A32 98�� ! Tax Map: �'Z Parcel: �
�� ` � � � ) � ���� �� Subdivision
' - �—� � � � � � �" Phase/Section/Lot #
]C�s7��a,���„-„-„ ����.Il IL���►.Il�I�
Permit Valid for: Five Years V
Type of Facility: �n � �a �w
Number of: Bedroo ��/ 0 upa
Proposed Wastewater System: CC
Proposed Repair: �r� d / /-1�r,�
Permit Conditions: •
�`uthorized State Agf
(X) Owner or Legal
Improvement Permit
Non-expiring
���Iew � Addition _
�( / Employees / Seats:
Water Supply: �W���
Projected Daily Flow:�� gallons/day
Type: �
Type:
Date: 3 - �
Date•
The issuance of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibility 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
aiid Rules for SewaQe Treatment and Disposal 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 wiil
remain potable.
Authorization to Construct Wastewater System
See site plan and additional attachments (�.
Proposed astewater System: � ��25% ,����n �v�M,J ('�)Type� Design Flow 3(00 gal./day
New � Repair _ Expansi Soil LTAR. , Z gal./day/ftz
Type of �acilit_y: 5' Basement: _ Yes _ No
(*) System Types Illb, IIIbg, IV, and V, requireperiodic system inspeciions by the Person County Health Department.
Wastewater System Requirements
Tank Size: Septic Tank �.�2 gal.
Drainfield: Total Area �'q0 sq. ft.
Trench Width �_ ft.
Distri6ution: Distribution Box �/ S
Specifications: '� �(e-i n�� ���n��
! A�� �'n�) n n.iD-�d�/Pr �i11�AM �
Authorized State
Purr�p Tank — gal
Total Length 33a ft.
Min.Soil Cover � in.
^vrzase Trap gal.
Max. Trench Depth _� in.
a,C.
Min.Trench Separation � ft.
Distribution / Pressure Manifold
/ � ' r
Issue Date: , -3 //-/lf
Permit Expiration Date: 3 //-�9
The system permitted is: Conventional /Accepted �/ Alternative / Innovative . I accept the conditions
and specifications of this permit.
(X) Owner or Legal Representative: Date: � �
Person County Environmental Health, 325 S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12)
i
Tax Map: /� 3Z
Subdivision:
���.sf ���.���
- � � ����
I���nu-������.ffi,Il IE3C � �Il�l�
Parcel: �
WELI,, PERMIT
(New� Repair_)
Lot:
Applicant's Name: Q�Qh �-�inKl� °� Moroq.r�; CL�risfi�an
Mailing Address: �� � �3
I�u�r�l�e Mi�15 �2.75� 1
PhoneNumbers: Qp�— 35�(-411( �'�7 —�55— �55�
Permit Conditions:
1.) See attached site plan for proposed well location.
2.) All applicable State and County regulations governing construction and setbacks apply.
3.) Permits expire 5 years from the date of issue.
4.) Issuance of a permit does not Quarantee a potable water supply
Permit issued by: Date: 3-ll -I Y
(�Tew Well:
EHS/Date
Location:
Grouting:
Well Log:
Well Tag:
Pump Tag:
Air Vent:
Hose Bib:
Casing Height:
Concrete Slab:
Well Driller:
Pump Installer:
Approved by:
Additional Comments:
Date Sample Collected:
EHS:
Person County Environmental Health
325 S. Morgan St.,Suite C
Roxboro, NC 27573
Certificate of Completion
�,iner:
EHS/Date
Depth:
Grout:
DAbandonment:
Date:
MethodlMaterials:
License #:
License #:
Date:
Date Results Mailed:
Phone:336-597-1790 fax:336-597-7808
11/26/13
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�nawns��an�na��n�am.� ����.���n
SITE PLAN
Name °� ¢f �1f���a Tax Map #� Parcel # �$
Subdivi ' n Section/Lot#
3 - / 2-/
Au orized State gent ate
System components represent approximale contours only. The contractor mustJlag the system prior to beginning the
installation to insure that propergrade is maintained
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OTICE: Recently, we ha.� h��l s�.ual��ueis iepoit bic. su co�m��aLih I t; i,,u� ��I cn t�ying �o access ourGlS website �ypicelly, the problem stems from users who F
�cently upgraded to the Windows 8 operating rystem or a new version of Internet Explorer. We were able to resolve this iswe by directing users to the Internet Expl�
ompatibility View tool. This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-US/internet-explorer/products/ie-9/features/compatibility-�
this does not solve the problem feel free to contact us at the number listed on our main page. Welcome to the Person County GIS Website. ConnectGIS has b
repared 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
otified that the aforementioned public information sources should be consulted for verification of the information in this system. Person County, Mobile 311, Connec
ssume no leqal responsibility for the information in this system. Grid is based on the NC state plane coordinate system, 1983 NAD.
http://gis.personcounty.net/CoruiectGlS_v6/DownloadFile.ashx?i=_ags_mapeedd3ef85762... 3/11/2014
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recently upgraded to the Windows 8 operatiny rystem or a new veision of Internet Explorer. We were able to resolve this issue by directin� users to the L�ternet Explori
Compatibility View tooL This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-US/intemet-explorer/produds/ie 9/features/compatibility vie
f this does not 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 beE
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 ai
notified that the aforementioned public information sources should be consulted for verification of the information in this system. Person County, Mobile 311, ConnectG
assume no leqal responsibility for the information in this system. Grid is based on the NC state plane coordinate system, 1983 NAD.
http://gis.personcounty.net/ConnectGIS_v6/DownloadFile.ashx?i=_ags_map62f40df436a54... 3/6/2014
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OTICE: Recently, we have�had seveial �useis repoit biov�ser compati6ility issues when trying to access our GIS website. Typically, the problem stems from users who hav
cently upgraded to the Windows 8 operating system or a new verslon of Internet Explorer. We were able to resolve this issue by directing users to the Internet Explore
�mpatibllity View tooL This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en US/intemet explorer/produtts/ie-9/features/compatibility-vie�
this does not 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 bee
'epared 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 ar
�tified that the aforementioned public information sources should be consulted for verification of the information in this system. Person County, Mobile 311, ConnectGl
�sume no leqal responsibility for the information in this system. Grid is based on the NC state plane coordinate system, 1983 NAD.
http://gis.persoi�county.net/ComlectGIS_v6/DownloadFile.ashx?i=_ags_map61374ab02019... 3/6/2014
ConnectGIS FeatLire Report
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�TICE: Recently, we h i. had x� �al us�.is ic ��o�t l ic,..,ei un�p�ubilrty i,sues wh��n t�ving to a�c��> uui �,IS website. Typically, the problem stems from users who hav
:ently upgraded to the Windows 8 operating system or a new version of Internet Explorer. We were ablc to resolve this issue by dlreding users to the Intemet Explore
�mpatibility View tool. This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-US/internet-explorer/products/ie-9/features/compatibility-vie�
this does not solve the problem feel free to contact us at the number listed on our main page. Welcome to the Person County GIS Website. ConnectGIS has bee
epared 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 ar
itified that the aforementioned public information sources should be consulted for verification of the information in this rystem. Person County, Mobile 311, ConnectGl
sume no leaal responsibility for the information in this system. Grid is based on the NC state plane coordinate system, 1983 NAD.
http://gis.personcounty.net/ConnectGIS_v6/DownloadFile.ashx?i=_ags_n1ap23a32900b37f... 3/6/2014
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