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A40 379r"�b-13-02 i���r15p P.02 v�� � . � . pWGI�t Dats' -��� 3 , � � . .. . . . ia�'�fli�a �k _ /� "` � V F`c_�� � . � 4� 7 ,...,,�� �' ' ~ ' '. . 'p�a1:� :- � I ,� � v'� ¢ �� j( �� ,� �;i_� -� � --- � I� '��` i.� � � '''}�� `/ � .��6�'CZ'l. +.--t"'�- �` � ����_,���1' ��!��� ��T � � � . . �S�Y. �m���ArJ9 .t�.36`�K'4Apy � .. _ fi `����i� ��.' ��i _''aa: .3`ibi�.��. � Nr�L�� . � . J • �• � (�',/rl' %�7'�t �((G�1 iI'Y�� 7� ��� ����7• � l�ri1� Phwi�: �.3 4��J�— AddeqsaC 4'S �< <t'�,� � �/.<' ' •�6 �+�in�sa Phon� � � ? � , �, ::; kiau� and aRid�s oE a� oea�r: �<.� ;�.-c' � � J ^.., J • • �� ►� �ro�� Qi�ton: �.ot s� _ �� Ta�d� �� : a E� ���� �._Y ��; %� � l �.:Z Dit� lo th6 .....—. �Y (� . �rr� �t�d nurr�s�:._,,.,,��'� �,C„_,�� ., /�.� ,_..,. _, �_... . , ,�,� �} �d iJs� and � O�on an�wer � o1'the �Q �bn� a� �+'�p�sd ,.. � F�deling � 7ype c�i S�urat � 1�Ad�.� pq� � b) �lurt�ber ol` Bedrocm� Numbae nf pccvp� ar psople �Cf Oe �ave� � c) ' 8we�t�enk Yaro ;, Nn _, lA�t ttwsre ba paa�ng tn itsm I�err�eitC? • .. c�) C�oC�ps Dhp�t Yes �,, Al�p _ • . �� 1il/�t' �y TjIP� Arht+�be ���t�► r.... �r eod�(t1'$ .� j. Rt�hib� C�r�t� ..,... �pr� _ . An�-aty � cn � pt�iy� Yoe _ No _.,. I! Y� Pk� ��p+�t�e {o�n an tt�► a�a �c. �� �s tl» peoprl,� t�os�h p�y I�i�d 1��� �? Yes _ No � � . � �► pur o�-n� �rr�r � � � �r ae � wnH �s ��ca� � . � �nr� �� � �euareE c�ra.�r�. �� er�oPo� �or.r►n� o� n�.�.., sr��� ��� a�t �.a►�, � � '� � �rre� �o�,�r,��,��►r� �vv�u.uw-raoN �nr�e �n� u�+r��°r s7�. �- ���or� �c me P�on Ca��r � pe� t� a s� � t6� 1ft� o�-ai�e q�� d�► sys�om � th a�v�.d�ec,r(b�d ��Y• ��Q that it� � a� tfti� � are ttus a�ud r�reee�c�t 1he ma�tm �me lnua�d. �� on th� p . I u�ers�d ii the � ia a� a= iitte �tended u�e ��yea, tha p;sct� si�fl , � �� e � , / L� �,�<-�-- v3'��Y►`��i� : •� --,iG ..�� , i O�Rtet ot L�1 Re�,�� - � �. ,� �arr7� _��J�� ������ �.� "— � � ���� I��������.,,-�, ��.�.�.11 �3LL��.Il¢Ila. Applicant: Location: Permit Valid for ✓ive Years Type of Facility: f # of Occupants z$' # of Be� Proposed Wastewater System: � Proposed Repair: [��,,� v�1v ,' Permit Conditions: �x M�p �i' P�;rce�l # / S�u�bdiivi�s�ion /►� � � Pha:s•e Secrion.Lot # , I � Improve�ent Peranit No Ezpiration Owner or Legal Representative Signature: Authorized State Agent: /; New �Addition Projected Daiiy Flow �-� ♦ J4 I���,�e Watea� Supply wei/ Type: �"� Type: -�� Date: Date: >�- 5-23 The issuance of this permit by the Health Deparhnent in does not guarantee the :issuance of other permits. It is the responsibiliry of the applicant/property owner to in sure that all Person County Plauning and Zoning and Building Inspections requirements aze me� This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit 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 and Rules jor Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). 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 wili remain potable. Authorization to Cons�uct Wastewater S�stem �Required for Building Permit) * See site plan and additional attachments (�. Proposed Wastewater 5ystem: ��ri.+��'3Sr'dnc�� Type 7�� Wastewater Flow k-�r� g.p.d. New � Repair Expansion Soil LTAR: � 3 g.p.d./ ft 2 Type of Facility: �k' ,S',;,,s/e �rk�.'� /�_.s'i'ol�.,,��. Basement Yes �No Wastewater System Requirements Tank Size: Septic Tank: i Bdd gal Pump Tank: -- gal Grease Trap: �— ga1 Drainfield: Tota1 Area: / t�� .sq ft Total Length �3_� ft Maxinnum Trench Depth �' in Trench Width �_ ft Minimum Soil Cover: 6 in Distribution: Distn�bution Box ✓ Serial Distribution pecifications: S Mini.mum Trench Separation: 9 ft Pressure Manifold Authorized State Agent: �"�� ,�. Date: /a - S-�3 � Permit Expiration Date: �,� _ S� o S� The type of system peYmitted is � Conventional the permit. d�wner/I�egal Represent�tive: Innovative Alternarive. I accept the specifications of Date: P�HD 1/17/2�03 ���.�� I�I��.�S��T �-- �_ {c � �T�T'��Y ]C�� s �,.,. ,.,.,. .a�.�.ffi.11 IE��.�.�.Il�7�. srrE Pi.�v 6 Name .sA�� /� Tax Viap # � " Parcel # 3 � Subdivision r�' t Secrion/Lot# �9 /a2� S- a.o�__ tluthorized State Agent Date Sysrem campoaents represeat approxrmate coatours on/y. 77re coarractor musrtl�g t6e system pdor to be�D the iasta/l�rion to iasure that pmperg�ade is maintaiaed H�N�L�Y ,�VENU� ��f � �YY �i N�� ; ,�o �� a�tn4o� ____ � �v15'fn �/ ��S�NI Gt � % W� � C�n c; ��ns � ��..�,.__ — Z��.16- 5��: / `=so ' PCfID, rev. 09/12/Ol � ��;�.�� �'��..��� `_... = �-�- � � �CT��IC� I��.�a-�mm � ���.IL IE�L�.�.Il-�1h� WEY�L PE�tN�'I' I'3.E1�SE SEE A'�'"g'AC�iEI) I'LElN FOIt WELL SI'�'E �Y�U'i' Tax Map #: ��b Parcel # 3� Township ��a� �'r.`er Applicant .��t �r nz y E/u�.✓�.% Subdivision: /�+ fz i^ �'��s e h�l_'�'P� Section: � I.o� � I.ocation: . f s � _ .� _ i . / e /�1 % � / � ✓7 / /✓ll t � r, / _ 'I'vioe of Water Sut��lv: �Indiv�idual Rec�uireffients• Site Approved bp Grouting Appzoved bp Well Log Well Ta;�; Air Vent Hose Bib Concrete Slab Well Driller. Communitp Public Well Approved �y: Y)ate• '�'See Attached Site Sketch� Wells must be 10 feet from propert.y lines. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any building founda�ion. Other conditi � / ��.�D�� PC�ID, sev. 09/07/01