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A40 276Aaaiicatlon Date: � 1 Jc� I� Amount Patd• / • v Recei 9 - � � ��l Tax Man #: " ` -� Par++�l �: Z.�tQ, ���_ � ���.� �� _ . - - � � � �T�i'�� - .: ��.�.a-�— �.�. .e�¢.m.a �E-�.a.�.�. . APPLlCA710N FOR SERVICES . • 1) Permit requested by: (Ownedagent/prospective owner): 2�ec�na r C� Home Phone: �S'� �t 3 S" 4's �f - Address; c� = 8uslness Phone: G( �, � Ho �'S/ � 8' .� � � a Y' � o r d 2) Name and address of currEnt awnec S a,ti �� S � lx� -� 3j -Prope�ty Description: Lot size: Township: Directions to the property,(Induding road names and c.�—�— Lot# -2 4) proposed Use and Stnu:ture DescriPtion: answer eact� af the following questions: i � ._. ' a)- Proposed _,_, E�sting , Type af Structure: � c a r C� G r a��—_ Width:� �pth:�_ ..• b) Number c5f Bedrooms:' . Number of occupants or people to be ed: - . �' c) Basemer� Yes_,�No ,_ i�il there be piumbing in the basement? _ ' � . d) 6a.rbaga Oisposai: lfes , No _ . � . 5) Water Supply Type: Private /(new _ or existin��� Pubiic . Communiiy ,$pring . � Are any wetis on adjoining property? Yes_, No _ tf yes, piease indicate approximate locatiori on the � 'site pian. � � 6) Do� your pro�riy cantain previousfy identifled jurisdlctlorral wetiands? Yes_ No PLEASE NOTE THE FOLLOWiNG: ' ➢ A PLAT OF THE PROPEiZTY OR SiTE PLAN MU8T BE SUBMITTED WlTH THIS APP�..ICATION. ➢ PROPERTY UNES AND CORNERS MUST BE CLEARLY MARi�D. •, ➢ THE.PROPOSED LOCATI�N OF ALL STRUCTURES MUST BE STA(� OR FLAGGED. ➢ THE SITE MUS'� BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMEiVT STAFP. ' . � 1 hereby make applicatton.to the. Person County Health Departrnent for a siie evaivation for the on-site sawage disPosal system for the above-descrii�ed proQertY• 1 agree that the corrte�rts of this applicatian are true and represent the maximum facii'fiss to be piac�d on the property. i understand if the siie is aitered ar the intended use ct�anges, the permit shail becam 'nvalid. ������� � -' l-�v � � Owner or Legai Represerrta�ve • Date PC2iD. re+r. �6127/U2 ; � ev� �� � �� a �.' � � , ��, � � `L.J �Y ���� .1L � •7L1L'�]i��'Tt,'ILs���.�.�.11 1L JJ. tG.�U.11 �� �uaid��g A�da�on5/ 1@�ob�i� �o�e Re�la���ae�� Tax Map #:�� Approval Requested for: Parcel#: Z7(e �t Mobile Home Replacement �/ Building Addition Applicant Name: �D Address: k0 . b G Phone #'s: 5�.��f .9�9 - 7y0 -8128 ' ✓ Permit Located: Yes No Installation Date: (¢- 2- 99 Design flow: 3(�D (gpd) Cturent Contract with Certified erator on file (if required): Water Supply: Well Public or Community Wastewater system shows no visual evidence of failure on: (� ' Z 0� D(.Q (��) (Applicant's signature if site visit is not required) Comments: � i�o�e�lac�ffient Appr�ee� . 4, � Zo �� Envir ental Health Specialist - Date 11/15/OS '���,,/� �J.���Y �� l �q7j�'9 �T 7� ' ^^ � � V7� 1 V 1L .11� J� -���3]L'a@�rn iemm �E'Il�.�.�.1L ��O�..LLU�JL3 .•�- �, , � / �• �•: �. Ii .,� l� ���� ,ir.-- �� .:! � �•r •� �.-� SITE S1�TC�I Taa Ma.p # �D Pa:�cel # 2?�O Section/Lot# / . Ce'�'� Date . System cumponents re�resent a�iproximate �contours only: The contractor must, fTag the system prior to beginning the installation to insure thactpro�bergrade is maintained u . .�� ~ � A�a�J� �cale: 7 JC�� PGHD, rev. 09/12/01 02/08/1999 13:49 �9i1799 PLANMING AND ZONING �u�Sy p�zuoylny �o »uMp �uSis . . PAGE 01 -p��i�}�o; pied s��.� 1!� P�Q p�an awo��9 iiB�s uot�ai1ddE s�yt'�d�d y���H �y� �q �>>s �y� �a uonErtEn� �u� �o ��Qp �y� ��id� S1�.`�Q 09 U�c�i�; •�d�Q �1�H, �q� ol �v�datd �� �o ��e�d �f�,�.ms � po��nt�ap u �nQq I �u�na �u� ui ��� p�saapun I •�d�Q �l�H �y� o� �fv�do�d �t� �o i�a(d ��n�ns e �uos�ad �snw Y •p�nssr u� �ttivad riu�utono�durl uE ��o��q �Eyl pare�s.��pue I•p��Aut owo�4 Iigqs �ttwxi �� `s��ueu� asn p�puo�ut ocp �o p���l� �st ��ts at�;i pue�sl�pun Y��tv�datd �y� uo paaatd 7q o� so►���i�B; umuutx�u� �u> >vos�ld�� pv� 7� � U01���1(CidE 51L�j �0 S�t1�jU0a 7u3 iQ�I 7��$E I•,���c3a�d p�qu�s�p �naq� �q� �o� m�s�s 1Bsods�p �88M�s s•uo �� ao� uot�En�en� ���s E�o� �u�tu}.��daQ �YB'a� �juno� uos�aa �ui a� vo�i�aijdd� �x�w �qo�o� I •s.�nx�nx�.s a�soaoxa z�� �o sx��o� �xs au� �i��ao�a �sz 3a s��a� z�► ��ss ����� :p�ns�s oq ai �ido�d .�o s�uEdn�x� 3o a�qutrH •g �sn�x� �n��uaseq ,�o # `os #I p o� [] s�� i�uow�s�g � p� � y`�� �tESbdSIQ 9gEqI'� -""+ :StU00]p� �0 J�QLUn� :s�v�eidw� �o �aqwn� • :ssouisnq 3o xi�s, � p:ssov�sng �]:�wo� �liqo�,� :�snoH � :8 .vfjl�mp �o xi�s � :�vns�x�[J -pasodo�d :�irjtaE3n�n��ruis �o �d�SZ •pt 0 . � v J� I I I .7�i� �.�i��i� P���i �P # P4O2T ����5 :�u�do�d o� suan��.nQ . • � a :diysunnaZ _. :�I7a1�cj 0 �s�Ey�t xEi . , � ��zts �oZ :voi�du�soQ �s��do�d • -:vcp��ol ��nu�pt �os,� _ � � . � oH � sa�G�vodo�d �uiv�aCp� uo sit�M �uE �s�,+ . � �uuds �'] ��iantuwoa p �ilqnd���B�vd ui � � :od!�� �(Jd�ns i��E� �{ :��uMo �u�u^�',�o - �vou ,�n.�as o� p�pL��u� s� w��s�s ��sa�stp ao�n►�5 Sty) 3Ltj3 �»ii��3 �o �an3�nJ�s �ul o� pa��dt�iluE si �u�usa�21d�1 �o �suotsuEdx� •suoT�tpp� 'rCU� �i� �31�� 7ELt� •g •'�"'�V.L :1.i1ptY�A :�an»ru�S p�sodosd �o suotsu�wiQ �� p��.�--= i opt�r�sod�.' pUE �LIIEx - - `D :r �U4Ljd 55aU15it � ? - - - y ` , :� �uoqa au�oH m � � u �� c�ti �� :ssaJ 7���:ouMo �ni»adso�d �UM � :�Cq po:s�nb�> >t • � tun�jo»a� - t���cu�y� — Eua»�g — i��,� �ui3s�xg ���da� 11�M ^�`a� �03 �ttw�d ....� va»s�fs a��CaS �ut�six� ��E�da�>>rd�� _"r (3uisoi' u�o�) wo�s�g �unstx� ao uo�iaodsuzo� — .�+Jr���r;�• �+c,,,.. _,,�M - �`j- ��. � � '�x:�'� :: . • �� Y .. t.,,,�,,.�,�,; �..�:,�. � M:. .,; r �CT :�23 E �Y�7'+e:� -��"'�� • Irr?�4.! �, ��i�""�r'r'%"Y.P:'�':.�s�? � � .y?I' W.� .,. '�:i�"•�rTi.:!v�`,-r_�r_ •.wE�wPl�+'i���'��%�'; �:+ry.rir`t� l'� � (uon�PPt') ��u.u�d r�u�us�no�dw� — (a��sd�� �u�oH ���qoy�) �luu�d s�u�wanoidwJ _..._ (�o� FaPao���un) �ruu�d s�uaw�nostiva� (��'I P�pao�2�/p��ist�qE=s3} �iui.»d s�u�wonoaduiX "— ` ,•.5�;,-; sr-"':r`r. t P!1... ��se r =�. J�;...�.�:..�.,..::: 1 � saar a �:�:�:�,�.;..::�i�:,:..�,,:�.,.�., �.,..,...,w� �c+ . aasp bb���-,� d 4R��1 , � �diaa�� b�'l�l—� OQ'��� t" �Q•��( ptFd aunowd . � �. � � � W � a B 2946 PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IlVIPROVEMENT 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. Tax Map # A� Parcel # � 7� Zoning Township Fct � �'�C/ Owner/Contractor S�MM ✓ /�a�,.�:.�r Date S- �� - 99 Location/Address S.R.# Subdivision Name Q k �' oc. c��cs Lot# / � SEWAGE SYSTEM SPECIFICATIONS Repair�r�,�, Z"�,w,��,1,ot Area %�� A� Size of Tank /400 SFD � - Mobile Home _� Size of Pump Tank eF�%r Business # of Bedrooms_� Nitrification Line NUU �X 3� Max Depth Trenches �y " Permits may be voided if site is Well and Septic Layout by �, Comments: See co:��' ��! or intended use changed. � � G'�a Ja.�,. � G'��,s����-,�,�.. .�Iv �o.� �, n ": Date �- 2- 9q Installed byG'ann��.. y�,F� 13�os Approved by. Well Permit Paid � WELL SYSTEM SPECIFICATIONS Semi-Public Slab Public Replacement Air Vent ,/ Site Approved Required Well Well Head Approved — Well Tag ��_/ Grouting Approved �/3� ►�{ (, - � -9 9 �o:Se l�� b Comments: ? � ,�v -i -� 7►� �F (� -�,� 9� ,�� — �GY 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 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 statements 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 Ol/95 rev.l.l P.C. 10, P. 18-G e �SITE � �p � � �' MACNETIC t� 4> > � 4 � i 1140 ALLENS , � LEVEL WILLIAAI L. HUFF � � � ` D.B. 212, P. 873 0 ��Cj � / 0 ��` �a / � / r�;�—,, �� � VICINITY MAP � � � p i i � �� � � � ��� `� NS ^�°i� � ` \ ry �ry. � IS / �,`O NF � TIA�OTHY M. TAYLOR NF WILLIAA� L. HUFF � D.B. 255, P. 372 � '�'.T6� D.B. 212, P. 873 \ � h ��6 5�3, � �, �s � . NF \� _� IF �3� IS i i � �6 � � S L �O �O. s�s. �' � -: �, O gs � �Q � �Qo „'O � O 0,,� � Q' � � I F � i ��- C 26S ��'� ,�p�� /�.'41�/� • 12� SAMMY 8. NAWKINS F D.B. 198, P. 602 ?2) �`�S, IS 28 IS . . � ACRES , � ���� 0 `� �� s, •�, � ,� \ o � `� ' �L � � 1� M�p ' NS � A �.,, NS 3�'��, P.C. 10, P. 18-G �SITE � � 1n5C7 MACNETIC 1141 1141 1140 ALLENS � LEVEL WILLIAAI L. HUFF � \ � D.B. 212, P. 873 O ���j � / 0 ���` �a � / `` / � �i'�,\\�,�` o��� � VICINITY MAP . � � � � . � ���\`� NS "��i� / � ` ry �ry IS / �,`O NF � TII�OTHY M. TAYLOR NF WILLIAA� L. NUFF � D.B. 255, P. 372 � '�'�s� D.B. 212, P. 873 � \ � �,h ��6 `Sil. �\ �� � �Gc� . � � NF �� \ V� � ry , \ \ \ NF � � I S � �,"� , 3 � � Ns % �1 � 9 ; .t� . °� � �s � � �- s �O O, NS �i `r`T6. `� �' ~' ,<v �,,� .r� AS "'�- `� , �, �, � ,,,0 o � • • : � � . s o � �. N ; .°` �,� NF �•'/'yT6. �� q�' ` � •; ti �'h FS� �� C \ I �"� :y SAI�f�Y B. HAWKINS O �J � . ,� `L NF O,� �' �� � • D.Q. 198, ('. 6U2 NS NF NS �`� ,� NF �2� , 16 0 2 �`�S, IS Za tg NS �y NS 'S� o I S �. 0% \`� Ns ,� . �� ACRES oo, s,'' � o � � . �� � s� � � � \ o �', h' �L � �� r.`O IF I 8 � , . Date: ' Owner. � � S.p�►�v, Location/Directions: Subdivision Name: Drilling Contractor: . . . . ... . . - . _ ......... . PERSON COUNTY ENVIROIIMENTAL HEALTH WELL LOG SR# Distance from Nearest Properry Line r� Distance from Source of Pollution . �O 0 ` Total Dep.th: 2 2 O Ft. Yield: 3 GPM S tatic Water Level ^ �_Ft. Water Bearing Zones: Depth QA F� � 2�F� Ft� ��. Casing: Depth: From C� to�U �Ft. Diameter:_�__�ches TYPE: Steel � Galvanizeci Steel � If Steel, does owner approve: Yes No � Weight�: � Thickness: l�r Height�Above Ground: 6 t% Inches Drive Shoe: Yes ✓ No Were Problems Encountered in Setting the Casing? Yes No ✓ If "yes" give r�ason: Grout: Type: I�Teat SandJCement_ ✓ Concrete Annular. Space Width Inches Water in Annular Space: Yes No _ . Method: Pumped . . �Pr;ssure � � Pourzd� �_ . . • •, - : - Depth: From O to �, c� Ft. � � Materials Used: No. Bags Portland Cemenc Weight of .1 bag_lbs. If mixtuie (sand, gravel; cuttings) - Ratio: to �ID Plates: Yes ✓ No � � � •� � � �� 4 x 4 slab Ye:s�rNo I HEREBY CERTIFY THAT THE ABOVE INFORMr1TION IS CORRECT AND THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH REGULATIONS SET FORTH gy�THE PERSO�t C��i�'1'Y HEALTH DEPARTMENT. � .� � �Signature of Contractor atc 9 �