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CASWELL,�- CHATHAM - LEE - PERSON COUNTIES
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'�1Nater Supply and Sewage Disposol
IMPROVEMENTS PERMIT No.
Da e �����
Owner: t� T� � No ✓ Y I S
�pq Locat�on:
(,tls
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✓
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�Q, Contractor: ,,
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�S � Wate Supplp: Private Public —�—
,� � _�� �.�l1 n�►r.�:�-�-"_ /�� �"i J/r�-�. ����-r��F
�G�I �i-tC��� oi- �iri,� E/!0/l/ C��'.fl -. ,S/9N�ct���
Sewage Disposal Facililies: No. bedrooms Dishwasher, Disposal,
washing machine, other
Size of tank: ��/
Other disposal facility:
� appliances
Nitriftcation line: .
Water supply and sewage disposal facilities location, ihstallati6n and
protection must meet state and local regulations.
Septic tank should be pumped out every 3 to 5 years an3 shall be main-
tained by owner in such a manner as not to create a public health hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVED BY A MEMBER OF THE D
STAFF BEFORE ANY PORTION O
ERED AND PUT INTO USE.
Date approved:
Well:
Sewage Disposal:
By:
CertiTicale of Completion
Date Approved: �E��
7
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Counter- /� �,,,,� `„
aigned !d ���e_��e�+
(Owner or his representative)
l'�,��6�� ��� CO�
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By:
S nitarian
(OVER)
Location of well and sewage disposal facilities sketched on back.
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A��siication Date. �% -14 ��
Amount Paid: 1� D. O
Recaiat #: �F�; ,� �_
Tax Map #: � 3 �
Parca! #: � � 3
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�aa�sa-�aa------- .oa:a.�.no.1l. 3��C<vm1i.��a..
� APPLICATIOM FOR SERVICES _ •
CONSTRUCT SHALL BECOME INVALID,
1) Permit requested b:(Owmer/agentlprospective owner): �b O iZ �S
Home Phone: � 1- b � Address: . d L � ,
Business Phone:gf�-�{?���/�� � p�. � LLS� � 2 /
�',y.�,2j fdame and address of curre�t owne� � D.12).�
',::w.,�.�. � a2� S
' - . � LL C.' � S �
3) Property Descrlption: Lot size: .7 Township: 1/�NY
Di�ections to the p�operty (Including road names and numbers): �I
4)
5).
Lot #
P'roposed Use and Steucture Description: answer e ch of the following questlons: , �
a) Proposed ✓ Existing _, Type of Structure: .�OBIL� �M� Width: �Li � Depth: �� :.�,- °
b) Number of Bedrooms: ,�_ Number of occupants or people to be served: _,L
c} Basemen� Yes_, No � Wiil there be plumbing in the basement7
d) l5arbage Disposal: Yes No �
. " ' 4 . . ' .
Water Supply Type: Private v(new _ o� existingc/ ),'Public_, Community , Spring _
Are any welis on adjoining property? Yes,_ No _ If yes, piease indicate approximate location on the
'site plan.
6) Does your propeciy contain previously identified jurisdictional wetlar�ds? Yes_ No„�
� '. �
PLEASE NOTE THE FOLLOWING: � .
➢� A PLAT OF THE PROPERTY C�R St'I'� PLAN MUST BE SUBMITTED WITH THIS APPLICATIOM.
➢ PROPERTY UNES AND C�RNERS MUST BE CLEARLY NflARf�D. •, � �
➢ THE PROPOSED LOCATION OF.ALL STRUCTURES MUST BE STA�D OR FLAGGED.
➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUAT10P18Y THE-HEALTH DEPARTMEi�IT
STAFF.
I hereby make appilcation to the Person County Health Department for a site evaluation for the on-site sewage disposaf
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 property. I understand ifi the site is altered or the intended use changes, the' permit shall
Owner or Legal Rep�esentative
�- I�/ -O�
Date
PCHD, rev. 06I271�2
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tIS
72
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DAVID E. �HITFIELD
D.B. 90. P. 548
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IF 177.66' IF
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Ci.ARINE A. NORRIS
D.B. 176. P. 772
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Tax Map #� Parcel #
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Existing Sewage System Report For: Mobile Home Replacement �
- Addition Twe:
Requester:
�i�i.�. � � al�u-U-� _
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Home Phone# �� � � � � � � �
Business # lj R���� Z� Z� r�
Original Permit Located: � Water Supply: 1�� �
Septic System Designed For: _ esidential Business Other
# Bedtooms � # Employees Other
System Type: � �� Tank Size: �UV� Nitrification Line:��� F�"3 c
Date Installed: �` � Certified Operator Required: �� V
On-site wastewater disposal system shows no visual signs of malfunction on �����
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Permission is granted
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Environmental Health Specialist Date: '� -" � �
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North Caroii�.� . � ory of Public Health
� Department of ealth and Human Services
� P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047 ' j
INORGANIC CHEMICAL ANALYSIS - PRIVATE WATER SYSTEM ./
Name of System: Norris, Ronald
Address: 11091 Hurdle Mills Rd
Hurdle Mills
County:
Report To
PERSON
Person Co. Health Dept.
325 South Morgan Street
Roxboro, NC 27523
Courier: 02-33-15
Zip: 27541
ATTN: �
(336) 597-2371
Collected By: BH Date: 4/2/2008
Location of sampling point: Outside spigot
Remarks:
�
Source of WateY.� GrA[�
Source of Sample\�
Type of Sample: Raw
Type of Treatment: None
Type of Analysis Private
Time: 10:28:00 AM
Parameters Results Units Date Analyzed•
Alkalinity as CaCO3 22 .. mg/I 4/3/2008
Arsenic <0.001 mg/I . 4/3/2008
Calcium <0.5 mg/I 4/3/2008
Chloride IC 11 mg/I 4/3/2008
Coppe r 0.05 m g/I 4/3/2008
Fluoride <0.20 mg/I 4/3/2008
I ron 2.91 m g/I 4/3/2008
Hardness as CaCO3 (Ca,Mg) 5 mg/I 4/3/2008
Magnesium 1.10 � • mg/I 4/3/2008
Manganese <0.03 � mg/I 4/3/2008
Lead <0.005 m g/I 4/3/2008
pH 6.5 Std. units 4/3/2008
Zinc <0.05 mg/I 4/3/2008
Date Received: 4/3/2008 Report Date: 4/18/2008 Reported By: �
Today's Date: 4/18/2008 Ref: 4359 Login Batch �8Q4pp�jg t= Sample Number: AB70579
Explanations
Coliform Analysis:
If coliform bacteria aze 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 remembereti that a water analysis refers only to the
sample received and should not be regarded as a complete report on the water supply.
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/I
No established limits
250 mg/1
1.3 mg/1
4 mg/I
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