A23 169Amount paid . ►b,i,00
Receipt .�� ` �OR6 i
. ' • c� �-a�.a .
Improvements Permit. (Established/Recorded Lot)
ImpFovements Permit (Unrecorded Lot)
Improvements Permit (Mobile Home Replace)
Improvements Permit (Addition)
�
O �-� x y � c3�
� . .. ,
Bacteria .
. Permit requested by:
owner/prospective own�
., a a_,.,.... iE 42 fl /1
�
W
U
�
a
W
¢
z
0
_ Chemical
_ . .� .,,, • g-1�_q`7
" Da �e
FOR SERViCFS ' `
, � ;� �- �
equested� �` � ��
, -.: . r w � ,l %_'L i` y fi .ty ;
. .. ..: . ... . � 'a .. . ...: ..,.. i .:: ) . ;...,.
.:::x..... . ..�, . !:' ..�
_ Reinspection of Existing System (Loan Closing)
RepaidReplace existing Septic System
Permit for New Well
_ Replace Existing Well
_ Petroleum I _ Pesticide I _. Lead
�ess�� �- R��� 7• Dimensions or Proposed Structure:
• ; � Width: a���o,: _3�.
/_ YL. . � _ n T.,..tl,. J' /�f .
[ome Phone #:��d )s`ty ^ � iys
�usiness Phone #: -
. Name and addre�s of_current ow
l ;ir;��; �. 5���
/ . l� • %3o x 77
['%Lfe/ SAriutiS. V�
�. Progerty Description: Lot size:
�. Tax Map#: �Z � �
Parcel#: � ��1
'I'ownship: c-N�.%,�-�g1Y<�+ -
�
Directions to property: State. Road #& Road
mes,�tc. �N /h�ie�`s /h// ��.• /;rs%�/r;ve.
i. � , !n . � - - - _. � _ �> _�a
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?
9. Water s pply type:
private fi' . public ❑ community ❑ spring ❑
Are any wells on adjoining property?Yes � No �.
If so, identify location: o� '' ; /v a�,�.
- � alo
1. ype of structure/facility: Proposed: DExisting: Q
Type of dwelling:
Hou$e: ❑ Mobile Home: C�Business: ❑
Type of business:
Number of Employees:
Number of bedrooms: �
Garbage Disposal? Yes ❑ No 0
� Basement? Yes ❑ No ✓�If so, # of basement fixtures:
6 Number of occupants or people to be served• 1 � �
CLEARLY STAKE ALL CORNERS OF THE PROPERTY AND THE CORNERS OF ALL
PROPOSED STRUCTURES.
I hereby make application to the Pers0I1 COunty Health Depat'tment for a site evaluation for the on-site
sewage disposal system for the above described property. I agree that the contents of this application are true
and represent the maximum facilities to be placed on the propercy. I understand if the site is altered or the
intended use changes, the permit shall become invalid. I understand that before an Improvements Permit can be
issued, I must present a survey plat of the property to the Health Dept. I understand that in the event I have not
delivered a survey plat of the property to the Health Dept. within 60 DAYS after the date of the evaluation of
the site by the Health Dept., this application shall become void and all fees paid forfeited.
- - „ Q � . ,
.
Owner or Authorize�► Agent
Permit Issued ❑ . Signature
Permit Denied ❑ '
Plat Observed ❑
� � Date
' , : FAcroRssTre Ev�unnox , .�� .r. . . : ;; ,> ;1,,xF±s t , ,: .. .... !+�4? . .. > <: ; +., .AR� 3 ... . . Ax&� a , . .
. .:3 .. : ,�. �...':
�....: ...<.. -:��.r .. , ...
'
l. SLOPE (%) S S S -� S
PS PS PS , ` . . PS
U U U U
Z. SOIL7FX?URE(12-36IN.) S S S ! ' �. S-
(SANDY, LOAMY. CLAYEY. NOTE 2:1 CLAI� PS PS � pS
U U U U
3. SOTL S7TtUCR1RE (12•i61N.) S _ S, , S • S
(QAYEY SOILS) PS PS PS PS
U • U •� U U ,
S S S S �
4. SOILDEP7'ti(IN.) PS PS PS PS , ,
p U U U
S. RESTRIGT►VEHORiZONS(1N.) S 5 S S
(IMPERVI011S STRATA, ROCK) PS PS PS ps
U U U U
6. S01I.DRAINAG&GROUNDWATER S S S S
(DCCERNAL k IN7ERNAL) PS PS PS PS
U U U U
7. SOII.PERMEABiLifY S S S S
(PERCOLAATION RATE� PS PS PS PS
U U U U
E. AVAILABLE SPACE S S S S.
PS PS PS PS
� U U U U
9. SL7ECLASSiFICATION(SEEBELOW)
SOIL SERfES
S•SUITADLE PS-PROVLSIONALLYSUiI'ABI,E U•UNSUITABLE
RECOMMENDATI ONSlCOMM ENTS :
SI'TE CLASSIFICATION DIAGRAM (Include: Soil areas, property lines, roads, streams, gullies, wet areas, �I1
areas, wells, �vater bodies, slope patterns� etC.� C:\Ah1IPRO�DOCSAPPSEC.S�iFINANCE.PC
,
�
�
�
�
�
W
U
�
a
�
PERSON COUNTY HEALTH DEPARTMENT
WELL AND SEWAGE SITE, LOCATION IlV�ROVEMENT PERNIIT
• g 1935.
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 # /�i 2� Parcel # /�o rJ
Zoning Township . ; q►� �.►-Y�
Owner/Contractor `��� e_ -C !� ect,� e S Date ��- 2 S� -9 7
Location/Address
SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area J 5- 07 A-C. Size of Tank I �stsn �a.Q
SFD �/ Mobile Home i/ Size of Pump Tank /v/,4
Business # of Bedrooms 1 Nitrification Line oZ �c�' k 3�(^, 3 LT �
Max Depth Trenches � 4 ''
Permits may be voided if site is altered or intended use changed.
Well and Septic Layout by �
Comments: � ,.9rna�a OQ .�i.v� _ ��
Date I(-I 7_ -�r y Installed by
t-��ol�el
ell Permit Paid Cl�' WELL SYSTEM SPECIFICATIONS
dividual ��_Semi-Public Required Slab l � /a.pj�? ~� �
�blic I�eplacement Air Vent l Q v
te Approved `� Required Well Log l�/:3�Y �
ell Head Approved �� � C� 7� Well Tag U-
-outing Approved //- ( -G/ "7 ��• ��.�
Comments:
Date / 1�c� 9� Installed by ��l _���'PProved bY.
This report is based in part on information provided the homeowner or his/6er
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 io the future or that the water supply will remain potable.
c:\amipro\permit.sam O1/95 rev.l.l
�
�
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Void sixty (60) months from date of issuance)
DATE: �'oZv� - 9 7 IMPROVEMENT PERMIT #: �j � Q1�}S
TAX MAP #: 2 PARCEL #: I(o �J
OWNER/OWNER'S REPRESENTATIVE: �SSe � , bZP��eS
LOCATION/ADDRESS:
Mc � l� e � 's /�1;1 I Rc� �� r- �- ��� � -e � n �( ; a I� ,►�
k P�; ,� �- o n r�,n�„ �,
SUBDIVISION NAME: LOT #:
SECTION ORBLOCK:
. AUTHO�TION FOR CONSTRUCTION ISSUED BY:
� AUTHORIZATION CONDITIONS
I. The Wastewater system construction and installation must meet all of the conditions of the
attached site plan and specifrcations as set forth in Improvements Pernut # 9 35 . The
constn.iction and installation must also meet alI applicable rules and laws.
2. No portion of the Wastewater system shall be covered or placed into use untii inspected and
approved by the Person County Health Department.
3. Any atterations in site or soil conditions (including structure locations) or modification in use,
design wastewater flow, or wastewater characteristics as specified in the associated improvement
permit and application, may void this authocization and associated permits.
4. Conditions:
� ������ �
Person Requesting:
i1r19/1997 10:50 80445d7843 BEN�ETT 4JELLDRILLIN6 PAGE �2
� i �pL J � r.+�,ap�'.'Y�i 3l 1 ►' . �uL
Tr� :�EP+� ;U ,,_ •�..•,
�.-�r-i4� ���� F�". PER�t� �f�" �
� � ,. lt�so� cour+sr r:iut�+�wNc�s�� �c���x
yeL�. �aa
'�at�: J " � ��' � $F[#
gw��r:� �� � .__
� .,r��,�nli'�ir�ctions: �� _� .r x �-r��,���� _ a�'g ,,��-�
-� � �Ci �...�..._ ...�..�..._
SUb�iv'ssian att�c: - . - �
t3riUi�g COntz,Gtor: ...r. , ..,..��.�.h� „-��,.t '� t .
Dist�ec from �ie��st Property �.ine �i�cst►cc irom Sa�rcc o�
Poliut+�� �
Towl Dap�t: �s�...,,,�,....... Ft. Xield: I'� '�3P:v� Sutic iN�t�r I.�vet„_,�..,�t-
1�t�ur8��ti��'Zoncs; t�p�h,,._.,....,_Ft.,�_.t,_,�,��,,,..�,....._��.�;._,..,.F�.
C�in : Ikpc1+: Fzot+n,., �.,...__ca ' �-- � t. %�tatt�cisc: � Inch��
T'Y'P�: S►tot� t�����ti�uS St�me�_ �--
Ii St�i. c�ot� avrm� �pgt�ove: Ycs,;,,r,�..��o,�.,..._,.,_
We�i�ht;,,_�',�,,..."�kne�s::�.H�i�t Above Gr�u�u!'..�a-� lnches
Dti+►e Shoe. Yes_„�,_,.�o�,..
Wess Psot�ls�n� �neo�n�erod in 5ea�n� �►a t�ain�� Y�s_ �-���
Il"y�s" �,,v+� r�on:,,,,.,,.�,._ • -.....—._...--...,
�sovt: 'lj�+�p�: �t�x,_,.. :.�...�. SutdlG�n�ert Caricr�.ta,�.r,._..._�.
Atu�ul�r Sp�cs Wid+�h_ — �-- — �---.Irraius
W�ter i� An�nul�r Spsce: Yes,,,,.__;,," Na,�, �,,,..,,
M�tl�ad: R�mp�d� Prss�urr��___,_ Qourcd�
�5�: �to�..,.,...,..�..,�..� ta �° Ft-
M�t�rix�s Used: Na. 8�� pan�� Cem�s,,.�„� weig�c oi 1 b��lx
�f' ��ctuta (��d► �rrre]; cuttin�s} . t���a:� to�....,,_
ID Platts: Yes� Na�„_
i H�R��Y CER"11PY 7HAT'�� A$�?Y� �I'��ORhI�►T�Q� I$ C:C7�REC� AItiU��
rt�iS w�LL w�+s CQNSTRU�`�D II�t �►CC�R�AIY��, W1T� R£�uLaT�oN� �
F4Rt� F!Y TH� FERS��t C0�'N''TY HEAL�`� �EP�RTM�N7'.
-.s�i - �Y�T"i � � .,.�� • �w+� �� '" �/ /
�i�nitv'C Of ���K:rac '""' .� ....._, f ,�,.
f �7'
��,�8 ,� � ,�;•� - --
� � 8 ' o s� � f�8�,�.�o"�
� � �• � -�� � /�p� c:__ 3i_3i _ •- g�,4-�y- ��.�'r�' 1
�j�� T,,�( � �9g,�z }�� \ ,,Q y —'_-_- n
�T ! � - ; . . . � � -s- S�L..,� . " � � 2�� �:� rj
* � � � � � z � 3 , �„ � -� •- t :
�! i r. \ � ?.�, �- - ?? � , `� 8-.�' .
� ; �:'1�) \ �v � r� � ��C" �c`�' "�
h� \ � i v � �
�' � � � � � 3 `I�
Q (� 'C� S� � c` ,. V�-�
� � � �� . 9, �.�n�
, i�l Z-q7
.� . 0 3,
�. `
� g � `� � 3� �
, � �� �y 3�� �
� c � � / EXHIBIT 2
ti�
. 8�•�� --� a�-q-�
I �� S / C�J�
w \a• �ts-� � ,
: �sr�'U,1 3 ' /1�� •�i (� � / �''�(3�') L{ Z, � Z �
� . �7t.c««� l.,.r frr.l-!//'J, _ •$,`� O—�� _— - .� �iL� � O�I�I`l� �
Mwr'�y ttrt cts�tM � !w � lr�t ��� ��,� ����' � l��,y¢��' ` ' � � � ( ✓ �""".' �
er..c� K �wie�Mlty LfrC tw .. � �i �•' �/ � . .. . .
K �w: .. �.,� i� �iy ss7= _ . � � `� 92� , , � 3 `� 9 �
.....,� �.�.c fa s.a.cs. l..i.s �.�es« K • '¢9' '�, /c�j- `D ` >� . . � : f
.,..� �. ,.,..,.�.�.. � � � .�.�. � . � � 2-�.� . � � : �s'• �,, � ' �`'�� ' � �, $� `y 3
-�: /1 _ (
w�..� �f aw «�.cf� �t K }Ks,t. d ��?qD` -� T - — 'l1
� �, �� S ' �
""" •r .`s'� '=�f. �.. w� ,^ ,� � J � • � �
�t �c+i� a.Rt-.cr.e.�/ ��� �,(/I�. � . �
eLw �! �t�lw; _\ ` �
•lla�L t� aL �„�..�� 1� rd► v.�t t r ' '�• !
t
.w i� a ,y�i . :.;� re+tws.�.t .ttstc� . � �; � � � ` � / "
� _.��� �.? � � . � � �
— 6 0 � \ ,
3. �8 � .
. �s �- ` � � �d �?9�, �^
% � � g .�
�t! � � � A �M
• � � `� -� Sq���
that I am(ve $re) the ovner(s) �
�.. . �'� �,�
� described hereon r�hich vas . . o `�•
deed recorded in the person � �8 �` �7 `•.� S
is Off�ce in Boak �, .t u� 2, o� �.
adopt this plsn o�' aubdiviaion � � �� ��_�
� �,�
�nt, astablish the ieiniaca� bu�Id- " UV
� aII elieys, yBI�� easements, , � � �
�.
paces to pub3ic or privat� use �-
� �rzby certify that the lar� �'j'��� ��tr �
�011ttlte �bdfvision�'iegulatian �. 1•c,� . ' P� �p w� tt2cr�s P►�c� Wtst-�-� �-Q►N� �crG--�. ��S ��. �' s
7� North Carol�na, Q�-o-rAG-- A2�A �. os,�
` �, I9 _� - � �-� �--`�-�� �' m/�
r�v�o . — . _
� g-zr-9�
5'9�✓ i � ,qc-A w� ✓JlR.
� �r ���o f� i�s ,f�
�iv� f%�mr�-,ery a�r r�'F .�..�.
4JE" f/�� f7r�i✓r SHosJ �f-�c Trt'�-
J�iC �/��7f' L /�/�l /l�Ys� ��'.2HC:CS' oF
�/f � mT � f,� �f Go�.✓6- %.�1.lt�;'
vTf /' �/Ew ��'� f'o.e ifis
.�oBi�E h'o.�E- � .�roiv� Purr�f'-
�o�net,
�-�' � f J}�ll �JosS,'61e
Gc�h / � ,
� o ui.v ✓, t--� � �'J� rn� �;
,
�-r �'l,; - ,
s b� 1��. ? ��.2
Uw n e� ,1/e ec%s -{�„ s,° ��. �
f� /l� ,
%J.r ��r �L r n �v/lr.�
G 7'\2 �Cl q �d OT � �
r
1 �
�%'1, 5 /1'1 c. � l-1� f�Jo ��c � ��
Csa s�
�/iJ�TN �l I f. � OIn F5�
!
d�ni L