 � -t� y-�a -va
t�rsi� P,s-i�
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Tax Map #:
Parcel #: �
PCHD, rev. 10/12/99