A24 117is qr
;�$ �<, �i � .
���,� •. � l`` �
�.....,..- . '' a � �� " � .r�
� � � ����
���n�^�n�n�n�n���.� �c��.�.��n.
;Ianuary 4, 2009
Janie Clayton
424 Roy Carver Rd.
Semora, NC 27343
RE: Site Evaluation Application Dated 3/30/2007
Tax Map: A24 Parcel# 30 & 117
Dear Mrs. Clayton:
nsuring a healthy environment
The Person County Environmental Health Department has a policy that states any
application, which has not been acted upon for 3 months becomes void, and aaly fees paid
are then forfeited. Our records indicate that an application was filed on 3/30/2007 for an
onsite wastewater (septic) permit. Our Department conducted a site evaluation on
4/16/2007 and with Kevin Neal(Regional LSS) on 6/6/2007. We have not yct received a
surveyed plat showing the off site/supply lirte easement areus connecting the building
lots. No other communication has been received from you concerning this property. If
action is not talcen by 4/4/2009, the application will become void and all fees forfeited.
If you have any questions concerning your applications, please contact Adam Sarver of
tlie Person Coi.inty Environmental Health Departmeiit at 336-597-1790.
Sincerely,
� ��
Adam Sarver, REHS
Environmental Health Program Specialist
Person County Health Department
phone 336.597.1790
fax 336.597.7808
325 South Morgan Street, Suite C, Roxboro, NC 275�3
, Rebecca l. Hester,
� R.N.. M.P ti. -
� ttEAl7H OIRECTOR
�
'I
�Ez�orz �o�crzicJ �Ea�tii 1�Ffi.a�tmErLE
� z � �outf o1 ioi9nn �'tt�Et
c�� ,c�•u.o, c�o:1�i eaioCina 2 �57 �
`�cl�/�f��,:E %9'9I 597-2zoq
1r �� !�
TO WHOM IT MAY CONCERN : 1 �il.IQ'YZd ��` �'YyeY
.� Q• tract of land, tax map /���' /� /
. The � o� � S C�Yrer s��
was found to be unsuitable for a ground absorption sewage disposal
systen that can be approved by the local health department.
�
0
P�rs��; �v�� f�e�(fti D��f
V !
�
c
0
Site Evaluation Application
Fee Collected YES " NO
�d'"-QO
� - APPLICATION FOR
�—a4-93
��
1. Permit requested by:
Address: V
Home±� Phone �� :
�
Date: z�/ ��
RHIT � /%�
� i�OS
�� �
n-, �, ��, , ,,
� V�S��
owner/prospective owner:
agent : T n� �, �. /,1 � �
2. Name and address of current owner:
Business Phone ��:
3. Property Descr-iption: Lot size: •���c ,
;�
��
0
4. Tax map �i�: Township: �11n�, �'`
Subdivision Name: o�-.� ��itr uF,i- � jJ Lot ��:
S. Dire/Ctions to property.�L: State Road �� /& Road Namejs, tc.
�/� n,r c I 1 r - /- v t' lJ d� 'l t1- �l l�%i 1/ (�%(Ili/� S
6. Permit requested for: New Installation: �epair:
Additional Renovation re-using present system:
7. Number of occupants or people to be served: �
8. Dimensions of Proposed Structure: Width: Depth:
�
�
�
e�
9. What type (if any) additions, expansions, or replacement is anticipated to the struc-
ture or facility that this � a,g�disposal system is intended to serve?
,
10. Water supply private? � public? community? spring?
Other source? (Specify):
Are there any wells on adj-/oining property? �� 5 If so, identify location:
.�. � n Ir--- ,.',� � c� .. n �.!� T� r< _
11,
Type of structure or facility: Pr�pased: �- Existing:
Type of dwelling: House: "� Mobile Home: Business:
Type of business: Number of Employeesi
Number of bedrooms:� Garbage Disposal? Yes No
Basement? Yes No If so, number of basement fixtures:
12. Clearly stake all corners of the property and the corners of all proposed structures.
I hereby make application to the Person County Health Department for a site
evaluation or existing system 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.
Permits are valid for 60 months from date of issue. Permission is hereby granted to
enter the property for the evaluation. G.S. 1� A-335(F) _
/ �
'gned Owner r Authorizeci Qgent
�
�
m
H
w
�
3
w
r
0
rt
m
ro
�
H
�
�•
rt
�
(P�"� n�°�' 'nr � � � �
� � �� v ( v
Permit Issued ��� /.�'3
Permit Denied � � � V � / v �'«�'"'L <�� �
__ . ..
Plat Observed � ' ��'
^ � /� � �
� � � � s
�t1`� � S� �/ '
�� � ( S ` � �.✓�` `� ° �
�, � c� �
� `� � �'���
,
��� S ��° `� ,I.,,, � �
Y �l �1y'`'� � ��� ' ' �1� �
� � lM 5 1 �� � _ �� ���, �
�c ✓ v��� � � , o {� y �it � . 4 �
�"`'' V . ;
� �X � 5 � ( �� � i
` S �
C' � �� �� �t� � � f �
� �' �, � �f � � [� ' � / �
,/'" k .-l-o G6'' �� S �
�o �� s � � �
� �
�
� ,�,�� W � �
�°'` �ri' �--� �f- ��� .-�- --r
,�
131 � S � y�°
i?ACTORS - SITE EVALUATION AREA 1 AREA 2 ARF.A 3 AREA 4
S S S
1. SLOPE (X) P , p �
U (� 7�
2. SOZL TEXTURE (i2-36 i.n. ) S „n S S S
(Sandy, loamy, clayey, S ��� „� pS `�p��t� � pS � C �y,!�
No te 2:1 clay) U U 5�.�,Q ( c,i� � U w< <�� S S U G�% /
3. SOIL STRUCTLTRE (12-36 i.n. ) �� S '_-Q,, S
(Clayey soils) PS �,�a.M P� PS �j e j� S�"`�'`� -J P
� � � U U U
4• SOIL DEPTH (in.)
5. RESTRICTIVE HORIZONS (in.
(Iaq�ervious Strata, rock)
6. SOIL DRAIIQAGE/GROUNDWATER
(bcternal & Internal)
7. SOIL PERMEABILITY
(Percolation Rate)
P
U
S
�
S--
PS
iL
�
PS
iT—
,�—
PS
U-'
s
PS
PS
�
S
—�
��
U
�
u
s
U
s
$. OTHER (specify) PS PS PS PS �
U U U U
9. SITE CLASSIFICATION �
(See below) � �
SOIL SERIES
S- Suitable PS - Provisionally Suitable U- Unsuitable
R�COt�SEIdDATIONS / CO24 fEriTS :
S�TE CLASSIFICATION DIAGRAM (Includes Soil areas, property lines. roads, streams, gulZies,
aet areas, fill areas, Wells, water bodies, sZope patterns, etc.)