The URL can be used to link to this page

A23 96� U � a Improvements Permit (Established/Recorded Lot) �_ Reinspection of Existing System (Loan Closing) Improvements Permit (Unrecorded Lot) Improvements Permit (Mobile Home Replace) Improvements Permit (Addition) _ Bacteria 1. Permit requested by: owner/nrosnective own� _ Chemical :ome Phone #:�I �-�� % 4 q � 6 usiness Phone #: � Na e and addre s _ 6 vm e,.n a , � . Property Descripti Tax Map#: �� Parcel#: ` Townshin: �c�nt Repair/Replace existing Septic System Permit for New Well _ Replace Existing Well _ Petroleum � _ Pesticide � _ Lead 7. Dimensions or Proposed Structure: �H ��`' �� `'� Ff l Width: fZ� G;zr s`,`� �'r"�i `� o�� Depth. S� � �s- 8. What type (if any, additions, expansions, or i replacement is anticipated to the structure or facility that this sewage disposal system is intended to serve? owner: 9. Water supply type: private C�public ❑ community ❑ spring ❑ '. � i�� Are any wells on adjoining property?Yes Cl�No ❑ � If so, identify location: . Lot size: l ► �{)�_ 23 Directions to property: State Road #& Road dames, etc. � I�aa �r- Number of occupants or people to be served: 10. Type of structure/facility: Proposed: �Existing: ❑ Type of dwelling: House: ❑ Mobile Home: � Business: ❑ Type of business: Number of Employees: Number of bedrooms: .3 Garbage Disposal? Yes ❑ No Lr Basement? Yes ❑ No C� If so, # of basement fixtures: CLEARLY STAKE ALL CORNERS OF THE PROPERTY AND THE CORNERS OF ALL PROPOSED STRUCTURES. I hereby make application to the PersOn 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 property. 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. z Signed Owner or Authorized Agent Permit Issued ❑ Permit Denied ❑ Plat Observed 0 Signature Date �AC7'ORS-SITEEYAL[JA770N AREA1 AREA2 ::: AREA3 AREA�:;;; : __ _ __.. I. SLOPE (%) S S S S PS PS PS PS U U U U 2. SOII. TEXNRE (12-36IN.) S S S S (SAA'DY, LOAMY, CLAYEY, NOTE 2:1 CLAY) PS PS PS PS U U U U 3. SOIL S7RUCi'URE (12-36 W.) 5 S S S (CLAI'EY SOII.S) PS PS PS PS U U U U 1. SOIL DEPi'H (IN.) S S S S PS PS PS PS U U U U 5. RESTRIC7TVE HORIZONS (IN.) S S S 5 (IMPERVIOUS STRATA, ROCK) PS PS PS PS U U U U 6. SOII. DRAINAGFIGROUNDWA'fER S S S S (EX7ERNAL R INTERNAL) PS PS PS PS U U U U 7. SOQ. PERMEABILTIY S S S S (PERCOLOATION RA7E) PS PS PS PS U U U U 8. AVAILABLE SPACE S S S S PS PS PS PS U U U U 9. SiTECLASSiFICATION(SEEBELOW) SOIL SERIES S-SUITABLE PS-PROVISIONALLY SUITAIILE U-UNSUITABLE RECOMMENDATIONS/COMMENTS: STTE CLASSIFICATION DIAGRAM (Include: Soil areas, property lines, roads, streams, gullies, wet areas, fill areas, wells, water bodies, slope patterns, etc.) C:WNIPRO�DOCSIAPPSEC.SM F[NANCE.PC � _ ��.�, : �wo x ferm�rlr Confrol RUOY M. CARTER corn�r z � N-03-46-44-W p 16.49' �, O u 0 � �� _ i . _ `". � CENTEit LINE OF OLO ROAD IS PROPERTY LINE � � NAltTSEIL TURNER D�. T3. �. SOI • ' ' 1 O CHARLES J. POINTER ' � ` 8 WILHELMENIA W. POINTER � ` � Z 1 � y . 11 ca Riw : ' 2 n � � a 2 O � � S :� �: ;y'. 1� . /:`; ; �; i: ; 5. �• i :� ,.r, , _ I (1h) ys�r otrtif�. ,`.: of tit l�M�rtf �MM; ;, coswrt 'c� r (�) k` Car.c7 Ihyiscar �t a�.' �.. _�,.._. . tye . aa� eltt I;: •;,�. ad �i►lai� vitl �; �;� t�e �dal�a l�til�l� i, ;.', valks. �oO�ats � �d ; �;'.. or �riwte a� �a �ott:; '� Wt tlse 1M/ �s �AoM;;,`'� . wMi�isioa re�rLtidr`:'' Msrt� Caroli�. . �, � •. � � � a W U � a � � � �� B0163 PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IMPROVEMENT 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 #_�� Parcel # Zonin� _ , Township Owner/Contractor Location/Address sion Name � (1f�-ti,��lGi �1m Date � - � � i��sf Du./{ Po:n{� � S.R.#�,� Lot# Permits may be voided if site is altered or ' en d, se c nged. Well and Septic Layout by Comments: __ Date � R- �� Installed by ' " Approved by Well Permit Paid ❑ WELL SYSTEM SPECIFICATIONS 3ividual Semi-Public �blic Replacement te Approved ell Head A " g Approved Comments: Date Installed by 1�"ir Vent _ Required W Well�� 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 O1/95 rev.l.l AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION � (Void sixty (60) months from date of issuance) DATE: —- IlVIPROVEMENT PERNIIT #: U d��o� `� TAX MAP #: PARCEL #: ��_ � /� OWNER/OWNER'S REPRESENTATIVE: � � �o �( LOCATION/ADDRESS: �12� /333 5��vfs�:� SUBDIVISION NAME: SECTION OR BLOCK: AUTHORIZATION FOR CTION ISSUED BY: AUTHORIZATION CONDITIONS LOT #: 1. The Wastewater system construction and installation must meet all of the conditions of the attached site plan and specifications as set forth in Improvements Permit # . The construction and installation must also meet all applicable rules and laws. 2. No portion of the Wastewater system shall be covered or placed into use until inspected and approved by the Person County Health Department. 3. Any alterations 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 authorization and associated permits. 4. Conditions: �-L� i� n'1 �� I n1 v i,Y F�t-� �� uJ �t—"" }� � 1.�� GP w� e� . � � �R ' t,�� I�.� w-� �„� (\ S G� � Y� �' i NPX-P W� J� W�-�7• � Person Requesting: r� �►aol(catton Dabe: �i � 2�-DCi Amcsunt Paid• Recei #: Person Countv Health Department Environmental Health Seation APPLICATfON FOR SERVICES Tax Mao #• • Parcei #: IF TNE INFORMATION IN THE APPUCATION FOR AN IMPROVEME�IT PERMIT 13 FALSIFlED. CNANGED OR THE SITE IS ALTERED. THEN THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INYALlD 1) Permit requeated b• Ownedagerrtlprospec8ve ownerj: � C�- Home Phone: Address: � . . Husiness Phone: '� � � 2) Name and address of cartent owner. ��d� . acYeS �� V �'� 3) Property Deacrlption: I.ot size: (.� Tovmshtp: Dtrec�ions to the property (induding road names and numbers : 4) Proposed Use and Structure Descriptlon: answer each of the following questions: a) Proposed �. Existing 19� b} Stldc Built a, Modular fl, Single wde l�; boubie wde ❑ .� c) Number of Bedrooms•� - d) Number of occupants or people to be served: S e) Basement Yes 0, No m,lf yes, # o asement fixtures: � Garbage Disposal: Yes 0, No � 1�� , g) Dimensions of Proposed Strudure: IMdth: � Depth: � � Water Supply Type: Private �ew 0 or exis�ng , Public ❑, Community �, Spring ❑ � Are any wells on adjoining property? Yes � o � if yes, loca�on 6) Piease Indicate Desired System Type: (systems can be ranlced in order af your preference) � Comrer�ttoaai �,Modified Conventional ^ Altemative _Innovative Other (sPeciiY). CLEARLY STAKE ALL CORNERS AND UNES OF THE PROPERTY. STAKE THE CORNERS OF ALL PROPOSED STRUCTURES. PLEASE ATTACH SURVEY P�AT OR SITE PLAN TO THIS APPUCATION I hereby make appiic�tion to the Person County Heaith Department for a site evalua�on for the on-site sewage d(sposal system for the above-described property. I agree that the cotrtents of this appiication are true and represent the maximum faali�es to be placed on the property. I understand if the site is attered or the intended use changes. the permit shall become irnalid. I understand that as appUcant, I am responsible for identifjring and ma�iting property lines, comers and making the site accessible for the personnei of the Person Courriy Health Department to co�dud their evaluations. i understand that I am responsible for nofiiying tha Health Depar�mern if my property contains any wetiands as designated by the Army Corps of Engineers. 7�" /3 �=�5 =�� Owner or Legai Representative . Date PCHD. rev.10l12J99 � � a � �1� A � 727 PERSON COUN Y HEAL'TH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IMP$,OVEMENT PERMIT Tax Map # �' � Parcel # y�v Zoning Township t Owner/Contractor G G(. Date �Z � Location/Address �j � I � [Vl � � ' S.R.# Subdivision Name Lot# /U � I.syout — � � %�] � ��-� �X15� t� 1'VtiVll eY�� D �� !�� I� �c 1 �� f Ul� � �� U� � ZEO � � i y� i 1'G' _ 0 Y �� ., �•'�°�3 � �" � � a c c � u� �u� , � ' ex�5 � � . � 3, � vC. 4�� , 0 lu � la" 5' �� lo ��v ��i' (��i'J''aJ, r�, � < �,� �� , ,� , 3 ��2/� 5 � �" 5�� , 373' +otce.� 2q2' � v�s�al l� SEWAGE SYSTEM SPECIFICATIONS �� Lot Area �, �'/� aL�S Size of Tank {�, � ✓ Mobile Home_�_ Size of Pump Tank � # of Bedrooms_�% Nitrification Line G��d�Q. Max Depth Trenches �� Permit Void after 60 months. Permits may be voided if site Well and Septic Layout b� Comments: 11/�Q,t�ii I �a. Date — Installed Site ppro Wel Head Gr uting � Comments: Date Permit Void if not in compliance with zoning regulations. � �,1teFed or intended use changed. Approved by WELL SYSTEM SPECIFICATIONS Installed by IRequired Slab ell Approved by. This report is based in pazt on infortnation provided the homeowner or his/her representative in the application submitted for this pertnit 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 conceated conditions on the property or for statements in tlus report that may have resulted from false a misleading statements provided to him in the application Neither Person County nor the environmental health specialist wacrants that the septic tank system will continue to function satisfadorily in the future or that the water supply will remain potable. c:�amipro�pennitsam Ol/95 rev.1.0 ORIGINAL �-��fF�� 1a2�►' ( c�CG�-I c�'15 � � � a PERSON CO�UN'rY HEAL'TH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IlVIPRQ� MENT PERMIT Tax Map # /q' Z3 Parcel # ``l� Zoning Township i��vYw>� Owner/Contractor 1 C� a OC Date o7—/C�—O( Location/Address � S.R.# Subdivision Name SFD Iayout �P Lot# � �nea r q 1785 '-' PU � � �D� ��r O M �C,X i�i n� W c I( o �l n��.bo� � �� o�c. - Di� -1,1lP �Scp-t�c I � hc, --c�.t Pc�►ye�Y�Ln�P�P� P/� _ p; ��,� �- rc rn a �c, at ( ��avc ( From P/L 7° Tt,c (oS' /�'larK� - f�.c�c r� � I wl Roc�l- cl� 33c� 5'q�-17�0 - Ca1� PcFf,O Far �n �c�'an SEWAGE SYSTEM SPECIFICATIONS P�,` or c. <<<<�,�. Lot Area Cize of Tank U Mobile Home Size of Pump Tank �a 113(.J �c AC�( P�rrnl� # of Bedrooms Nitrification Line f� l7a 7�SS cd a� Max Depth Trenches q—a !- D O Fo I' 1 i n c Void if not i compliance with zoning regulations. G� c�d r� E i or1 � � ..r. . ' Permit Void after 60 months. Permits may be voided if sit is Well and Septic Layout by Comments: l0— Oi Installed � ,-.•, � � ► , / I" � � i � "� _ � i ��. ' � I � ,�� ' � � • � � • • � � �i I I ..'I �� i}L�]i _..� � �� WELL SYSTEM SPECIFICATIONS idividual Semi-Public_ ublic Replacement. ite Approved Jell Head Approve�� routing Approved Comments: Date Installed by Required Slab _ Air Vent Required Well Lo� Well Tag 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 infocmation contained in the application. The environmental health specialist is also not responsible for concealed conditions on the property or for statements in Uus repoR that may have resulted from false or misleading statements provided to him in the application. Neither Person County nor the endvonmental health specialist wazrants that the septic tank systetn will continue to function satisfactorily in the future or that the water supply will remain potable. c�amipro\permitsam Ol/95 rev.1.0 ORIGINAL ��.s� ��.�� 1 � � �� aa�aa-o�n,.-,.-,+ ��n��.�. ��.Il.�Il.a Applicant: �� Location: S� h �,�P�-�� . � , • , Ta�x M�� F�rcel # � S�uhciivi.s�ian _ - �Frl,��a�s:ecSect�ioiaiLolt # Improvement Permit Permit Valid for Five Years No Ezpiration Type of Facility: � i5 �I � New _ Addition _ Water Supply ,-��{z wuI # of Occupants max� # o edrooms 3 Projected Daily Flow �D g.p.d. Proposed Wastewater System: �; n Co c%� a�-� . Type: Proposed Repair: .�_i � d- =n,spcct T n K Du-�Ic-E Type: Pennit Conditions: Owner or Legal Represe Authorized State Agent: Date: Date: 9 —3�a The issuance of this permit by the �ealth Deparkment in does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to in sure 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 o`r 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 for Sewage Treatment and Disposal SYstems' (15e�t 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 will remain potable. � �, Authorization to Construct Wastewater. System �Required for Building Permit) * See site plan and additional attachments (_�. Proposed Wastewater Sys� m: �X � 5��'17- Type �- Wastewater Flow �� g.p.d. New Repair �/ Expansion _ Soil LTAR: N�Pr .p.d./ ft 2 Type of Facility: (Y1Obi Ic. �-{� n,.� Basement _ Yes _ No Wastewater System Requirements Tank Size: 5eptic Tank: gal Pump Tank: gal Grease Trap: gal Drainfield: Total Area: sq ft Total Length ft. Mazimum Trench Depth in Trench Width ft Minimum Soil Cover: in Minimum Trench Separation: ft Distribution: Distribution Box Serial Distribution Pressure Manifold Specifications: fq (,� °I' Z/15Pcc,-E �,-�(t� t` F n�-cx.s S� � 3` S'�cli 4O PVG ' r � Authorized State Agent: Permit Expir 'on Date: 3' i The type of system pernutted is Conventional the permit. Owner/Legal Representative: F � Fi� nc � Date: 9�3 �a Innovative Alternative. I accept the specifications of Date: PCHD7/30/2002 �"��; ; , S� �� .� V �' �� n.�n��ang�n��n.�.tn.� �'��.Il.��ia. Applicant: Location: T��x M�C� P�rc�el � St��hc1'ivi�s�ion Fh��•s�e Section Lot � Improvement Permit Permit Valid for _ Five Years _ No Ezpiration Type of Facility: New Addition Water �upply # of Occupants # of Bedrooms � Projected Daily Flow g.p.d. Proposed Wastewater System: Type: Proposed Repair: Type: Permit Conditions: Owner or Legal Representative Signature: Authorized State Agent: 'The issuance of this permit by the Health Department in does not � applicandproperty owner to in sure that all Person County Plannin Improvement Permit is subject to revocation tf the site plan, plat o� by a change in ownership of the property. This permit was issued Rules fbrSewage Treatment and DisposalSvstems' (15A NCAC 18A Authorization to Construct * See site plan and additional attachments (_). Proposed Wastewater System: New Repair Expansion Type of Facility: _ Tank Size: Septic Tank: gal Date: Date: ssuance of other permits. It is the responsibility of the and Building Inspections requirements are met. ThIs use changes. The Improvement Permlt is not affected � with the provlsions of the North Carolina `Laws and Sy3te�I �Required for Building Permit) Type Wastewater Flow _g.p.d. Soil LTAR: g.p.d./ ft 2 Basement Yes No Wastewater Sy�in Requirements �'ump Tank• gal t Drainfield: Total Area: sq ft Toti�l Length ft Trench Width ft Minimum Soil i�over: in Distribution: Distribution Box ' Serial Distribution Specifications: Authorized State Agent: Permit Expiration Date: The type of system pertnitted is the permit. Owner/Legal Representative: Conventional Innovative Grease Trap: gal Maximum Trench Depth . in Minimum Trench Separation: $ Pressure Manifold Date: Alternative. I accept the specifications of Date: '�� , �� ' � � �L.J� 1V� �� 1E.aav�.a-o� �**� eaa�.11 IE7T�a.Il�l� ► , ►.. - + � ► . ,..i�.. .'•.. � � � r••■ -• �r ' ��w� SI'I'E. S��ETCI� Taa Ma.p # r7 a3 Parcel #� �O � � Secti.on/Lot#� � `� 3-�a - Date � sy�t�m cvmpon�n� r�p��t �r,pro��o�rs onty. Th� conrra�or m�s,�g ��-�. beginning the rnstall�son to insure that�bropergrade is maintarssed Scale: � � � E / � ��.m� T�� , .�Q�j ��- C,�ncou�� F�rst lo -1 S aF � . N_ L i r`C., Z ns P�-�-� Far �rc,c.. �5 �F Ne..c.c.55� rY RtP lc�.c..c t�� 3"v`c.� 4Z� ` -�- �C-rr�'�-� P�G TO Prcv'Ll�t ��t ��` � n . W I� �FFluc�t F�v►J F� c / r' T a n K 0 I'C��D, nw. 09/12/01