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A32 223� { _. . _____ ` � � � � _,� " A I;�ation � �" � � n Tax Man #: /� 3 � Amount aid: ' O�U � V RecEi : 3 � a. � Parca! #: 2�� � �—�.� � ��T ��,1 I • b1e --� � � ZCJ1�T']� � �d.' d � �� � sav�a-amaa_�-� maa�a.IL ��Lm+.eo.7L�7�a 1� P ��� ��� APPLlCATION FOR SEiiVICSS v COIVS'TiaUCT SHALL BECOME INVALID. - '�P�rmit recyue y: erlage U pective owner): ��� <� � Home Phone: � ' � �� Address: � Business Phone: " �- C� 3�'�- ,� � �� 2) 1Vam� and addr�ss of carre�rt awner: � � � � a�s � . 3) Prapeity Descr�ption: Lot size: �? Township: l2 ��S Subdivision: l��ti�� Lot # � y Directions to the property (lncludin�road pames and r�umbers); 5-1 v v u � • 4) F�roposed Use d$tructure Description:.answer eact� of the following q�testions: S�v�-. � y i2S� C2 a) Proposed � Existing ,� Type of Structure: �� Width: Depth:, �, b) Number of edroo s: �. Number of occupants or peopie to be served: �1 _ c) Basement Ye��, N� Will ere be piumbing in the basement? ' � d) 6arbage Disposai:.Yes _,; No �, � 5) 1�(ater �upply. Type: Private� (new� or existing�, Public� Community� , Spring _ � Are any wells on djoining property? Yes No _ If yes, please indicate approximate location on the 'site plan. � . � . 6) Does your propeity cantain previousiy identified jurisdlctional wetlands? Yes_ iVo„� � PLEASE PlOTE THE FOLLOWING: 9 d� PLA'i OF THE PROPEiZTI( OR SiTE PLAfd MtLST BE SUBMITfED WITH THIS �►►PPL9C�►TI�N. 9 PROPERTI( LlNES AND CORNERS MUST BE CLEAitLY MARKED. �, ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STA�CED OR FLAGG�D. 5� 'fHE SITE 91flU$T SE RE�►DILY �►CCESSIBI.� �flR AN EVALUA►TION BY THE HEALTH DE€�ARTAAENi' STA�F: � I hereby make application to the Person County Health Department for a siie evaluation for the on-siie sewage disposal system for the above-described property. 1 agree that the cantents of this appiication are hve and represent the maximum facilities to be placed on the property. I understand if the site is aitered or the intended use changes, the permit shail become invalid. ' �Q �,,�„r,�' � ��� 5 _ �,5 - ��- Owner or Legal Repre entative � Date PCyD, rev. 06/27/02 May.16� 2007 10:59AM Coldwell Banker HPW No.8081 P. 2 ' � .. �• �v� u � � _ ... . 1�NEFt S�g 3� pk"W 75a.15' � �. 1 � a�, $� � �1.49 AC. �'' ��^ + OU75tDE RfW � � . ' AC. ,� �,�, ���'�y 5�9•����•Y� . ��oaa' �� . �ittR (,�u - . . 1 � �'� � �g 59" . . � J. T 'e . � � � �3.s� • � � 7 AG �' � . ou we R/w v �_ . . e�.tv c , .. . �" ' � N88"54'00"E � 9D3.80' . r� � 3 N ; �J . 4 4 AC. $a�'o. . 5.82 A�. °urs+o� R/w '$ �r,� ; KlTS�RE R/W • . . N$ 00'31 "yy � 1033.42' . �I � �� � 574. . � g' ���5 s��eo„� WT51�DE j1N � � � �C. � r R� r � . � �yq� 4� '3� sB9s2' . � . N � � ¢9� �e � � 5 ���� � i '� , �3p 0?. � 1 ��`T� w , �.1� AC. OUTSIAE R/N/ • ; (� z �a �� q ` � 7 � P 2.87 A,C. �� � ,�a"'^�',' Z t�iG�. W � �TSIOE R/W �N �1r ,�,5, DE R/W N $� . . b, � x �S�s�sr� � ti��'� Nr33 26'S2'W . ; , , ��y p� �g0a 284.t31�"�`" Nr�. • �o S3� „ '� ti ^p "� � �� ` +29¢, �s� � � g �9 �� •R�.� ' � ��� g ' �� . . �.0511C. . . � QUiS►p�, R/5V . � a�+ � ' � ' . , d. rn • ' ' ' . . . . ' rj "` . ^ rn . , . . .. 'Y� • . � w �. .. . . . � ����1 ���.�`i � l0. /� � �l� �� . \r+� w ' l ' ' `�/ �- �� Ji 1L ;i �_.3a�^v.�cm�+^++�r'tt"+<��.¢.�LJl. ����.�.'�.1�� Tax Map � �� �rc�el :; � � SU!ilC�!IVIS�40:t1 � � � Rh�:s�e Seck�ian:Lat ':' ' Applican� `�or���1- r�r � Location:_ �•Nv,`����- �'�\\� �- C� c�r� C-, ��ess 2�1 -� C ca� ('�rL,�i's C,r� -'�' 1�-�- �-, �, � i�praveanent �'ermit ' � ��rmi# iTa3id for � �'�ve ��s PTo �xpiration Type of Facility: c�W New � Addition i�atez Snpply wP. ( I� # of Oc�upants �c�.�c. # of Berlrooms Projected Daily Flow � g.p.d. Proposezi Wastewater System: C mv ►�!; � Q � Type:�; Q Proposed Repair: . �'x�v �r�i ono9 � Type- , �o_ - u ... ..� � `.- � I.� Owner br Legal Representative Signatzue: Authorized State �Agen� `���,v.� t� Date: C� I � I v� The issuance of tiris pe�it by. the Health Department in does not guaiantes the issuanc� of other peTmits. It is the respons�biliiy of the � aPPli��ProP�Y owner to in s�e that all Person Cowrty Pla�mmg and Zo�ng and Bwidmg Inspeciioas reqtuicments are met This �mprovement Permit is snbjecf to revocation if the site plan, plat or the intended use changes. The Improvemeat RErmit is not affec#ed by a change in ownersirip of the property. This permit was issned in compliance.with the prnvisions of the North Carolina `Laws and Rules for Sewage Treatment arid 7)isuosal Svstems' (15A NCAC 18A .1900). Neither Person �Connty nor the Environnaeatal �ealt� Specialist'warran�ts tb�at. thg septic tank system wi71 cantinue ta function saiisiactonly in the futnre or'that the water supply wi71 remain:potable. - -- . _ � � � Authorization to Constrnct Wastewater SysEem (Res�nired for Bwlding Perm�it) * See site plan and additional attachments i✓�- . Pr�posed Wastewater Sysfem: rvr,v�n�i �� � Type �a- Wastewatez Flow�_ 43b -g:p.d. New �G` , Re�air Ex�ansion _ - Soil LTAR: • au g.p.d1$ Z� . Type of Fac�ity: �-I �{Z Q��4P�.tr;,�, r� ��l �arn Basement ��0, Yes _ No � � .� �aste�vater Systean Res�nireaaents 'Tank Size: Se�tic Tanlc: ( �r 1 gal PnmP Tank: l- gal Grease Trap: gai �rain�eld: 'Total Ar�a: (�� sq ft �Total Length �33 ft � 1Y�a�mum Trench Depth �,i � in Tremc�'JVidtdt �_ ft 1V�ini�um Soi1 Cuver. l o.. in 1dlinimnm Trench Separation: 9 ft �istr'sbntaon: Distribution Boa � Seaiai �istn'bniaon Pressnre Manifold Spe�ifications: -�a11� Si-� n1cz._T,r�� 1��p�-}i �n� nr�-k1c� nv. Nea��d'� �'�I7�1�9�� -- Ant6orized State A.g�nti � �n C Pernut Expiration. Date: 2 Date: The type of systeai pezmitte3 is �Conventional Acc�te3 Alternative. I accspt the spe�ifications of the P��- . i�wnerl���a1 �8�presentative: Date: ' pL'�ID rev. l l/lfl/OS � � �` ��� �, �a,o �-a� � � � g.� b,�,�•�1"�. S'� c� S�� �� � , ��'�,"�� ��cqir� •ao+ddv w,b ,s� �=� ��s , ,�Z �"C�j , a� a c N 0 hl m n ,a�� ;,I��1� ��P �� U�'� � ��1 �n� � �-� �� � �� �� h �° `'`S O � M �� / � � c� ���-1-c�b� � `�-� �^`'� -���� sv� �}sa� � G,u� -� r' � ��', � , s���� �.arnv.� � � sa' � �s� ���Su�. �� a�:� �,�.u�, �� .�s� ���u�. �� ��� � s���-has ��� u���u`b`N � pammme� sr opezJsadardieqi amsal ol uoAe/�tsur aqi �'uru¢r�aq w.roud �a�s.fs aqi �eQ�snra rot�es7uoo �ryt .fjao smatuo� a�s�urmdde ivasardar s�rraaodruo� ruals.fs a��Q iva�� a;�S pazrso�ln� �� �o-I�uou�ag �'g�'� ��'��uotsrn�qe+� �—��# ia��cl �# d�Y1I �.I. /� bUt..r�a�I�I I�IF Id S v.������� -Q���c¢c.��o.aa��u� A,.I[��L�11 � � �-� �.-.`� �� ���� -�� �� �..,��.:':: ..�';:��:. .: `'.: ; ... . .. .. . �. ::�����`�� . :.,......... . . l:. . �'•:::.}•• .1.. . .. •��•�•r ..j':..;.,-•• • NrYy '. 7/^ . ., '�;��:�.• ;`1�/;,�: V•.�� . ....:.. . : ..::.yY :.: w�'vS.:}:•y�y': :."ti:"s . :.�y.: ; : ; .. + . ..v. .� ., ..:. . . . ... .......: v . ♦ ".'.. ., �; .,- . ..r .. . : .......:. �. - .. ' . . .�., v . v .. . .� r.}+��' ,.' . . . ... �, . . .. ' lTT'•'tY'.1r'i�'� ... �( ' . ,,. . • ��+JLJL': ::.y:... �.���Il:�,,Q'�''^�'l� �— ��Wf.��' .' �,�."!� ..... . 9 1 �.'�L i Y141J11 ' P�.EASE SEE �.�"�A�D �� �'tA�t �I�L S�'Y'� LAXOYT'�' Tax Map � Parcel # �.,� Tov�mship: Applicant•`��r,f-a +- ��� Subdivision:�,,�,,�'� C,�eek Lot # (� � Location: -r (L� �, � 1 �-� �r� 2n ) • c� `Type oi'VVater Supply: O individual �.tequirements: Site Approved By: Grouting Approved By: • Well Log: Pump Tag: � Well Tag: � Air Vent: � � Hose Bib: Casing Height: Concrete Slab: Well Driller: Well Approved by: ****See Attac�hed Site Sketch**** Community Public Liner: �Installed by: Depth set: _ Grouted• _ Date: Wate� Sample: Wells must be 10 feet from property lines. � Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any building foundation. Other conditions: Date: PCHD rev 01/27104