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A24 1380 r d� �-10� �s I�Y�� oh �� 1 na� no�'c�� Z �r�cc � . . . ad7en $. _ Zg-p? /�(- w� � � � ! �r�ed �t�n� �unnt� lrr�q �r � �,v�ier'Q /a,►�Sea f�r5 jlad �'l�� J r, pes 8''2g'°? 5�,�' f� �3-.L - �S . -�— ' o -�,-aG�-�v,rs .� cs D� G{ �� I`�'i q�1 n C �t .. � �j j,�,e, � i 5 t-�' �' P c�\ , �� t Jc� ✓1 r �, ,�- 2 3 1 5�e W1 � C� J4�.�._-tJ , h A� z�re,�c�e� ��ou �, s y �`� d �v ,� `Sa.b,o� � �' A�oftation Oatg:��5-�y. nt !d: p"l�b �, o iy R_ecPiot �• G�l� ��. ��" a �- � � c o� ��-� •o � - � ��- �3� � �. 3 � ��\�� -o�� Improve+na� Petm3 (F%caded tot) �maro�e�r� �,rc-a,so.00 (Mobite Hame Replecenw�t/Addition) a�pucanoN Fo� s�v�ces ►il-'�� w��coan nuv�ortatlon for ;15�.OtYS200.00 Pemtit Revision Fae - S75.a0 Tau Man #: �' ? 7 � �� : � 3� IF TH INFORMATI N INTHE P A�iON FaR AN IMPROVEMENT PERMIT IS lNCORRECT FALS1FiED CHANGED OR THE $IT'E IS A�RED THEN THE 1MpROVEMEN7 PERMIT qNp�AU�#�IpRIZA'�{pp �p CONSTRUCT 3HALL BE�OME INVALID � �� pa� 1) Pemtit requested by: jOwner/agertttp�ospec8ve owner): �Q�`o5 2,Cfi� �, o wna-(' C's�- �'�� Home Phone: 334 - 3�-a- n 3(�� Addr�ss: 2 S ' 3�_c�c.� 35�`.y 8 u s l n e s s P h o n e: 33 G 5 n� t 3� ��,r ra, N L zZ y 3 � 1 Z) N�ne artd address cf cumant ownor, �L9 �� n lJo, � G 4��}�� L �1 ��—� . .��F041 �ave.�' Rna�. . �lch m �I C� a�7o �- 3) Property Descrlption:. �.of siae: . Z`i �'ownship; Sa.,mz � a� Directions to !he property (Inc� ing road names an_dr_n�mhers): (� � k� D t n�1-t �.L i�Ierr Cr _,l..d �1a.�. e �n Ir. �, L _ J � _ � � y �_ 4j P'roposed Use and Struclure pescription: answer each of the fo1�a,N;�g questions: a) Proposed ✓ Extsting._, Type of Stre�cture._ �o�a� �vidth: �13 t�pth: SS b) Number of sedrooms: �� Number of accupants or people to be served: � c) 8asemeM: Yes�, Na ✓ Will there be plumbing. in SShe basemera�? d) 6arbage Disposal: �'�s ___, No ✓ 5) Water Supp{Y TyPe; Private � (.o�w ..ar.existi , Pnbl�;;; Cammunity_, SPm►e ` Are any wells on adjaining property? Y�� Y�, Piease indicabe approximate locatiori an tlie 'site plan. 6) Daes your ProPertY c�air� p�evicnsly-identi�ed furisdlctlonaf wetlanda7 Yes, No ✓ �SE NOTE THE FQLLOWIN • D A PU17 OF THE PR�FERTY DR gITE pl,p� MUST BE SUBMfiTED y1(ITF! TH�g qppUCqnDN. ➢ PROPERTY LlNES�AND�ORNERS-MUSTEE �LEARLY#AARKEp;. � THE PROPOSED LQCATION aF ALL STRUCTURES MUST BE S7A1(ED OR fLAGGED. ➢ THE 31TE MUST BE REAQILYAGCFS518tE.FORANEyqti#A'�N gy T}{E HEIILT}� DEpARTMpVT STAFF. I hereby make appiication �ta the -Person County Health Depattmertt fw a site evatuatlon for the on-site sewage disposal system for the above-described propertY• .��. that the c,�ntents of-this aPplk�iion are �ue and represent the maximum ��ties to be placed on the pro rty, t understand if the s�te is alteced or the intended usa changes, the permit shall become invatid. or Representative � `� � Date PCH�� rev.-D6JZTl02 6/£ 909LL659£L 4ZIeaH �eluawuoi�nu3 0� uoaiad Wd £5=ti0 f00i/60/£0 Owner: l L�ation: Subdivision: DrilLer I�D » • Com��ny N�ame .� ' • D�at�e Drilleel % Grout Log - " Tax Map � Parcel # � Lot # � ' WeIl Constrnc.tion Distance Fr+om n� Property L'me (]lriininuun 10 feet) �;2� r Distance from Septic Systiem (1V�in� 60 feet) � p� Total Depth: I/o'�? ft Yeld: 3 U GPM • Static Water I.eveL- ft Wa%r Bearing Zanes: Depth � 3S ft 1� ft ft ft Casi�ug: - Depth From .%(� to �� ft. I?iamet;er: �� in . 1`ype: Galvani�ed Steel _� . � - WCigh� T�11CImeSS: •��`� gCig�lt 3bOV6 GIOLIIId: :L_- lII - Drive Shoe: Yes No An roblems encountered wh�e � � Y P �g casmg • Yes No If `�es" give reason: . Gran� - � Neat Sand/Cement � Concrete GraveUCement � . --- Aiuiular Space Wiclt� • mches Water in Ann Space Yes ✓� No Method of Grou� Pum�ed Press�me Poured � Depth �_ to %'c� Ft ��aterials IIs� � - No. Bags Portland cement ' Weight o� 1 Bag Poimds If mu�re (sand, gravel, cuttings) —Ratio to ID pla.tes: � Yes _ No 4 x 4 sIab �_ No Liner: " � _ .... Depth: Date Installed: DriIting Log Grou� installed by: � Localion Drawing I�om To Rorniation • ,� � � , ,�I : ��,�� _ , � \�' �.�,�' � - a . �1 � � , . � �: . - �h� 3 , I hereby certify tt�at the above• infarmatian is comect and t�at dris well was cansttucted 'm accordance wi$i regulations set farth '�y the Person CountyHeatth Deparhuent. .' - , � ��tnre of Conirxc.tor '' _ ID # � Date . 2 �. �'L � _ - Pamp Instailment , %% fnstallation Cantractor_ � '�`� � f i Slate Registration Number. K� ('� �ep�h: �n'� ft Shatic Water Lewel: $ �fake & Model: r� t o:( l �ti, � Ptanp Sizs and Ratin� //ThP `v 8Pm �.'erhf' y that this pump was mstalled and t3�e well head completed acc�dmg ta the Peison Co�miy Well Rnles in effect e and t�at a capy of this record has been vided to�e well owner_ . � �Qer�re - ,�. � � - Date- � ,•b PCFIDrevUl/27/04 . . .. �� .. �� . �'�,,. � ,., � . . . . . `,� ;, .. : �: �.� �� . �ixawu:ac-��a�a:�?r:aQSKn��►.11 �IC�,�u.IL�7Ea:. WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map �`� Parcel # I3'� Townslup: Applicant: Subdivision• C1i ✓� �- Lot # Type of Water Supply: � Individual ltequirements: Site Approved By: Grouting Approved By: Well Log: ✓ M ` Pump Tag: __� Well Tag: Air Vent: � Hose Bib: Casing Height: Concrete Slab: � =�07 Community Public 07 Liner: T Installed by: Depth set: _ Grouted• Date: Water Sample: Well Driller: %3u.r� �d�� ,✓.c,� / Well Approvec� by Date:. $'�28�e7 ****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 any building foundation. Other conditions: PCHD rev O1/27/04 � �, � r-- I, ;; �' ) �� ;' '� � �( ��,� � 1 � � 1 � � , j a _� �� ..� �..� � � ��'`" y� �� " �� l �'�' ', �- ��,�.zs�-�.�� ;��:�.�.�.ii.�,.'�1 {I---?��.�1�::� �a��d�� m��/ lY��b�� I�aga� ��fl�a��a��n�� Tax Ivlap #:—��'� Parc�l#: /�� Address: �G�Lirl�'tifj�/ �, Approval Requested for: Mobile Home Replacement ✓Building Addition Zs�'XZ�� G� `''i!�� Applicant Name: OM �S ` .. Address % at�►. � S�morQ ,vG Z73 3 Phone �#'s: �5,�(0— Permit Located: ✓Yes rlo ,/_, Installaiion Bate: Design flow: Y�`�t� (gpd) Current Contract with Certified Operator on file (if required): /v� ., Water Supply: ✓ Well Public or Community Wastewater system shows no visual evidence ef failure on: {date) (Applicant's signature if site visit is not required) �+r��/��fl��a�aat ��p��e�l , �l Environmental �ieal peciaiist !D Date Pe:son Counr�� Environm�ntai :,eaith, �?5 S. y;orQan St., Suite C; RoYboro, NC 27� � 3 Fhcne: ��6-�47-??9C/ ra :: �� -�9�-"i�0� � tiv-�:��t�.�ersoncountv.i�e: ',� -. ` �� .� . Person County Environm2ntal Health ��y �- ��,,� �� ' 325 S. Morgan Street � RADNS: 30953' �}e ^ IFNCtH: 14998 d9� SVIIG V . UELTA 2TN'10' �� . Q R��,{�,� M NpMTY M � ]�YV�O� NC G/� rror ro scuc . � auxncv c.rus . a�s �a u... m�m,• n,,,r ves / / � v,w r�s auw aeov .m �ert�. sue�cr woe umm f��r�l��' w�wPv+�p+rtspop�t�' rynu�r(.m1Re� �� um `i(s� ` B NOnlMKRdMEa£MLLYINdG1FD 4 ORAl1I! MANA/10N IISIED IINUf PR�LiI�I ,�„� ��,,,� ,,,,,,,,,, ,,,,,, . �� NotforRm00 �""�`,"`° ,,t�rr�r!y9-. Qdbfl www �tro�rssoFiyr&ic cauasr�n 4°CQ° .� �n.� - � ••.+�,.•••..•d..+.�,.�,� � RECN'�i881S:.,-:. � �nrssswanaruc _ ,'' SEAI. � '= , � PW�: 9086-�OY�20i3 � � � � ��ss.,u°N = ' _ naf: �2��ai,�.: ,�, ;�y.rt� �'3'` D.B.: 259�s53 . � I .�.,. a� �7s2 ... a� ''..,� <EY W�� `` . � y, � ' er awv. t.v� seR�mx �a aaree�v � .�':::�,'� �� To PL f� � mnn nw va n,v a w na rouan«r me I 4 �.� , ,��6 � �� z .� , /I ..wm. ae wn ,vm oocs asve A ,a. I`y� . am�r av awx�r N srw� sm I `. �� .. s, ACREs vxo��w io ar+�rro, ua�,w�n u., G�B de WENDY BAU�! , I ` 78878 29.7Y PIN/: 2875 No�s y.. . � . v -.. . . � B& 4-232 x. ys. � '°r 'd".Ta"L:.f. � •,,....,�..:r....�;.+.�w.tr..�...e.yw:-.« : va.�,,,r.y �� .e*:!vrr.�`-'' .�L1rr•t - -. :m.�`+ . ... �f��Y'�. `r ..y � * �� - �� -�aa 0 i93=766 a' e'I', '^�`ce5a . ,': a. e , . , . P � '6�5.^*..m'.� ,, , a: • - ,�.,. -^� . �* . .w I � 1.c, - , • .��.�; �.��W- . ti�` �' INS� .,A„ �,�m�;� ��°` ` � � � SCALE: 1 "=30' . + � � r"-�� T�N � � �o� �� w -... .� , � '_" T2p°p�j, Pu+/: eo�� 2no INSET �"�C" a�S�` SEE A r� � 7!A/: A2J-iS9 �'.e� �� i� D.B.: 196-126 .ovr �� . � � m� :;. I . P.B.: 4-232 �'p '1�� ,.13 0�'� ' �, . . • TQ GJ'c ` o°i 1'� � � �� " ' ACK ��`� y,o�� '" . ��`.�`pGo' JE `�'c+�, ��"�a' trcCo I:�,, s'� c� :o�,,�m� Fyc^Q�RG 20.65' arsmExcEs TO PL �; �� 5o450'OYE . aa vm 21.25' � . nk �afa .55' TO � ' PROPERTY scacE r. _ �o. I - UNE 40' o ao' 80' � ._.. _ . �,... _ _ croerawnromos a�ns� ,�xwr - g� tECENu OONSIII.TRw�TtWRh�tS � �pq� � �w.17� p wGirimoonr't�tr v�„�;;� . G BSNBAUM SUMMIT 06-404R �,�,�„a � .��...� � ��,°"'M�'° �,` ns��r+cm �� c�va�mvcaraarrn�:rmsoxca.rra�xracNeor�va �. ctsns�m A wnewrx.oem ' FIISDwoRBPffi¢PORI�DH�Lffi�.waG Cor�sutHngEnglneers' aavwo ��W �s"� � � � � ��T �� 914A Norlh Madison Blvd. - wa.��xsaw�mas�mue� �py°�� ecrwf�mt � ■ mwcnneuwn�.axr PROPER7YASDH4CRffi�IND�B00%493PAGB766 ^'„�.�°��°��^�^.,: � �.�... sravnmmnvz�xanmoa R�moro,NC27573 FOUNDATION «��m,�,�,�, �+� � �� Voice: (338) 69&3800 Fa,c (a3s� sesnzs www.summRcigineer.am _�1 j � J f �� a71.71.�3L7L��*'n T'n'�" �.]C]L�dL.� ��d�.L.�� Ta�x M��E� � - Parcel # � . S�uhciiivi�s•ion l � � Ph��s�e Sect�ioii Lo�t � Applicant: (SI �''f hS l�4 v� Location: . _ . _ ,� _ '� � � .. • . Permit Valid for `�� Type of Facility: # of Occupants �� Proposed Wastewater S Proposed Repair: � Permit Conditions: Owner or Legal Represe Authorized State Agent: Improvement Permit Yqa„rs _ No Eapiration # o�Bedrooms 7 � New � Addition Water Supply Projected Daily Flow �$c7 g p.d �� Type: _ � 'I'ype� _ � ,� �e►�-, �f Ge�.�-� �o r � � Date: ( � 7 � � Date: '" The issuance of this permit by the Health Department in does not guarantee the issuance of other peimits. It is the responsibility of the applicant/praperty owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met This Improvement Permit is subject to revocation i# 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 for Sewa�e Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the sephc tank system will continue to function satisfactorily in the future or that the water supply w�l remain potable. Authorization to Construct Wastewater System (Required for Building Permitj * See site plan and additional attachments (_�. �� p� Proposed Wastewater System: �-vtytC��'i�- C�n�,%+r New � Repair Expansion 'l Type of Facility: �t �� • Type � �J Wastewater Flow 'Z�v .p.d. Soil LTAR: R � g.p.d./ ft 2 Basement _ Yes � No Wastewater System Requirements Tank Size: Septic Tank: i�� gal Pnmp Tank: gal Grease Trap: gal Drainfield: Total Area: l2o''C� sq ft Total Length �� ft Mazimum Trench Depth �Z- %3 in Trench Width �J ft Minimum Soil Cover: a in Minimum Trench Separation: �_ ft 0-�� Distribution: � Distnbution Box Serial Distribution Pressure Manifold Specifications• 5� �/�� S �-e�PJ� • Authorized State Agent: _ Permit Expi Date: � �I N� Date: �� -I The type of system permitted is Conventional �Innovative Alternative. I accept the specifications of the permit. � Owner/Legal Representative: Date: � � ? d� P HD7/30/2002 :��;��- �'��.�� - � � � ��- ��.��.�� .�.� �� . .. - /1 . , �� r� •/ ,��L,��' r � / .1,� � ,. ... -. � � -. 5��. ��: Tag lYla.p #�Parcel # l �' � Section/Lot# � -- � -0 Date . �� System componen�r repr�esent upproximate�con�ours only. The contrctctor must fTag the systemprior to begr.'nning the instaAativn to insure that pro�iergrade is maintained `: �� ,�a� �� - � ��1� t�/'1 iv1 4 � � �s a'''e°c . G� �,�,�� e� � �. s� � . :. . (�� p� Sca1e: ` � ,� ��1 P—Pe,c w � �-� �� 1,-�,��s. � r (09 (�gR 20 � �S � " S/ � �� uo . �e � 1��' � � . ��a � � c0��4,- /. 7� N �'co L,� K E �o 0 ��,�-�-�°`�t �-o �oa-� i�ous.�. PGi-iD, =ev. 09/12/Ol .��,�� V � � -�/� Y _� � `1.J' �� 1��-�y�,r,,,n,.,, ��¢�.11 7HI��.Il� S�'I'� ��'��I Name m 5� Tag Map # Z'� Pa�ce1 #, 3� Sub ' n � ' �' Section/Lot# 2/3 �--Z-I1 Authorized State Agent Date System comporaents nepresent approxinaate �contours only. The contructor »aust, flag the syste9ra prior to beginning the installution to insure that p►�npergrr�de is maintained � � �I�ai,l�at�,� ��r �r� `��jj� s � � � � ��-� , � �1� � � , � � �: � ' �' 4 �� 1��.� �:�.��s�-�.�.��.�.��Z ��.�.��.� ��a�fl�a�� a��fi��an�/ P✓ff�� +�u�� .$� Tax Map #:_,�� Pazcel#: Approval Reqtaested for: abile Home Reglacement �uilding Addition Applicant Name: i��i�_ Address: t o 2.� i�l a rt%a-�i� ov� �� !i �e �aaRtTt�� Phone #'s: � Pernut Located: Yes i�To Installation Date: ___�1_ �- �� Design flow: �� (gpd) Current Contract with Certified Operator on file (if requixed}: Water �upply: Y Well Public ox Communi � Wastewater system shows no visual evidence of failuxe�on: Z'2��( � (date) (Applicant's signature if site visit is not required) Comments: 1�d '��o�a/�3��I��c�a�a��t ��a-�d�r� 3-z-1� Enviro nta.l Health Speci�list Date 11/15/d� ��: ss ��.� �� ` �� Ji � lE��s�� .�,.Il. ZE3E��.Il� Applicant: �t �hS Permit Valid for � Type of Faciliiy: # of Occupants �' Proposed Wastewater Proposed Repair: � T��x fl�•al� i � P��rc��! # . ► S�u I� cl�i v i�ti�i � ia l i � P'h:��5e Section Lot # � Improvement Permit e Y s No Egpiration ^ New 4� �ddition Water Supply �� # o Bedraoms Projected Daily Flow �$c7 g.p,d, � tem: 1/'e.. � Type: ' Type: -j�c� 'a u �� '. �� , .� � . � .� — -- � r � I � ,.. ._ Owner or Legal Represe Authorized State Agent: The issuaarx of �is pemait by tha Hplth Deparmient in does nat guarantee the issuance of other pemiits. It ia the responsibiiity of th aPP��P�P�3' ow�' to in sure that all Peison Counsy Planning and Zonmg and Buiiding Inspections requirements are meL Thi Impravement Permit is subject to revacation i# the site plan, plat or the inteuded use changes. -The Improvement Permit is not affectei by a change in awnersIup of the property. This permit was issued in compliance with the prnvisions of the North Carolina ` a s a� Rules for Sewage Tlreatmene aad Dispo Svstems' (15A NCAC 18A .1900). Neither Person Couniy nor the Environmental HealtJ Specialist warrant�� thst the sepfic tank system will coatinue to fimction satisfactorily in th}e futnre or that the watcr suppty will rema.i� pntable. Authorization to Construct Wastewater. System {Requ;red for Buuaing permit} * See site plan and additional attuchments {_ j, �Z �l �Jvu a� -�� Propos Wastewater System: �-vtvtClli��. C�+�,�2,r Type ..� � Wastewater Flow �� g� .p.d. � g New Repair Expansiori � Soil LTAR: � o g.p.dJ ft 2 Type of Facility: - �+��. l��= Base�aent _ Yes � No . Was#ewater Spstem Reqnirements Tank Szze: Septic Tank: t(�0�7ga1 Pnmp Tank: gal Grease Trap: gal Drainfield: Total Area: 12C90 sq ft Totai Length �� ft Magimum Trench Depth ��Z— %3 in Trench Width � ft MiniYnunn Sail Cover: � in Minimum.Trench Separation: _� ft �• e-= Distribniion: pecifications: � Distribution Box Serial Distribution Pressure Manifold S'�� `-�e SY'-e�e� . Aathorized State Ageni: Pemnit Fxni Date: l..0 Date: _ �`� Q`� � The type of system permitted is Coaventional �Innovative Alternative. I accept tho specifications of the perrmit ` . Owvner/Legal Representative: Date: � t 7 a�p � P xn�i3 o�zoaa � Z' � I J � ll ��`) � '`._.�' � V� � L11�� `_'' ---�- c� � �.T�� T 1L��.�T'�.s-�,r-+ -,-TM-„ ��a�Ls.� 1L'��2.�.�.� A{�P�;car�t ' Location: 7�' -- on cef �--`� L . . n„ rc �:,,.1-,� (1.� ---� � .�M�(. la,�.�;�► �x M� � �i Farc � � 511�7CjIV�t�1Q�fl % � � � , - � ��' ec-�iore a T a., eciraa:m�s � /1 ' � - � . �r�°t��r� P� � i� . � - � System Type (in Ar.,�ordanca With Tabie Va): !� � Z 'i}�11S SYSTEi�! 1-IAS BE�i�d fI�ST�ALLEi3 IN CL)MPl�NC� WITH AP.PLICABI..� �IORT}-t ' CARflL-1Ad�+ G�iVE�iAL. STATUTE�, RULES FaR SE�I.�►GE TREATIVtF�IT AND DISF�0.SAL., AND AL:L Ga11�DCTioNS � OF ' THE iB11PROVE3WEiVT PEi�NI1T AND COi�STRUGTION • �►l1T'HORlZ�iT10N. � - . ' • % � : -�� /-�G -oG • - Ins#aile�! By:, : Agerrt � � , Date � � . . . • Dai�: // (4 rtl/� . . ' . I . I . ' , �LI-�b �,z- �o L3-�a ��f-�n � ��o� rCnD, r�u. Grl=�lQ� 0 @ , � �� t�� "�� B �1 -�. T� Nlap m �� Parc�� # /38 . � �ys#em Typ� (Ta�le V2) . • �'�. �wneN?,��(icani Subdivis�on �aK �,.;,,�� Address!l.n�Eion Ser.�PfiasS � � ,; � - � - , . , . . � pci�d rev. 3!'k?Ja�i a Feb 18 11 08:46a Clearwater Construction �•� 336-228-0334 p.3 Y �` Applicat+on Date: 2/.1�111 �% e.`�, ^ ,� Tax Map: ^A24 Am�ouni Pa�d: _$1 S4 �—� �� 1+��' Parcel #: 138 Receipt#: _ � _`-��.s s 1�� --- = � � � g.�-��- 7��:caw-niz-ca�au7rn..c��r.n.�.rn.iL 7C-3C.�.an.11d-ll-n. Application for Services (Septic Systems and V+�ells) Se�vices Re uesfied Improvement Permit (Site Evaluation) Canstruction Authorization 00.00 if> 600 ee is d endent on the of : Mobile Home Replacement or Building Addition' Permit Revision $150.40 if site visit re uired $75.00 Wefl Permit (NewlRe cemen pair Repair of Existing Septic System $300.00/$200.001$75.OQ No Charee `_ .� 1} Sei-vices Requested by: t�'�,';�{�°°R`k t S D� Name: Clearwater Conshvction Group Phone #(home): 336 516 2191 Acidress: 3580 Sout6 Church St (work/cell): 336 516 2191 Burlington, NC 27215 2) Name and address o�' current owner (if different than applicant): Name: Tom Russel Adc3ress: 672 Plantation Dr Semora Riglit. 3) Pro�erty Descn-iption: Lot Size: Subdivision: Oak Pointe Lot #: 43 Address and/or directions to Property: McGhees Mill Rd to Oait Pointe Dr, Left on Plantatian Drive, Last on 4) Proposed Use and Type of Structare: Residential ves BusinessfType: Other : Site Visit for Pool Number af bedrooms 1 Number of people served (seats/employees): Basement: Yes No (rvith glwnbing. Yes No _� Garbage disposal: Yes Na 5} Water Sapply: Private Well (Proposed Existing �esr j Community Well: Pubtic Water System: Are thece wells on the adjoining properties7 No Yes {ptease show location on site planj Note• A completed apolication must also include: ➢ A plat/site plan of the property thatshows property dimensions ared ihe size and location of all proposed strrutures. ➢ A sigrred copy nf the `Lot Preparation'form veri,.�'ying that the property is ready fo 6e evatuated I am submitting this applicatio� to request se�vices from the Person County Hea[th Department. I understand that if the information provided is incorrect or if the site is subsequently altered, or if the intended use cha�es, �11 permits and approvats s�all become invalid. j' Signaiure (OwnerlLegal Representalive): � Date :��5 � 10/08 Person County Environmental Health, 325 S. .Morgan St, Suite C, Roxboro, NC 27573 (336-597-1790) Feb 18 11 08:46a Clearwater Construction FEB-l4-2011 10:Z5A11 FROIA- ��4 �� ^�� 1�� y � V �.L tiL � .ii �xa.�^a�o� ---�-oa�a.s�.�. IF—�ve+.m.B��. �,� �t ��s Permit i�aIid �ur � T�e of Fac�ity: # of Occu�aats� I'rbposed �Vastewater Pr�posed Itepair: � P�mit Can,diliaas: owi�er or �l R�e oW � s� � 336-228-0334 p.1 T-828 P.U91�aue r-��a �� d i �'� i(��W�1�� -i � . Improvemeni Permrt No �xp�x�on '.~ N�w �, Addi�ian 'Wat�ar $ugply �� oa�s _ Projectedi�yFlaw,�_g.P•� _ . - -�-- � �� _ �� a�: � � � d� Date: 13� i�uagr+C of ti�ia peuait iry t#�e He�ltit Ue�eut ia does sci guar3nnea i�s i�aoancx af othet paimii9. Yt is 1�e raspau9��liry of t3� �F��og�tY o�n�' to � socr �at aI! Pcr�au Caumy Plaaaing �d Z�g acd B�s�7dit� Tnspections �qa�oo�t� era ma. Thi Itapr�vemetrt P.rsmic b snbj ect to revocstf�c i# tbe si�e pls� plst ar !he ��eaded usa disage9. •The improvement Parmi�t n not aff�cea by � c�sage ia �wacniiip o� ibe p�perty. ihi� per�ttfit �nros ivaea � eomplian�ce with !he provi�isna a� t�he Nordi Caroliw 'Zma� a�n� Ralai�a� 5e�� 2Y�e�r aad �is�sal �ys��,[15A i�ICAC !8A .�900� Pir,itber P�oa C4imty � tlle Fav�Cnnmeatal $ealtl SQedldtst �rszrsD� t6st tbe aeptie qtnk ty�t�a w� caa�au� to f�cti�a �stisfart� 6t tt�e liuure at thst tl�e vv�fer anp� w� re��ti, Patabi� �thoriza�oa to Co�tract'pVastewater Syst�m (Beq� � sn�a�ag pm�tj * Sae sire plan ur�daddidonal auarl�a�earts �). �Z �j�Jv+� - D wastewater syst,cm: �-vcKc+l�� .he�r Type.�� saewater Fiow �„ dg.p.d. g New Ropair Ezpaasioai �' Soil LTA�: � Q g.p.�.! ft 2 'I�+pa ofF�Y: � ��P$ - Baseme� ,�, Yes � I�To . Wasttwater Spstem Re.q�emeats '�k Size: Septi.c T� 1� P�gai i'nmp Tan�c ga1 Grease Trap: gal kainfield: Total A�$: �Z�D sq $ Tot�i �,engt�e �,c3d f# M�nfYtm T�e�ash lltpth �'Z-13 im 'rea�h WidHt �?' £E M�mt� So� Cove�r: � ia Mms�L.'I`renc�Si 5eparatiaa: _,� � Q��-• �taibntian: ,�Disra�wia�n Ho� Secial D9s�ibuiian Presstire Nf�ld , pe�catia�as: S'� S�`�c S�'-c�e� , . . _ ,-,1., .�., . „�� ,� .•, . ' _ �,._.�:� �.�� s:�_.,.i� s : L}ate: _ �"'{ �`� � i•�r t� a►f s)rsiPm p�mfc'ted i.c ,"_, iC'�s:..�+�� Ys.uovasive L°ilt�tiVC. i aCCCpt [�le SpOC1SC�[OIL! O� � �t ` . OoYlscrlLega] Represe�'4v� • Iiate: � � ? a� � P HD7/3 a/2oo2 Feb 18 11 08:46a Ciearwater Construction FES-1d-2011 1fl:25A11� fR�M- � . t �....,�-�,� � ��'a..� �.�.'�f� �� `�', . � � �T�� ' �a��•�►�� .�. 336-228-0334 p.2 -$Z� r.uut�uvc r-ai+ ��i.�.�j...., p�l �'..�.3 S ...�'�....�. ��.....:�.. �� - . � � � . �3p+�r��r� P�r�rv�i� . � � . . �-�� . , Sy�rrt Type (!n Ac�ar�ance VIl�r Tab�e Va): � r`� . � 'rH[S SYST�Nf ,HAS BE� INSi'ALLR7 fN Ca�!!Ptl�t�+10E W1T�i APPl1CA�t� MOF�rt � �' G"AROL• ��[A GE�AL STAT[ITES� �.� F�#� S�E TRF•ATMEAIT AN� DlSPC3SACy . ANp AL-i. CONDI'i'l4rtS • OF ' THE i�AQRflY�i[E�iT FE�RI� AM] CONS'�RLJCTiON • �►U'f'3�1UtRIZd�ON. • . � . - :' " //-,G-dG • .. . yr��r� r - A9ent - Date � . � . _• . Ir�stai�d 9Y: � ��;, ff /o-t1, _ ' ' . .,.. . ; .. ,�5�. � . � . � . . . . . . . .� �.� �'�Q . . � . �l �� . � - — z �a - _ . � � �r 4' � , 'I . I . , �3—go . � �a � ; � ��3% e�l<�� ►,, d�a e �, � c.Y_ � - �� , `�� LS � � (,Jl� � 1' � 4 , , � b � . �� , i '� r • _ ' `� Q / f � , � i . . � �$ `� �� <<1 � . .� . � r��• �e . - . � ' 9'r. � � - j - cr-:sr, .._.. r-�..,,.. �