The URL can be used to link to this page

A32 184�ount paia 1Q�,00 �ec�ei�pt ll � L 136�1 . _ �� . .' � � 3 � �' � H O � � a w U � a 3- 3 -� � Date �� Improvemencs Permit.(Established/Recorded Lot) _ Reinspection of Existing System (Loan Closing) _ Improvements Permit (Unrecorded Lot) _ Repair/Replace existing Septic System _ Improvements Permit (Mobile Home Replace) _ Permit for New Well Improvements Permic (Addition) acteria - � _ Chemical _ Replace Existing Well _ Petroleum I _ Pesticide I _ Lead . Permit requested by: . 7. Dimensions or Proposed Structure: wner/prospective owner/agent: 3e�►,rr ac��s Width: .2ov �ddress: a�o cTu�r�� aa�u�� z4� Depth: � ►-�Q � � F wt ��s . u $ What type (if any additions, expansions, or � a�s�� n.�.l 1 ome Phone #: 3�-56N-2��1 � �►'��`�" - usiness Phone #: 3�6-s��_-�� 3s � g;3 d_d �, �lacement is anticipated to the structure or facility . t this sewage disposal system is intended to serve? �2 a�D�oo.� ,Mo►��c c rroM � — I�Iame and address of current owner: FA�� AQ�' 9. Water supply t}�pe: ' ' ' ,�,y yg 5 private f�!public ❑ community ❑ spring ❑ ' �;zc,yr,�i�,eo{ .c �c Are any wells on adjoining property?Yes ❑ No [�. �'�s?3 If so, identify location: y6S �m �T� ...� ..,,-r 7,ni,_zn., ..�nc �A� . Property Description: Lot size: l�C.��' . Tax Map#: /-� 3a� Parcel#: �l� Township: r3��s�.hQZ�� _ �. Directions to property: State Road #& Road lames,�tc. .,�.iw�s �c� T�I url�a�E rn iLLS %L E�T Number of occupants or people to be served: �._ �Type of structurelfacility: Proposed: DExistirig: Q rype of dwellin : House: obile Home: C� Business: ❑ Type of business: " Number of Employees: � . : ::. Number of bedrooms: .�,__ � Garbage Disposal? Yes ❑ No � .:. ;Basement? Yes ❑ Noi�'i�o, # of basement fixtures: �� , CLEARLY STAKE ALL CORNERS OF THE PROPERTY AND THE CORNERS OF..ALL � �PROPOSED STRUCTURES. .- .- I hereby make application to the PersOn_COunty. Health Depaxtrnent for a site evaluation for the:on-sit� sewage disposal sy'stem 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 if the site is altered or the intended �use changes, the permit shall become invalid. I understand tfiat before an Improvements Peciniti can 1 issued, I must present a survey plat of the property to� the Healtti Dep[. I understand that in the even[ I have nc� � delivered a survey plat of the propeit}i to.the:Health;Dept. within 60. DAYS after the date of the evaluation ot the site by the Health Dept., this application shall�become void and all:fees paid forfeited. �� .. � � � wn F tho 'zed Agent � �� ermit Issued ❑ Permi[ Denied ❑ plat Observed ❑ Signature Date � i " � � . , ,' . � " . � ` y � .. � . . ... _.. -- - -�- � -� .. . . . - . . ... _ . . . . , _ j.. . .._ . . . . . . � - � � .. .. . ' . . .. . , . .- � � • . • . . . • ~y � � -._ ....�....... . .. : ' • "i (....'Ts:\•.-.+„`. . . �..'_.� _.. . ...... . .�._..��.�....�..�.."'..... .. ..�. . .. . . . ... . '. ..w ✓!•�.:5� . .... . . . . . o�f.a'�S$��i ��."��.� e $IIE UA • � ` y `�"�. . +< � FCf kyl�1. 1a;�rs.�.c4�, � Y�+.s..".A''��?�!�.xt�`t..i>.. a. r.....«,w.. '. .. . $ ..n. _«`�wE us: .:c 1. SIAPE (A) S S S . .. _.. S . ., , _ . PS M PS ' M �' ' .. U. U U ' U.';.... -.._: ' LSOII.TFJC7IJREU2-36�IN.) � S S .. S . . ..� S'.' �:.�, < (SA17DY�LOAMY.MYEY.N07E2:IC[�'n , . . K ... .. . TS....�.. ...y_ tS- . � PS:Tj�>•"�)� : .•,.•. ..._ . , .. _ .. . . . . � U U • Q`: "*�-• • ;s.+ V . rw:.w..c¢,�. f3x 3. SOILS'l1tUCfURE02•361N.) . .. , . ' : t' S • . . S . . . , s - . � , i S'.;':�c; ;•r...� � '.c 1 .,-+, � - . (QAYEY SOILS) � PS PS TS PS � ' : }� � ' ` . . . U U U ' U." : • t`:%''' SOII.DEP7}i (INJ .. . s S . S S • . . . PS K K PS � .. : . . .. . v - u v u - 3. RFSiRICTIYE HORCZDNS (iNJ . S . . S . - , S . .'. . . . . . . .. . ?::.... - .. . (R.tPfRYi0USS7'RJITA.ROC]C)_... tS PS � .. K,, PS .. . . . � . . . "_ . .. U- U U- . ". �.- U: . -. . .a .. _ .. .. ... . . .,..�, , . . 6.SOILDRAINAGFICROUNDWATER �.�.: . ..:.... .......` . - , • . . S . . . . S . . . . . . S S ~f � (t7CTERNAI:I2UJTEANJW " n '" • � ' . . n� ... . . , ,: �:;..�:,-�.•,.� : , ,_: u' - v � v o v._= �s'sou.�.t�snrn ' • � . - s . s s s cefRcota►nott xn� : . . rs . . rs . . es rs. , ; � •t :• i��. � . � _ _; t: .. :; :,t u,: � • u : o.; . �. �. . � x'nvus.�tssrnce . . : „ '. s . . . S . . : S . .. S. , ,;;;_.�..•; : . , . .. . n rs • , rs � rs� t ��..; , : x, e , . , u ' u ' • v • . ' � 0 �5l ► � � 9.1SRSCiJlSSff7G710NISEEBfLO� . - .. � . • . .. . • . ' . . . � " • . . . ..: ,e�[. '�_''•�'�i'':�:.t'i_`'?i,::: � _.u.., ; . . . . .. . ... . . . � � •Y.iFra•.: .�.::�,. SOILSfR1ET.'... • . . . , ... .. . , . • .. ' .. . . ' 'f.t�r .,. �� :;.. . • . .. . � S-SUITABIS `KTROVISION111LYSlJfTADLL LLLJNSVITADLL'! �`. ' ;;.� .: '•.�-��i:v.{jr.F•. i � RECOMMENDATIONS/CONiN1ENTS: - . �r, . . . �_ . .. � . . . . _ :F •J:j ":I�•:;x� �ia��,': � �}. - - . ; STTE CLASSIFTCATION DIAGRAM (Include: Soil areas, properly lines, roads, streams, gullies, wet areas;.:F�l ;.:y areas� . �_ ..: >: : - , wells, water bodies;�s7ope pattems;'etc.� �� C1AMIpRO'�DOCSV1PPSfC.S�1 FWANCE� •�-� . . _ , . + .. . . . i�. 0 � a w � a B 2399 PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IMI'ROVEMENT PERMIT Not for waste water system construction. No permit(s) for Construction Location or Relocation Activity shall be issued until Authorization for waste water system construction has been issued. T� Map #� �� Parcel # 1 g Zoning Township �,(,5121,( p r Owner/Contractor f`p.n-4-- �� GLG'� Date �-�7-�'g Location/Address Subdivision N Lot# SEWAGE SYSTEM SPECIFICATIONS �air Lot Area ,� C. > 1/Mobile Home i/ iness # of Bedrooms� �T _otcl � n�P�/ S.R.# Size of Tank - Size of Pump Tank Nitrification Line��C Max Depth Trenches " �� o � vc.� �� Permits may be voided if si e � Itered or inten e use changed Well and Sept� yout by mments: � ' j C.. Date � D`I - R Installed by Approved Well Permit Paid ❑ WELL SYSTEM SPECIFICATIONS Individual Public Site A ved � We ead Appro� Gr �i.�� Co ents: Date -Public Installed by_ Required Slab _ Air V nt Rf q �ired VJ�ell Log �Ve Tag j l / 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 or for stateme�ts in this report that may have resulted from false or misleading statements provided to him in the application. Neither Person County nor the environmental health specialist warrants 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 O1/95 rev.l.l EARL L . 1�ADE p B, 116, P. 141 LEGEN�FOUND NF • NAIL NS � NA1� FOUND IF • IRON SET IS o IRON MP o MATHEMATICAL pOINT IS IS pATED, THIS IS A FOR RECORDATION, SALES SIGNED, SEALED AND UNLESS p�AT, NOT ORECONVEYANCES• HAMI-��5 �NP.A ' & p,�SOCIA ' , �RED �N� S� ppE B X 1266 REGIST- STREET 27573 Z� 2 S LAMA NORTH CAROL�NA i ROXBOR��910) 599-8742 I S82'16'04"E 248.71' � ,00 � �4.58' IS � IF - 1� �. s� I ' . �`i� � _._. . ( INOM E-(iy,��o) I F� _ � 248.52' N82'16'04"W EARL L . 'NADE p.g, 116, P. 141 -- -� �. -.,;,, S80'44'05"E��;, , " . 103.00' IS S05'23'53"W . , ...r:�:- 35.56' �..:..R_•. 140.49' N80'44'OS"W ,,;'' RICHARD S. DICKERSON D.B. 188, P. 212 �4��-: LE ,`,'';�., , � -------------. `'�, 00 M }�'�7'";.,. �r � !�iy'� ; �. � ETZOLD PAINTER ESTATE • �.�`� 4F' I S �;t` � - . �':� w --- ;>; � N ::p: M � � �' � � JOHN C. DOWELL Z D.B. 235, P. 610 IF -------------_ �'�;i. CONTROL I - CORNER I I Person County Health Department 1 Environmental Health Section Tax Map #• � 3 r� Parcel #• 1�� Zoning: Township: Subdivision: Section: Lot: Appiicant: � Location• Operation Permit System Type (in Accordance With Table Va): 6 ��o��X- 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. � �_ � y_ � � Aut orized State Agent Date ��o�'� � ' s' � .,_ _ - - -- �' �s� �si Tax Map #: Parcel #: �a " 8d,i PCHD, rev. 10/12/99 IS � � Q .� w � r � � � � � 'NADE � � '� EARL L. � p g. 116, P. 141 Z � � � IS LE�EN�FOUND NF � NAIL NS o NAI� FpUND IF � IRON IS o MATNEMATICAL � MP pOINT SEALED AND DATED� TION,ISALES UNLESS SIGNEPLAT, NOT FOR RECORDA PRELIMINYANCES. ' pR CONVE HAMI-��JENN�N�S , & p�SOCIATEs, P •A. . cTGRED IAND SURVE BOXS 1266 REGI., - STREET - PO 27573 ,212 S �AMAR �ARpLINA . R�xgpRO NORTH g742 (910) 599- � 103.00'` IS S82•16'o4"E IF 248.71' S05'23'53"W • � 35.56' i" ' �` � 140.49' � N80'44'OS"W . �` � V � �d r• ^ � � = � � N O 1� O O �_ ^' rn N� RICHARD S. DICKERSON . ., } � � D.B. 188, P. 212 ` o t;,; f , a � �`r � •.�. �,:: � ��:a In XLE -------------. �:;�: NOM E(iy,��o) � . � � .. �n �o � �- . a� � a —'� o E7ZOLD PAINTER EST � 248.52' � a7E N82'16'04"W IS w -- N N WADE ''� � EARL �• ' ' p,g, 116, P. 141 �, rn �r � JOHN C. DOWEIL Z D.B. 235, P. 610 � lU'� /� -------- , IF �� ✓�" "`� CONTROI. � CORNER I � ��-l�� i � . ' l��(� g� _... . . ..:.x.�:�.�r��..:�<: . • � . L'erson County Health Oepartment Existing Sewage System Report For: ✓ Mobile Home Addition Keplacement Requestee: �2�1� �r� s Home Phone# � 1� �ZD�d TQ1�� CL'Ld Business� 5�� $O�� 1'TL.�r'ci �C �1 ��J�j IvC _ '�ax Hapn a a�c�� I�y Location/Uirections: l�� `5��-'�� O O/1 E'�ZO l ci PGii�-� J� cxt, d �� a,t ! q(o - e Original Permit Located '�S , Septic System Uesigned r'or: _ Kesidential � I3usiness Other {specify? � 13edrooms � # Employees Other llate Tnstalled � a�� Water supply ,�ri �af.� W�( I_ O►'t � i noi l ..�, re.�CE i f� o�-a �l -Op Type or System COn�cllf,�onaf Hitrification Line �d� !X 3 � Tank size )/DOc� %�.l�o" Certified operator Required � � _ � On site wastewater disposal. system showes no visually apparent malEunction on � a��OO . Permission is granted to: ��M�� tt-��f According to the attached site plan. Environmental Health �'�G. a ��o� DATE _: �-q-0() Application Date: Amou,^, nt Paid: t �� Receiot#: .2( [� / Person CountY Neaith Department Environmental Health Section . APPLICATION FOR SERVICES . ::Services Requested�::. . (Recorded Lot) - 5150.00 ' 0, Well Pertnit (New/Replace� I�vements Pertnft - (Unrecorded Lot) - 31 Improvements Pertnit • 5100.00 (Mobiie Home ReplacemenUAddition) ConsUvdion Authorization - $100.00 Site Existing Tax Map #: !T3 � Parcel#: � � �ertt) - 5725.00 - 5100.00 1) Pertnit requested by: (Owner/agenUprospective owner): /�Ia�.E/i�4x Home Phone: Address: �9rs /,C.`)rc 2� .�.+. i2d . Business Phone: �3/s --�'b3 —Sng � �Q]f %1 A o�1 • C' - d17��3 2) Name and addres� of current owner: ^' - ,� ,�qi, f'Tz o1.D ' al. ' 7S'�i/ 3) Property Description: �ot size: f'�= Township: � Directions to the property (Including road names and numbe�s): �'.) Proposed Use and Structure Description: answer each of the f�Aowing questions: a) Proposed 0, Existing C�' b) Stick Built �, Modular , Single Wide �, Double Wide G _ c) Number of Bedrooms: � d) Number of occupants or people to be served: �_ e) Basement: Yes 0, No B-tfyes, # of basement fixtures: � � � Garbage Disposal: Yes 0, No �� g) Dime�sions of Proposed Structure: Width: � Depth: � 5) Water Supply Type: Private new � or existing �blic ❑, Community �, Spring ❑ Are any welis on adjoining property? Yes ❑ No O lf yes, location 6) Please Indicate Desired System Type: (systems can be ranked in order of your pceference) �nventional +Modified Conventional _ Altemative _Innovative Other (specify): CLEARLY STAKE ALL CORNERS AND LINES OF THE PROPERTY. STAKE THE CORNERS OF ALL PROPOSED STRUCTURES. PLEASE ATTACH SURVEY PLAT OR SRE PLAN TO THIS APPLICATION t hereby make application to the Pecson County Health Department fo� a site evaluation for the on-site sewage disposal system for the above-described property. f agree that the contents of this application are tn�e 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 invalid. 1 understand that as applicant, I am responsible, for identifying and marking properry lines, comers and making the site accessible for the personnel of the Pe�son County Health Department to conduct their evaluations. I understand that I am responsible for notifying the Health Department if my property contains any wetlands as designated by the Army Corps of Engineers. PCHD, rev. 10/12199 a� �� A 1530 ��` PERSON COUN'I,Y HEAL'I,H DEPARTMENT � WELL AND SEWAGE SITE, LOCATION IlVIPROVEMENT PERMIT Tax Map # �3� Parcel # 1�� Zoning Township ��,�5�� ForK Owner/Contractor �r�� r�� S Date o�-/ 7-0 O Location/Address `/ Co tZa a+��tr � lS� %ld«d a^ � i�t lfurd l c M r 1� PoS�t o FFi cc S.R.# � Subdivision Name Lot# As Instailed Iayout , �1 Pu.rnQ sePt�c. far�K 2 F tc�n k �..ctn b� ir1�J�d� da 50 .,. �ar :S t�N nOt, Cr'u.51,�"t `�' Sct rtcc.� ortc �,re • 1 ftdd;�t�n _� Q�u.-� OFF e.�S oF <<ncs, rePa;r � ---- ' a� d re.� lac� cl a�� F� x-t•arfl,s i � � add ($a' x3� d F ncc.� tJ- �;nc. ;; .�r�-► 5� F�� r� bc,�� id �^�'y , ; Q K��-P 6�s . � , ��nda-E.� �n �` ` � rc,�c,�E, o � /11c�'� � /1 �-a,� � c.o n� a Oc,� E. add. �so' K3 ` to � Fo` �e.xa�-E l Y SEWAGE SYSTEM SPECIFICATIONS Repair _ Lot Area i� 0 0�} c Size of Tank 1 � o o O SFD Mobile Home Size of Pump Tank Business # of Bedrooms__ � Nitrification Line l$0' x3' � A Max Depth Trenches Z o" Permit Void after 60 months. Permits may be voided if sit�' Well and Septic Layout by \ Comments: Date Permit Void if not in compliance with zorung regu�attons. > alte,�'e,d,or itabended use changed. Installed by Site Approved Well Head Approved Grouting Approved_ Comments: Approved by WELL SYSTEM SPECIFICATIONS Semi-Public Required Slab _ Replacement Air Vent �'��— Required Well Lo� ��) `- " - Well Tag 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 pertnit. 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 or for statements in this report that may have resulted from false or misleading statements provided to him in the application. Neither Peison County nor the environmental health specialist wazrants that the septic tanlc system will continue to function satisfadorily in the future or that the water supply will remain potable. c�amipro�pemut.sam O1/95 rev.1.0 ORIGINAL .QS! ' �o��a Jo� �2 ' �=� Sl ; Ob SL , ��v��. �o� ' � �,��e��!PP'0 fi i ' •S� w �S :ba 0Z �' ' ' Q V ' Zx � 1'� �� • � .S� xS S��t ' ,s� , ' _ _ ' � " ,,�4 ' : �� a� �1� �� c�� .�,� �� ,