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PERSON COUNTY HEALTH DEPARTMEiti'
ENVIRONMENTr1L HEALTH PROGRt'�M
325 Souch Morgan Screcc
Roxboro, North Carolina 27573
(33G) 597-237I
Date: � -(p - C70
Re: prQAaScd lot oFF Ru��S Farm Ro�
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Dear �S. NataStia �'X�� :
��e�'�1 ��1
The above referenced lot has been evaluated by the Person County
Environmental Health Department. The results ot the evaluation, a copy of wi�ich is
attached, indicate that the site is unsuitabie for install�tion of a ground absorption
sewage system for the following reasons:
o �9'�3 �o; � dcPth. Ozp�h,5 �o .�psa�itc� K,tx,�c! UnSu�tablc So�IS ��ss���n a4 i r��hcw.
0(9 4�' pua� lab� ,5pnce. �nSuFF�'�,i �nt �acc i n 6t�itablc. ,So� IS avai Ia�Ic For �
r�i tri Fi en-Ei en Fieid and r�ai t',
Due to the limitations on your site, this Department is not aware of any
mod�cations or altemative measures that can be implemented to upgrade ttie
classification from "unsuitabie° to °provisionally suitable.° Your appiication for an
improvement permit must, therefore, be denied.
You have the right to an informat review of this decision by the environmenta!
health supervisor of this health department and a(so by the regional staff of the
Department of Environment, Health, and Natural Resources. You should contact the
health department to arrange for this further review.
You may also wish to obtain the services of a private consultant to collect
site-spec�c data and submit such data and a system design to the health department
for technical review A site may be reclassified to provisionally suitable provided
written documentation, including engineering, hydrogeologic, geologic, or soil studies
indicates to the loca! health department that a proposed septic tank system or a
proposed altemative system can reasonably be expected to function satisfactorily.
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The substantiating data from these studies must indicate that:
A. Tiie effluent (wastewater) will receive adequate treatment;
B. The effluent (wastewater) will not contaminate any ground water or
surface water, and
C. The effluent (wastewater) will not be exposed on the ground
surface or be discharged to surFace waters where it could come
into contact with people, animals, or vectors.
Finally, you have the right to a formal appeal of this decision if you fiie a petition
for a contested case hearing with the Office of Administrative Hearings, P. O. Drawer
27447, Raleigh, NC 27611-7447. A copy of a petition form will be provided to you
upon request. The petition must be received by the Office of Administrative hearings
within�ri0 days after the date of this notice. The hearing will be held in the county in
which your property is located.
If you file a petition for a hearing, you must send a copy of the petition to Mr.
John C. Hunter, Oftice of General Counsel, P. O. Box 27687, Raleigh, NC
276 1 1-7687.
Please call or write this office if you have questions or need additionat
assistance.
Enclosure
:: ,-,K:
Sincerely,
���
Environmental Heal#h Specialist
Environmental Health Division
Person County Health Department
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The Disfrict i-lealfh Departmenf
Orange, Person, Caswell, Chatham. Lee Counties
SEPTIC TANK:.PERMIT
. __ --- - ,
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_ _ ._. .
Name of owner: " �
Nazne of contractor: _ �
Address and Directions �-}' � � ►�1 �rci � C��((S � C i
�) � F -�—� ���, L �o � „cl �r � j I R4- � . . "
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Person or firm doing installation: '� ___ __
.
Address •
No. of persons to be serve� � Bedrooms 1, 2, �4.
Additional appliances to be used: Disposal, dishwasher, washing
machine
,�---
R,ecommended• Septic taril 1
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Nitrification line: .
Above recommendation based' on information received and observed ,
soil condition. Septic tank and nitrification line mus3 be inspected and
approved by a member of the District Health Department staff before
any portion of the installation is covered.
Date Approved: � �y%�'%�
By• � � �
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Countersigned
SignecL
Sanitarian
O. David Garvin, M.D., M.P.H.
District Health Officer
(Over)
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Amount paid l d ^ �.3 �—�_
Receipt ll � ��� ���' Date
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1. Permit requested by: .
owner/prospective oxrne�
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ome Phone #: y' I `�— ' �
usiness Phone #:�.
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Reinsaect►on of Existing System (L'oan Closing)
Renair/Realace exist�ng �epuc �ys��m
PPrmic for New Well
RPnlar_e Existin� Well
7. Dimensions or Proposed Stru
Width: 6 � 1���
r,,.���... /1.(.�
'C •�-% 5��1 8. What type (if any, additions, expansions, or
replacement is anticipated to the structure or facility
_ that this sewage disposal system is intended to serve'
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addre�s f current owner: 9. Water supply t}pe:
5 private �j . public ❑ community ❑ spring ❑
, Are any wells on adjoining property?Yes ❑ No [�.
�nn ,►< `i'I. G � dl ?S�L If so, identify location:
Description: Lot size:
. Tax Map#: a� �' �
Parcel#: �
Township• 1� � � . �' F^ �''
i. Directions to property: State Road #& Road
ames,�tc.
10. Type of structurelfacility: Proposed: �Existing�
Type of dwelling:
House: C� Mobiie Home: L7 Business: ❑
Type of business:
Number of Employees:
Number of bedcooms: �_
Garbage Disposal? Yes ❑ No �
' Basement? Yes ❑ Nofl If so, # of basement fixt
6 Number of occupants or people to be served• .�._�
CLEARLY STAKE ALL CORi�IERS OF THE PROPERTY AND THE CORNERS OF ALL
PROPOSED STRUCTURES.
I hereby make application to the Pet'SOn COunty T3eSlth Department for a site evaluation for the o
I a ree tha[ the contents of this application are t�
sewage disposal system for the above described property. g
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 that before an Improvements Permit
issued, I must present a survey plat of the property to the Health Dept. I un afte thetdate ofhhe evaluah o,
delivered a survey plat of the property to the Health Dept. wi[hin 60 DAYS
the site by the Health Dept., this application shall become void and all fees paid forfei[ed.
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Sig� Owner or Authorized
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SGR�C:�SBED ANO S11VQ�4N BEFORE ME TNIS
T Y OF 19 ��
� TARY PUBLIC.
MY COMMlSS10N IRES 9�.iZ. -� p
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NORTH CAROE.lNA
, �,•�„ _COUNTY
�� l4� 4� BEING DULY SWORN SAYS THAT TNIS PLAT OR r�
HEREON IS {N ALL RESPECTS C�RRECT 70 THE BEST OF HIS KNOVJLEDGE .
BELIEF ANO WAS PREPARED FROM AN AC7JAL S:;R�.'Eil Iy1;;DE BY NiM .-
COMPLETED ��y �� ��� �
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Yerson County Health Department
Existing Sewage System Report For: Mobile Home keplacement
!/ Addition �
Requestee: ���. .�-p�� Home Phone# � /�a-$�a �
�% � r�-�f� ��*�-. l�� Business# 336 2Z g 1�%/
`Pax Map#
Location/Uirections: S'%� I��%(�-!�� ��i�,..,, 7��" . _
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Original Permit Located
Septic System Uesigned r'or:
Kesidential _�/ Business Other (specify) _
# E3edrooms � # Employees Other _
llate '1'nstalled ` — —' Water supply ��[%�rr�1� � 1-�Z���
`Pype ot System , —
Nitrif ication Line __� ! � �2� /
Tank Si2e / �v �%��
Certified Operator Required 7V D
On sit,e wasL-ewater disposal system showes no visually apparent
malEunction on 1 �— �-ci'S �� �
Yermission is gr n ed o: ` ���
G� ��o �� %� �.z�-t%e-� ` �
Accordinq to the attached site la
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Environmental Health $�C.. ���D �. _1_
�—DATE