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A32 126Aaqlication Gate: � �-�� Tax Map #: �� . Amount Paid: �,2 d _ Receipt #: I 7 4�2 !_1 Parcel #: �a� � ~' GO � • �� - � Ots� V � � �._. - , � �� "�- � � �T � � �- ��-��,--�-,- m��.�..n ��,.m.a�� APPUCATION FOR SERVICES ir TtiE iNFOiiMATiOid IN THE APPLICATION FOR AN IMPROVEiVIEFIT PERMIT IS INCORRECT, FALSiF1ED, CHAiVGED OR THE SITE IS ALTERED THEN THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. � 1) Permit reque ted by: (Owner/agent/prospective owner •�►�� Gl � Home Phone:� - � � Address ` � � Phone:0 � B�.s��ss � � � 2) Name and address of current owner 1 3) Property Description: Lot size: a a�Ct sTownship��ubdivision: Lot # Directions to the property (Including road names and numbers): f�SyQes �rta� ��s t,�� 4) P'roposed Use and Structure Description: answer each of the following q�estions: AP�r'�t � a) Proposed ,(�, Existing Type of Structure:�-F'�Arv� 1'�oQw+��c QS�= Width: '� ( Depth: ''�$ � b) Number of Bedrooms: ,� Number of occupants or people to be served: �_ c) Basement: Yes . No Will there be plumbing in the basement? d) Garbage Disposal; Yes '�� No � 5) Water Supply Type: Private �(new x__ or existing�, P�.Sblic� Community , Spring _ Are any wells on adjoining p�operty? Yes_ No �L, lf yes, pleass indicate approximate iocatiori on the � site plan. � 6) Does your property contain previously identified jurisdictional wetlands? Yes_ No�, � PLEASE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. . ➢ PROPERTY LlNES AND CORNERS MUST BE CLEARLY MARKED. �, ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAICED OR FLAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT STAFF: � I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-described property. I agree that the contents of this appiicatio.n are trve and represent the maximum facilities to be placed on the property. I understand if the site is altered or the intended use changes, the permit shall become ir�valid. Q Owner�Leg�� Representative � o�- � Date PCND, rev. 06/27/02 4 / . .... ... . ' ? �i l �� , �`; F, {.s- . �� , � � � � � � � � . : nsuring a healthy environment ��n.��nn�ac��n.��,� �c��.�� Misha Taylor 895 Guess Road Hurdle Mills, NC 27541 March 14, 2007 Re: Application for improvement permits for lot on Byrd's Creek Health Department file: Tax Map # Parcel # Dear Ms. Taylol: The �Person County Health Departrnent, Environmental Health Division on March 12, 2007, and March 14, 2007, evaluated the above-referenced property at the site designated on the plat/site plan that accompanied your improvement permit application. According to your application the site is to serve a three bedroom residence with a design wastewater flow of 360 gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A- 333 including related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule. 1900 and related rules. Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system. Therefore, your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: _ Unsuitable soil topography and/or landscape position (Rule .1940) X Unsuitable soil characteristics (structure or clay mineralogy) (Rule .1941) X Unsuitable soil wetness condition (Rule .1942) X Unsuitable soil depth (Rule .1943) Presence ofrestrictive horizon (Rule'.1944) � X Insufficient space for septic system and repair area (Rule .1945) _ Unsuitable for meeting reqaired setbacks (Rule .1950) _ Qther (Rule .1946) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, into surface waters, directly to ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. However, the Health Department has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. phone 336.597.1790 fax 336.597.7808 . 20-B Court Street, Roxboro, NC 27573 For the reasons set out above, the property is currently classified UNSUITABLE, and no improvement permit shall be issued for this site in accordance with Rule,:1948(c). However, the site classified as UNSUITABLE may be reclassified as PROVISIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish . to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. � You have a right to an informal review of this decision. You may request an informal review by the soil scientist or envirorunental health supervisor at the local health department. You may also request an informal review by the N.C. Department of Environment and Natural Resources regional soil specialist. A request for informal review must be made in writing to the local health department. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Center, Raleigh, N.C. 27699-6714. To get a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 733-0926 or from the OAH web site at www.oah.state.nc.us/form.htm . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150B-23 and all other applicable provisions of ,Chapter 150B. N.C. General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER The date of this letter is March 14, 2007. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 150B-23) to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. Send the copy to: Office of General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-1601. Do NOT send the copy of the petition to your local health department. Sending a copy of your petition to the local health deparhnent will NOT satisfy the legal requirement in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel, NCDENR. You may call or write the local health department if you need any additional information or assistance. Sincerely, `�.�J,"�{J /iJ!� i��-�" Bonnie Holt Environmental Health Specialist Application Date: �o� 30'( � Amount Paid: l 0 .00 Receipt #: 1 �� c��.�� < (��T �--.� )� f �� Y1�1 �y Tax Map: �' 2► ._..._ "�- ��,�.� Parcel#: ��i�� 7�� nao-n n-cnnna�caaa.andm.Il IHI ac3�..� Z�;Lr. ❑ Improvement Permit (Site Evaluation) $200.00/$300.00 (if> 600 gpd) ❑ Mobile Home Replacement or Building Addition $150.00 (if site visit required) ❑ Well Permit (New/Replacement/Repair) $300.00/$200.00/$75.00 tion for Services Services Re uested ❑ Construction Authorization (Fee is de endent on the e of s stem ermitted) ❑ Permit Revision $75.00 Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 � 1) Applicant Information: Name: � �C � � Cx: �� Address: �� ✓�'�5 � wlurtoL.�: wj�u,s , nl� z�s+i ( � 2) Name and address of current owner (if different than applicant): Name: Address: 3) Property Description: Lot Size: Subdivision: Address and/or directions to Property: �oxu�in � Phone(home): '3Z` ��'� � ZOS 1 (work/cell): 4!`� (030- oH'S S �c.t,. Phone: �t�oeE Lot #: -► /Z ❑ yes f,� no Does the site contain any jurisdictional wetlands? ❑ yes ❑ no Does the site contain any existing wastewater systems? � yes �t no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes 'f7 no Is the site subject to approval by any other public agency? ❑ yes � no Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Use and Type of Structure: �Residential ` 3 ❑ New Single Family Residence Maximum number of bedrooms: ❑ Expansion of Existing System If expansion: Current number of bedrooms: � Repair to Malfunctioning System Will there be a basement? ❑ yes ❑ no With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential Type of business: Maximum number of employees: Total Square footage of Building: Maximum number of seats: 5) Water Supply: ❑ New well �Existing Well ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? J�yes ❑ no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): ❑ Conventional ❑ Accepted ❑ Innovative � Alternative ❑ Other ❑ Any I certify that the information provided above is complete and correct. I also understand that if the information provided is inaccurate, or if the is subse uently altered, or the intended use changes, all permits and approvals shall be invalid. 1Z Signature (Owner/ , g Representative*) Date * Supporting documenta ' n required. Permits are valid for either 60 months or are non-expiring when accompanied by au approved plat. A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (10/11) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) •` � . i � I �.1.�..lS �� 1� �� I ! �'�� C� ��1�� i t � s3rn., �Y'u.'S-t� �^, „-„-„ <G 7rn.�.��. �� aL �.1.�.'l�� x Ma� � - � �rc I ' - • Su�bd,ivi ion h�.se;Section: �t' Applicant• LTi,�/l � �Cre �r � • Location: � � • � � S'- � � S S _ .. . . . �pra�e�aaen� �e�mi# �'�r�t �alid �or ��ve �eaa�s _ I�io �iaa�ti�n Type of � New Additian � � # of Occ uits # of Be�ro Proje�ted Daily Flow g.p,d. Proposed Wastewater Syste�: � �� ' Proposed Repair: � � Pezmit Owne� or Legal Representative Authorized State Agent: � Type: Type: Date: Date: 2 � The issuanca of this permit by the Healt� Depaztmezrt m does not guaraniee the issuancs of other per�uits. If is the respons�ility of the applicaut/property owner tn in sure that aIl Persnu. County Planning and Zo�g and Bui7�ing Taspeitions zequsemenis aze me#. This �nprovement �ermit is snbjeci t� revoca#ion if the si�+e plan; �pla�'ro�� t�e in.tended use ct�ges. �e �na�roveu�ent �ernm�t i� ��t a�'e�ted by a c�a�ge in o�vner"s�ip of the pxoperty. T�s permit was isgued in c�mpli�ce �vith the provisio�s of the North �Caroiima, . `Z�ws a�d Rules for Sewa�e ?'reabneni axd IDisposal Svstenas' {15A NCA� 1�A .1900). Pleither �arson �munty.:mor��t��.�`'� �nvironmental �ealth SpeciBlist wmrrants th�t the septic t�ank sysieqa m71 cun�ue to fnnetion sadis�faet�s�ily iri tla� fufnre�or�tF��#. the-wat�r supgly wiil remain potable. �• • • A�athoa�ation t� Cma�stY-ue�t �laste�a#er Sgste� (R�cgaa�e� %r �aa�aiing P�s�t) � � *. SeE site plan c�d additional attachments (_). ' � � � . -. Proposed Wastewater ystem: . Q' .(Y�i l � � Ty'pe ��_ Wastewater Flow ��Og-p.d. New Repair � ExQansion - � .� SQs� LT�B: — g-p.dJ ft 2 Type of Facility: �%2/j�'S- ' � Basement _ Yes ,�, No . �'��P��' ,,��$�ffi �L'��flflB'�3$1�� , '�� Size: 5egtic'T�nk:'Lv �gafl �np Tau�c: -- gai �Grease Txap: � g�l I�rrai�fiefld: Tmi� �r�: `"" sq ft Total Leugth --- � ' 1��a Trenc34 DepgRa `– in '�'resncla �id#h - fi 14tinia�� Soifl �overi ^ in � �enc3a �ep�one `� ft ID�bu�ion: -- �ista�ibu�aon �o� �' Serial ��riian�noa -- �res�e l�afold . Sp�ffieations: �.1 State A.gent u��F� Pernrit Exp' on Date; Date: � .• - e i.ype of system pernritte� is � Conven�ionai Ac�spted Alternauve. I a��pt the sperificatio�s of the Permit• . ��e�l.I,ag�l �8a�rpsa��tive: Date: ,a�K ��C � PCHD rev.1111010�.- � ,. .. . : e .. ��. f I�I�I�� T . .. _ �� . �. ��.� � ��.�.�� SITE PI.�1N Name I'ST��J rYYCe ��^• Taa Map #��I'arcel #� Subdi � � Section/Lot# . � Authorized State Agent Dat, � � System rnmpoaenis xpresmt sppmaimare aoarours anlp. 73e coatractormust Sag r6e system pdor m begin� the iastaUatron m iasurr tharpmpergnde is mzinttined � �-S�n� � � � � �i S� � � � �� c� �,cQ �'" �l-Pn� ��K � �' Sa w�,e. .� e�� l ares�, �ta;�-�4-� fi� -�f-- -�,,�, - -_A f� �� .�(. C 0 �+�2G'� � �,�•�5� ar4►�i-� � �. �... :" t��l��e ,�r�`t �s i�o� �— �,. ,� � „ , i._ ;? 00 5•T �uess �. We11 PCHD, rev. 09/12/Ol 1 E. � . � . - . :_ � � �1.J � � � � n n �71'71.]L�c{�ICIILL'LLf�.11 �<Ci�.1L'�� Suilding Additions/ Mobile Home Replacements Tax Map #: �i 32 Parcel#:�ZtQ Address: �S u u 275�{ � Approval Requested for: �obile Home Replacement ✓ Building Addition Applicant Name: ��P �, P�i c,e, � r� Address: Gu 5 i ( G�Z7S Phone #'s: Permit Located: Yes 1� No Installation Date: ? Design flow: �G2 !� (gpd) Current Contract with Certified Operator on file (if required): Water Supply: ✓ Well Public or Community Wastewater system shows no visual evidence of failure on: 2' Z�-1S (date) (Applicant's signature if site visit is not required �J Comments: �a Addition/Replacement Approved r Enviro ental Health Specialist �Z�ZB"-/� Date Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 Phone: 336-597-1790/ Fax: 336-597-7808 www.personcountv.net C�,nnectGlS Feature Report Page 1 0l� 1 Person � ' �� '`° � � � j � � Printed December 28, 2015 ` v,;r �,r:_�;;,, See Below for Disclaimer �� "�, . . , � �. ,... `i � � � � �,� .; . .e . ��.. �: ..� . . . _� � �� , . �-«� .� . . .. . . . � � �� . ;_ � � . .. t��= � g� � �� .. �.. �1� ,�� , . .. �` , .. _ , '��a �� ' � � �`% \'.\: . .. . .I � ��',�: �. . . .. , .�\�:�� . � . � � � . � �; ,� g � � � � m, . ��'� � � � t�� . a��.�.� ' � �_ �, � s � . x ',�� ' „,-� � u � � � �. r : ` i ''S , �, 'c 3 �.� o`� . _ � � � � , - k a " � � . g .. '>a 'S � �� ,� �� f "� �`�� # ¢ � � � �5�.. �, � �� > m� �� .. � z A � ,' t < : � '� � � I�i ' 4. �"�v-� . � .. � g ,. ., .. � � tg¢;� 0 � � � .'>n i - :e$ ... � \ . ..`r�. �'f � .. .. '� �". . - �. . . ' .. . � y �� _� � ��' t, r ,�� . i' ' . .I'� ra"�a` ... r +,� . � 1, �. ��5€ `� . . . '� � � �. " � � �. € `"�� §t ' . 3 � 3 � � � � ✓'( � .. �� ,.. � .N ,4. � ; �,& S � kF 3i3' q�j� . ,� rvx✓�'.� . r £��..._ y :� �' � i v � �� > . o� � .�N � �� , an=` - . . � t , ; � � S � ... 1 . _ . ��. � 3 � �, 4^ � ,� � �t e 3 � �� ` ` ° m . � ��a �. �4 ',�. . , .. .< '�� « .:. , � � � � �, � � - � �•f�� .. �� , � � ; ; s : ,. - ' � � .. - _ _ � �:" m ..�. � � � .. .,� _ F .. . . � ,. i 1 � �, 1- , � : ,�.�: R � . ",��-� �' �,` �.,__� ��- . �� `, � ,,� '��`. � � � � � a' - � � �€ � �. �.. € � �'3 . .. a �� „ , � .� �, �:.Y . `». . ' .. 5 '��: .. . �� . . .�,. c +'rs � . � �. � ,� � �' ,. �,�. � a �. .. . �>: �«; � :�� .� _ � � `+ � � � , �� y. . � ` ' � �'� �;r . ,. 5 ' � � � �,�^ �: v '� � �' . .. �5 � � . � #�� , ��. s� � 5 - B � � �� , `' � . a � . �� . '�, ` � �. , � „� � � = ' a�` � r,� � � �� - � � ,. :� - �a �' ° � .1 �` . .. �, � > � 'd'�� ►, f-- v � � , �rj -� [ � � � �_ R ,,rf��' y ' !�„c' j � S � � , 5p F�et �.. .� NOTICE: Recently, we�i• ;�,��t Lro:•.ser co�>>patibility issues�when trying to access our GIS website. Typically, the problem sterns from users who have recently upgraded to the �^✓indo�vs 8 operatiny rystem or a new version of Internet Explorer. We were able to resolve this issue by dlrecting users to the Internet Explorei Compatibility View tool. This link is to Microsoft's "How To" for the tool: http://windows.microsok.com/en-US/intemet explorer/products/ie-9/features/compatibility-vie� f this does net solve the problem feel free to contact us at the number listed on our main page. Welcome to the Person County GIS Website ConnectGlS has beer prepared for the inventory of real property found within Person County, and is compiled from recorded deeds, plats, and other public records. Users of GIS system are notified that the aforementioned public Information sources should be consulted for verificatlon of the information in this system. Person County. Mobile 311. ConnectGl� assume no leqal responsibilitv for the information in this rystem. Grid is based on the NC state plane coordinate system, 1983 NAD. http://�is.personcount}�.net/ConnectGIS_��6/DownloadFile.ashx?i=_ags_map2e563c4166... 12/28/2015 �3�. - � 2� oPERSON COUNTY HEALTH DEPARTMENT 355A S. MADISON BLVD. ROXBORO, NC 27573 BACTERIOLOGICAL WATER SAMPLEANALYSIS Name of Owner or Tenant t"�� P(1G Address �q5 �t v..e� � County �� Y:4`n Collected By �� Date Collected ��l ��0`3 Time Collected '3: � S��t� Source: ��Yell � No Charge 0 Spring ❑ Well Tap ❑ Other �Charge �***�***************�************�********************************�***** �***********�****��*�*�***�***�********�*�****��**��*�***��*��**�*�***** Results Present Absent Total Coliform � FecaUE. Coli. ❑ ' � , . Reported By � L �U � ti Date ��% � 2 � I �% � 7 .�