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A32 41, �A�iplicationDate: :3-?3o-1(Q Amount Paid: n1 C� Receipt #: � � �� 5 L C�J�� OU Aa ❑ Improvement Permit (Site Evaluation) $200.00/$300.00 (if> 600 gpd) ❑ Mobile Home Replacement or Building Addition $150.00 (if site visit required) ❑ Welt Permit (New/Replacement/Repair) $3 00.00/$200.00/$75.00 �� ) ( ��q �� Tax Map: " 2 ._...: "' l Parcel#: �� rav-nn-�an.mra�.an.d.m.11 JHI��..II.��La. Services for Services ❑ Construction Authorization (Fee is dependent on the type of system permitted) 0 Permit Revision $75.00 �r of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information• Name: �d,0.v�n +uirv�2�H �M0. ►^ Phone (home): 3 3 �c � ?J �o�i. -" � � S � Address: IO Lv r-f D �-{,�fd � e. M i llS �• (work/cell): �J ��/ - 9 7/ -�7 � Zco E-tJr te c�n��cs � Nc a�s�t 1 2) Name and address of current owner (if different than appl�cant): - - . . ., . . . P�Z�,O�}� �� 3) Property Description: Lot Size:�� 31Q�ubdivision: Address and/or directions to Properly: Phone: Lot #: ❑ yes C�-n� Does the site contain any jurisdictional wetlands? ❑ yes �L�'�Goes the site contain any existing wastewater systems? ❑ yes F�-�� Is any wastewater going to be generated on the site other than domestic sewage? O yes II'no` Is the site subject to approval by any other public agency? ❑ yes n0' o�re there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) �;a �� z� -�-a y,�ee� 4) Proposed Use and Type of Structure: ❑Residential ❑ New Single Family Residence Maximum number of bedrooms: � ❑ Expansion of Existing System If expansion: Cunent number of bedrooms�C� � Repair to Malfunctioning System Will there be a basement? ❑ yes �te With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential Type of business: �y,.�� Total Square footage of Building: Maximum number of employees: Maximum number of seats: � 5) Water Supply: ❑ New well Existing Well ❑ Community Well ❑ Public Water 0 Spring Are there any existing wells, springs, or existing waterlines on this properiy? ❑ yes ❑ no 6) If ap ' g for `Authorization to Construct', please indicate preferred system type(s): Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any I cert� that the information provided above is complete and correct. I also understand that if the information provided is inaccurate, or if the site is subsequently altered, or the intended use changes, all permits and approvals shall be invalid. ��►� \ � �-.,-� Signature �Ownerl�Legal Representative*) * Supporting documentation required. 3-2� (� Date Permits are valid for either 60 months or are non-expiring when accompanied by an 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) ConnectGIS Feature Report { �, . Page 1 of 1 Person � �' �" � � Printed March 3Q 2016 !� �� See Below for Dlsdaimer — , y�. _' k ' � $ ''F' , .: .. &^ � it�: � � �, � : � ; ;¢�.. ,,'�:� § +� ��'. ,�� . . �. � � .. .`�- . ��,;;$'f' C � x `j, k,��_ •'�' � �fs F - � ' . �t i ` :`� �� ` . �. ":�� ,, . � �, �,�.�.� � j �/ � T .i ' �E � � � � �' i � �� . . ,. � '�s�.�. �` �`> �t� � r �` �i . . � ,� �! �� ``"' ` .F�..�y � _ �� a ' f i �f �� t � � � �, 'se'f °a � � �" 4 _ E � � � -, } ,� � ^� rv , f L 5 g :�5,� p C �� 1 � L�� ' r` . ,. � � � ry � � } g i : � �, ` > _ �, *z� t �. � �� i .� j �'�. i � . � r � � '�, �. � � � : . � � . . . . . ,.. t , a �'. � { . .. . ... ,.: �. r .s: �� ..._�._. -�-� � 9 -. � � ' � �?` � � . , � > � , x. *�, �' � > � �� - . ,�``� �, ��-' � � e � +� � � 1 � � �� '� $ �� ,�� > ; � � � �� ar � � ir � . �, �,> , � <= a ' : : : .. , j �. �y s � ; + � jt'.: �, � � „�„ � , s�*'^ � �.�' � �� F` i „'# f, f �i:? a � �� / ,,. > ,� � � � �� f � 1 � r' ` � � � �, _ � � s'� �� '� �,� � ri �� i � � � � +� � !� ° r �� . � i� � . � � � '�� . ,t� ��`�' �� '� �� 1 �� \,� � �� ;�Y� f"�`�"�� . 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'�. � �r �� . f � .. . i ��• � � • :� � � 7� . �i� . / �� t d�.. t # i � �";' � s��,r �� ` ti a� . � �'�E � � �: t�s �s -� �S � o%��, E � �: h'.i...� � � ; �� '' � i �-� 1 g'' �" �� ,�,t ei` � � �'^`` ,� �, '�,� � � �J ��F e�e t S '', '� ' �,: > . :.,:;, NOTICE: Retently, we have had seve�al users report browser compatiblllty Issues �vhen tn,�ing�to access our GIS website Typlcally, the problem stems from users who have recently upgraded to the Windows 8 operating system or a new version of Intemet Explorer. We were able to resolve this issue by direding users to the Intemet Explorei Compatibility View tooL This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-US/internet exploredproducts/ie-9/features/compatibility-viev. f this does not solve the problem feel free to contact us at the number listed on our rtiain page. Welcome to the Person County GIS Website. ConnectGIS has been prepared for the inventory of real property found within Person County, and is compiled from rewrded deeds, plats, and other public records. Users of GIS rystem are notified that the aforementioned public information sources should be consulted for veriflcation of the information in this system. Person Counry, Mobile 311, ConnectGIS assume no legal responsibility for the information in this system. Grid is based on the NC state plane coordinate system, 1983 NAD it � '�, � i,n:,es � � � � � — Z � , L`� 2- Z`1" ;25 http://gis.personcounty.net/ConnectGIS_v6/DownloadFile.ashx?i=_ags_mapd2fe099ed53£.. 3/30/2016 _��,sf ��.� �� _ �`-{ C� � �CT.�� 7C�e��n�-��.Il I�-��,Il�I� Applicant: • �� - . . ��i��%�i�� Permit Va ' for: Five Years Type of Facility: Number of Bedrooms Proposed Wastewater System: Proposed Repair: Permit Conditions: Authorized State Agent: (X) Owner or Legal Re Improvement Permit Non-expiring New Addition _ / Employees / Seats: Tax Map: � Parcel:� Subdivision 1�i� Phase/Section/Lot # Water Supply: Projected ily Flow: gallons/day Type: Type: Date: The issuance of this � it by the Health Department does not guarantee the issuance of other required permits. It is the resp�risibility of the applicandproperty owner to insure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws anrl Rules for Sewape Treatment and Disnosal Svstems'(15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic system will continue to function satisfactorily in the future, or that the water supply will remain potable. �.. Authorization to Coastruct Wastewater ystem See site plan and additional attachments (�. Proposed Wastewater S, �em: - ZS `. j�2�c-�'c.� (*)Type � Desi Flow �(� gal./day New Repair 1/ Expansion Soil LTAR . 2 gal./day/ft2 Type of Facility: • -- Basement: _ Yes _ o (*} System Types Illb, Illhg, IV, and V, require pzriodic system inspections by the Person County Health Department. Wastewater System Requirements E�sfi� Tank Size: Septic Tank � gal. Drainfield: Total Area / d��lb sq. ft. Purrip Tank gal. Total Length 3(p 0 ft. Trench Width ..�5� ft. Min.Soil Cover _� in. Distribution: Distribution Box i/ / Serial Distribution / Pressure Manifold . . _ ., � Tlie system permitted is: Conventional and specifications of this permit. (X) Owner or Legal Representative: ' irease Trap '-- gaL Max. Trench Depth � 2- in. o�C� Min.Trench Separation � ft. / Innovative . I accept the conditions Date• � �—�� Person County Environmental Health, 325 S. Morgan St, Suite C, Roxboro, NC27573/ph: 336-597-1790 (rev 5/12) � � (� � � � � � �� N� : 2a��, , � y N R O �p , . a„� 0 � � � c�i o p � a"�� R � ; �y �° „ �+ S'!� m A ^� 3a ro � o � � o. '<° b „„a e Q I y � � � q � A N a � �0 T � A � O � 3 O O �� C �0 N 0. � o � ` C�1 < � '� � � � a � C � � o � � o � 3 � �q Q � y �1 Q� 3 0 � � a � � o a �a 3 � O � � O � � a q O S � o � � �--� � °° � �: �� - � q �.Q � � � � �" � � � � � � � �fi � yz K w O�. � , `<_' e 0 �. n 6 y :: 0 n � � ) d N