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A40 310s •il.;1!�i ! it i ' ' � <« • _�i i . �. i ! ;_ •� i � Tax Mao �k � � � k �� �e: �3 /r� ,� v �` .�a— �L� � ��i ��1•_ ��i� .ii i► �• i i ii�. .:��i ... . i 'i _l�l. ��: �:\1�2� i� �iA� hQ1i�b� ..7• ��1MI1� � ��� Hort� Pho� ? �u a- �6 ��� • �es� Bu�iness Pho� �� - Z, � aR1d idd[Oii Of Cui70� OWI'Nr: .� �''�-� 31 �P�It �oc� Loc at� , e o Tar�pC �- �P I J J„ n Diredians ba the propecty pnc3�p �nad names and numba�sx N Y-�` f, . G .� 7 �73 � Ptspos�d Us� and S�u� D�scriptto� � e�ch af ths f�a�eirp que�iona: a� Pro�oaed 0. Ex�nq 0 b) Sti�dc Buit 4 Noduiar 0. Sinpie Wfde 4 Da+bb Wids � � l+�unbec d 8edcoonnx s, c�Ntut� ot oa�tus�a� p�oplt to be sen�ed: � a) Baa�t Yes Q No 6�tf yes, � ot 6aaat��t fGduce�_ .. ' t) Gaci�e Oi�ak Yes �tro � � Qi�uionsaf Propo�ed Struc�ue: VVid��: �Dapltt � ° a) ��PP�Y �IP� PrivaLe 6�ine�w a ar ood�InO �. Publlc 4 CoamuniY 4 Sprirw D. An any w�s on adjoininp propetlYt Y�s 0 No 0 lt y�s, locafton 6j PMas� Indlcab Daii�d Sy:bvm TYP�: (sysi�ma can b� rania�d h otd� af Y�' P�) ��«�� _�m�.a G�t _�. � . oaw� �: CLEARLY. 9TAKE ALL CORNERS ANC UNES OF THE PROP�ItTY. STAKE THE CORNERS OF /1LL P�OP08ED STRt1C'iUREB. P�EA�SE A1TA+C� SURVEY PI.AT at SRE PLAN TO 7H�S wPPl�CATION C�7 ��'�Y �� to tha Pe�on Co�ady Health O��t ior a a�s ivak�tian tor ttr ati-siis sa�waq� di�P� �' tt� above�desc:ibed proQaty. l aq�ne fhat the contenta of �his appli�tion a� trus and tepce�nt the rta� �s to Pt�c�d an the pnopecty. 1�u�daa�nd �tt� sim 1s a�ared artt� i�nded tw ct�anpa. ttN peRn� sfiat bscan� invdid. I unde�ata that as ap�ant, 1 am tespo�ai�e ta� id�iyirq and rt�kin9 P��Y �. ��d �aki�g ths ai�s ��c t patso�u�al af Per�on Courdy Heaith OeQ�Cnent bo conduc� ittait wdu�i{ons. l tn�utid itret 1 atn teapo�a�bb i� no�A�9 . kisadt► It rtry pt�cparty aa desipnt�d bY tt� AcmY CorP: of Esqnses. , . �`��`Qo Lpal �pr�titattve . Oa�te . 02/08/1999 13:49 59�1799 PLANNING AND ZQNING 1v�S�t pszuoy�ny �o ��u�Q �l-� . . -- ,.,., �,,.,,�, 1 PAGE 01 -p��r��o� pzQd s��,� 11� P� P�o� �u�a��4118ys uop���tddE �%n'�d�Q y�j�H �� �Cq ���s �y� �o uopEnjEn� �t�� �o o��p �t� »3�E S��Q 09 U�c�i„n 7d�Q y��H �t� o� ��uodoJd �� ,�o ��e�d �(�nins � poJ�n�iop u ��Qq I �u��o �u� ui ��� pu�s��pun I •�doQ LPT�H ��l o� �Suxio.�d �y� �o �u(d ��r�ns � �u�s�d �sntt� 7 'pvnss� u� �tuuod s�vow�noJdcuI uE �lo��q »� pv¢3sJ�pun I•p��Ant �wax�q lIzc�s �iuu�d �� •s��tr�u� �sn p�pua�vr �t� aa pai�7j$ �st ��ts �t� 3i ptre�sl�pun j��tu�daJd �� uo pr�a�d �q a� s�nr�t��3 umwix�m �� �u�s�1d�1 pvE 7� � UOt���l(f�CIE SiT�j �0 S�lI7i110a �l�l i4t�7 ��I�E �'�j3�QIH �U�57p �AOQB 7Lj7 10� LU�'iSl�S jBSDCtSIp OSEM7t s.no �� �o� vot�EnlEn� ���s E so3 �uau�.zEd2Q 'q�IEa� �uno� uos�aa �u� o� uotl�a?idd� �x�u� �tqvao� I - •s�n�nx.i,s a�soaoxa Z�� �0 52i�0� �HZ Q2�i� �,I.�i�dO�Td �HZ 3d S?��0�'I'I� �I�'ZS 1�'I2iY�'I� :paiu�s oq o3 �Ido�d �o s�u�dn��o �o �aqtunH •g ,Jnlx� �u�w�sQq � o� bs � D o� r] s��, ��u�tu�sQ g� p °H (] s"'x Lt�sods�Q �S�c� —�" :svJoospxt 30 �oqcun� :��Coldcu� �o soqwnH :ssautsnq3o xi/�1, Q:ssanisng D:�m��.: �Irqoy�p� :amo_.� � :8 ,�rf �,Mp ? o a3,C,L i :�uns�x3� -pasodoia :�itlt��3nsn��n��s �o �y -p I 0 � i v � � ► • � -���'�s�tu�e� pEp2i 7p # pQo� ����5 :�u�do�d ol suopr�.nQ .- � a :dt�sux►o1, - :�i:�s�a n ti #�EY�t xE.I. :7ns �oZ . osd . :u�,���ol ��nu»t �os � � _ � � � � r✓Oq7� v� -- �o� �sa,�����do�d outu�afp� uo sl1�M �CL*� �sY . a/l'r �_4_ Y �� � �a�cs j� ���unun.uc� 0 �:�qnd�^ �l�tiu3 u, �� � � " , , cu �,�, . . .� � :�ds� �Ic�^s.::EM •� :�ouMo �u�.u::�'�o s5�r�oe pu� ot;.TEN — �'U�`U �NaS 0] �:p���v� S� tlte:s�s �ZS�=stp ao�n�,:s s�;:; .2ti F�tti��; �o ::r.�iV�S 7'yl 8� �a:z�:�t�uc si �u:;�.::�21c� Y �o �suo:sv�dxo `suoT�tpp� 'i.u� �i) �3�� ���,� 'g � :•;�c�Q � '"' � I:1 � . �.�, :�sn»;1.7S P=So=��d �o suaisL:•.:»Q •, . p��.�--- � opt�r�s�� — � •�:T;1�jC17a� — 11�M �urlstx� :���d�� —� :L auot�� ssa�isn `� �- -/`.! %f`' :*u,, iU0'`.�G �SJO ___,��✓ �✓;/Cl x�✓d � j j= �; � � � k c� : ss+/`�� � � :2�a� �;.:L�r,c� �ni;�a�S���� �un�t � :�q �::s:nb:� �;L��" � iratu��y�— � E110:��g — (uot��PPY) �It:,u�� s�u�m�no�awl II=A'� Ma� so� �i„–� -.�� ----I (o�zid�� �mcH �I�q�I�t) �:t:.u�a s�c�u.,o�o�dtuJ _"{ � u»>s�Cs �����5 out�s;x� ��E�d��J�rc.� """I (�oi F�P�o���ujl.) �r,::.s_a s�u�wano�w� u�o-�) w��s�S Bunslx� �o uoi:�esus:� —(�0�7 p�p�o��/p�t�sT�q��s�,� �1:r:s:� SSu�wano�dua7 � ,�,r.-. .,�..-� �...,rr:_'�� ;i�''v '�3 SOA 2�:53�1 ,I8 •• . "`,;':r''».."_r�r :�..-..r• -.+,• � .'s:l:=�""•�;� • .;•.�y(� •r,-...J�.v... �•-�:, : �Ir. t � _ !• . . ..... :�."•i-:• -.�x.:..:''C•J� �,y;,��.. y� ��.. '.�"�J .r"i. ,i!\. .1/�:I"'��"'�' �`�7i.JIt..�:Llr/tir..�w.��� � O � � a� p a Z�D r� 53Ja�h3S 2� 03 t� U1.LbJ17dd v �.I I o I#� F ✓' . � ., . �F�� O�' , �' �C :aaPg �r��—� �1rfl''�1 04 � St"� �'� ���'O�'f P,e� ;unomN `� PERSON COUNTY ENVIRONMENTAL HEALTH FiEAS�E St� �iTTq�F��� F�LAN FOR SOIL AREA AiVD SYSTEM LAYOUT Tax Map #: _ �� Parcel # _�� 3 , � Zoning �j� � /n i /'� Township __ ,(.�Cj C(,(,�� Applicant: _ �yi1-+„— Yd'%/.l�L/'�liir�% LocaUon: S�bdivis(on: �MC(%�v [G'1Gli gz�,inn: Lot: � � lm�rovement Permit A buiidi7a perrr�it cannot be issued with onlv an improvement r�ermit New �Repair Addition Type of StructureS �, ) _ Water Supplv � # of Occupants # of Bedrooms .3 Other Basement? _� Basement Fixtures? � Projected Daily Flow: �(� g,P,d, permit Valid Fo •, Five Years ❑ No Expiration Proposed Wastewater System Type l', �;,e, �h,,, Y/� Pump Required? Yes l No Proposed Repair : Permit Conditions:_______�Q�, � �� c��� � �,� � S �/ �, � Owner or Legal Representative Signature� ,����v Date: Authorized State Agent: .W Date:� ��� � The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal Systems of the North Carolina Administrative Code. Hutnorization To Construct Wastewater S stem Re uired for Type of Wastewater System C� �p Was.tewater Flow: �g.p.d. Facility Type: S r� ��,(f New Repair DExpansion ❑ Basement? 0 Yes No Basement Fixtures? 0 Yes� Wastewater Svstem Requirements Septic Tank Size: f C�Op gallons Pump Tank Size: gallons Total Trench Length: �Da feet Maximum Trench Depth:7� inches Aggregate Depthf Z in. Maximum Soil Cover: 12 inches Trench Separation: � Feet on Center Other: Permit Expiration Date: /�- 3p - d(L Authorized State Agent: - ���� ,� Date �'`�"` f- The type of system permitted ❑ does ❑ does not differ from the type specifled on the application. I accept the specifications of this permit. Owner/Legal Representative Signature: Date: PCHD, rev. 11/18/99 s Application #: ���3 Tax Map #: � Parcel #: __��� „�� � � � Person County Health Department Environmental Health Section SITE SKETCH •�c�� �G� �> �2�> 3'z' _ pplicant's Name division/Section/Lot# i�-��: �D �� /� ��a -4�3 Au horized State Agent Date System components represent approximate contours only. The contractor must flag the system to be�innin� the installation to insure that Scale: h%!� }'� � : � '� 1 -. �- � / �/�' G+� � D�vZv�p m�iu� P�-t��n � is ma�nta�ner� PCHD, rev. 10/12/99 � �n�J�� � • . � � �vitom��en4ai �i�iiE� S�on. • • � m � . � : z��,� A-�'0 _ �r� .�f0 . � , � . � ' Ta�hl� __1.;LL� ������ � � � �!� �� •� �� . _ _ � � ' � � . � an.� e ri1. ' . . ' . . La�wC . � • , . � � - � Qpetatior�-��.Permi�t � � , � . - � � sjrat�tp T�e M A� v1�h Tsd�e ve� ,. . '�S 8Y57E�i HI�S 8E@I 1N5t'ALL� IN C�Pl.1ANC� YIRiH Ai'PLlGABL.E NORiH �. � � CAiiOLlNA �H�16�AL STA'11TfES. RULES FOR SEiNAGE TREAiI�Ii MIC DISP08AL; . . . � ALL COND�IYON9 OF THE �IPROVEtiENf P6t16f • AND CANS i'RUC7'IDN �. � s � 3-1_�0� � � . wr�ed St�s Ape � � �° . ' .. • . . . • � •' . . . i � � . • . � iN� l�� �d�.. �� . . ' � . . �.�� : . - � � . . . t: . . � �-- � . � . : . � — --- � � � � � — , � . � .. . . . - . � o,',� � • ' a� � . � . . . � �� . � ! � I • ' � . � � . � g � . : . �ID' . ' ' , . : .. �. � 1�' . `�� " . . � .. . � • . . . ��' � � . . . . . , t�. . �� . . � i�� � . . , . 'A . � f . - ? J/ • ' ' ' , . - - . � . . ' ��w mN : . . ��� S� ���.�.� �� °�°o� a� � �o� L� — .=' `�--�- C�o�p� � f�.,;-,.�� �,J< / �-►� ������ �ga�asoaa�*-,*-,. ��a.��.�7 �-���.7L�I�a � � " ° ��� � Qr. Well Log p��; (,tii��c;.�,7 f�i��,�' Tax Map Parcel # Location: Subdivision: � Lot # Well Construction Distance From nearest Property Line (Minimum 10 feet) Distance from Septic System (Minimum 60 feet) Total Depth: %Of� ft Yield: ��� GPM Static Water Level: �s ft Water Bearing Zones: Depth SS r.�. lft ���i `(ft ft Casing: Depth: From � to � ft. Diameter: in � Type: Galvanized Steel >� Weight: 'ckness: ,, � Q� Height above Ground: C� in Drive Shoe: �Yes No Any problems encountered while setting casing? Yes If "yes" give reason: Grout: Neat: SandlCement Annular Space Width Method of Grout: Pumped _ Materials Used: No Concrete GraveUCement inches Water in Annular Space Yes No Pressure Poured Depth to No. Bags Portland cement Weight of 1 Bag If mixture (sand, gravel, cuttings) — Ratio to ID plates: Yes _ No 4 x 4 slab _ Yes _ No Drilling Log Pounds Location Drawing F� From To Formation d �v �.� ��-� � ��l � N��l�� .� � . .�:_. ;., t � .M.-� _.> ; ,��,iu� �i� tt 1�'�'�' v�� r�� y �``���'� �l� � G�o� I hereby certify that the above information is conect and that this well was constructed in accordance with regulations set forth by the Person County Health Departmen Signature of Contractor ID# ��"_ � Date 3-C.� -Ui PCHD rev O1/16/02 ���.�� ��I�..��� �.: � � � �1�°1�� �aa�n3r-�aaaaa�na��.� ��a�.m���a WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map #: _�,� Pazcel # �/�� Township Applicant: Subdivision: Ty�e of Water Sunvlv: Requirements: Section• Lot• �%� �ndivrdual Communitp Public Site Approved by � 3-7-D a Grouting A roved b i_.� 7�� Well Log � ��a Well Ta.� 3 - ! 3 �c� ' Air Vent ✓ �'I 3'Oa r- Hose Bib 3'13-oa` Concrete Slab 3' � 3"°� Well Driller. Well Approved By: � 3 --13-0� Date• '�See Attached Site Sketch** Wells must be 10 feet from property lines. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from anp building founda.tion. Oti�er conditions: PCi-ID, rev. 09/07/01