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A24 34
-� //�/� �jv,��,�/y' �2.0 %i � z-7 D� � � �u cU �� /�C� ���'`-' � � �v,��8��� � / ij° � �,�,� �/�, �v� .�v�a�� ������ i� �i�%�P � , l,p/� iy,��/ ��,J�c �'ih✓!L . %�vfi!� �i���D�.�� � � � � j-/ , �� � q� �UiG�17/� �/J��� • C��V`�✓ L��� �� � � � . . � � � C�G�t:t �..'� �� ��� �� The District Hec�lth De artment , ,P Orange, Person, Caswell, Chatham, Lee Couniies Wate�r Supply ond Sewage Disposal IMPROVEMENTS PERMIT No. - .� _ _ — ,,..�.. � _. � -2 - -7 ,f� • Owner: _ Location: Contractor: ' – ' � � Water Supplp: Private,�.� blic � ,,i ' :� � Sewage Disposal Facilities: No. bedrooms � Dishwasher, Disposal, ;washing machin other auto;natic appliances / ; �Size of tank: � ` � Nitrification line: •-� Other disposal facility: ' Water supply and sewage disposal facilities location, installation and protection must meet state and local regulations. Septic tank should be pumped out every 3 to 5 years and shall be main- tained by owner in such a manner as not to create a public health hazard. Septic tank and nitrification line MUST BE INSPECTEI? AND AP- PROVEI3 BY A MEMBER OF THE DISTRICT HEALTH DEPAR.TMF.NT STAFF BEFORE ANY POftTION OF THE TN_,,STALLATION IS COV- ERED AND PUT INTO USE. �,.�'�/ ,1 � ;i %� / �i Date approved: Si�ne `'� 'r�l�J � ^ � ✓ Sanitarian Well: .� „� ; �� � a.a.v.�.-�-D{ � l c c� l �� .�, � � j `� ' � `t �''�' Sewage Disposal: Counte��'' �' ��' '" `'f/� `,. ` -: BY: sign ' • � � ` -- f�,'t� (Owner or ' representative) Certificate of Com le2ion � ! � � i Date Approved: � � ' By; � anitarisn ' (OVER) . �� Location of well and sewage disposal facilities sketched on back. NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located at later date. Note location of water supplies on adjacent lots. (1J (Z) ■■■�■■■■ ■■■■..■■■■ ■�.■■■ ■■■■■■■■ ■■■.■ ■.■■� ■■■■■ ■■■��■■■ .■■■■ ■ ■■■.■ ■■■��■�■■■■■■. ■ .■■ ■ �: C i i�i i ■����� ■ ■ �-� ���.�w��:� �I ����li!��1�� ������ ��� ������������ ■■ ■ ■��� ■ ��■��1i1��1 ■��■� ■■ ■ ����■ ■ ■��■�� ■�■■� ■ ■■�� ■�����■�����■ ■ ■���■ � ���■������5��� ■ ■ ■ �■��■ ■■�����������■■ ■ � ■�� � � , �r` � � ; _ � �� � �rc�on oat�: �-3'�3 �lmount �ald: -1S ° =— �. �.�s-- Qv vn� �� e��� � �-e� �,�`����q'�3 � e ( W �� �.!-\�� 7ax Maa #• r' a� �a����:34 �.�--,�� ...�- I�'I�IC�..� �� - . �����- ��.��.m.w......,_,..��.�...�. ��.�.a¢�. APPi.lCmT10N Ft3f3 5�ViC�B • I� TNE INP�RMATION IN TNE APPl:1CA77ON FaR AN IAAPROVE�AENT P�Rf9A1T iS� INCORRE�'T F�1L3�FiE�t C�IANGE� �R THE SfTE IS �►LTERED i'HEAI 'tHE 1MPl�Oi/E�11�17' PEi�11�IT AiVD AUTHORIZ�►il�Pl TO :. GONi�TI�.UG1' �HALL BECDiiE IWVALID. � -• 1) permfdt r�qua�tad by: (Owner�er�tlpros�ve owne�: fS E.v�✓�"1'!,� C�orrJPr� Home Phone; e33� - s7f� • r.�,'a.o Addcess: 3s8s sE-c�,o,�s ,��.vy ' Busineas Phone: 3 3 C• a� a:3SaS • r� EB.a N s�,v c..L 73a�. �) 1V�� a� aldade��s �f ca9rr�nt a�es; �E•v<v � r�! �omo r� ' 3 �8.5� S�'LLAQS .e��4� � � • r�E'��vE��v.c �a�3o�. 3} �i� Prap�rrty De�criq�on: Lak size: Townshl�: Cu.v��G�dA�ubdivision: E✓� "� S Lat # 3 ' Dit�tians to the prapert}/ (Ina�uding r�ad n�ames•and numb�rrs): .s�c�y S7 rd �.:�,�a - c���� Qo��o _ . �Z���/T To 5Tol� 57�N - Tu,2N ��F> o�.� Yn�l./'/E� �t« ,E'.�Ai� - LE-'F7`pyy5lioR�DR, • � rG.r/�l �v�.l S/,/��e� �4G�2ES vRzv�' - r4rG,UT �fn� /Y/U•v�iay o,9JCC.tY 7za . . 'rS,Qs'T /'7o6.fiE: Xa7✓�� ar�1 Ld'c�T .. �dv mNNPAY��9��'/ �.6IaD. . Y�ro� u� ana s�tur� D��i�n: ans�a►e,r eacl, nf tne toltawtng questians: a) Proposeei ,`', Exlsting . Typ� af Strudures h��usE � Wl�d�th: �d T �epth' y� - b) Numher of ��droom�: � Number of occupanfs or peoQle tn b� �rved: y - c) Basernen� Yes,,� No � Wil1 th�re be plumi�ing in #he•basemani? Y�s . d) 6a�age Dtsposat: Yea � . No � �'l�fat�r Sa�PI� lj��: Priva6e �i�evu' ,i ar existing__.). PuhQa• , Cammw�ity'_„ SP�9 � . Are any wells an adjoining praperty? Ye.s ✓No _ If yes, pi�se indtcate apptmclma#a loc�tiari an th� 'sife pi�n. • ' 6� Doe9 your pro�aty contatri��eviou�iy id�e�dad Jurtadir.ti�n�i w�tlands? Yas Na„�/ L •1LL . _ . • ➢ A� Pl.AT O� Thl� Pl�OPfliTY 06Z �ITE PLd�N i�U�'T HE SUBMCifE� VY�f'H Y�llS �t.1C�11i10Pl. ➢� PlZOP�TIf LlNES AND CORNER8 flAll:J7 BE CI.F�IRLY NiAR�. •, • 9 THE PROP08m LOC�4T10N O� Ai.l. 9TRUCTURES iIIlU9T BE 9TA6� OR �LAGG�. 9 THE �ITE MU�7' BE REAi]ILY A�CFSSI�L� FOR AN EVAI.UATION BY THE HE�►LTH DEPARTtI�Eid'P STAFF. � � I h�reby make appiicatian to the Person Couniy Health Department far a site evaluatIan finr th� on-siie sewage dispa�ai. system for the abave-described pro�erty. 1 agree that th� cantents of this applicatlan ae�e true and represe� the maximu�. fac�i�es to be placad an the property. ! understand 'rF the site is altered ar the intended use changes, the pesmft sha� I�ecame Cwner ar � 'a -d� Date -- PC'�iC�, cev. D6127JD2 g�,y{1� «��� � ��' � , Jf D �• � 1 � �:� �...... � � :� �. ..� �"" �� � �'`�; ° a`�".� r. ���,.""`"`.�..�,....�. +� � �' � � 1 � •� � i .'�1 �. i�+ fJ 1$�Wr . �B' � � r� ������ �� � �� ����� �� ,,� 77�� ,��„ . � � y � �r s � �� � �'�'+i+ �� I � �uMN �92$9W � 1 �i � � .i � -% NL'iS1X� � � � � �� � +a� � �I � � � ' "�" � � � � � i ��� �. .t 1Y 1t�' �. �, � � '9 � ��/� �b. � �'. ��j "�j � �M 35Fso}i,� ��' �� � �} '�.d y� �' "� � n' a'c—� 'l !" {��� � u � � �' �t.�� �S �� � +� � � � ,� � i.� � ` � � .,,,Y,� � � � ,�,rt,�+� g �`• �'�` � 'T''�' � �' � � � � ,� 1 � -� r,� �' � ,� ,� b �` .� � , � � �� ��°► �i". � � ��'' �a. �, ��3�'' � � �' � �;,�� , � , �� r '+. . i � � J � � �e,r � � � � a ,� ��, �� � l.. a�+Gt .�t �� � � =. $CL' i�CC�1t� Si1�C FOL �.@CCr1C31 S�f1CaC�QLS � 6" � 1 �L� =11� — 111" �I1 l i l= r� l= m- /�Iq=111-�11 �.•. � _. . . . - . .,. u,ae�«atia c�te � c�c pith Suitable Sealer In Both Fs�ds OE Conch�i[ �, _.�� - . _ ... . .. . - _� . - .- . .. - . .. •t •• ir • . r - � • � •�c- . - -. .. _� . , .- ....� . . m � pre�i ua (cnt L{j� �o d c �i uc; , �� � � 8p�loO�kflcns�GS/G�� : �� � — � _�e. Submersible �� �� Effluent P1� • �u � Concrete BLock • �ar �i� �.iia� �i • - '� -� � �• _� r =i �r_ ■ ��a .� • •��r• _� •� r -� r �� • •�r' f- a ; ' �S3ngle lIt3,5E1 CaL� � � �t� _ �►� _ ��j =1�� = ,►t - !�� =��I=1�1=It( =1t1 111 = i 11 =� t Il = I l� =�s�—='�� _. . . . �_.:�: - �.. , j� ���� �� �� � j . ,f �il 1 � Supplp Line 'Io .� e► Diace[er ScheduTe 40 PVC . _. pi� • 1m R,ttp Re�si�ral R�e �� • GaCe V21Ve n zt�� �{Cu� ��� . � ihceaded Uniac� .LcJ' � Q M • , piecic 'Valve 3/16" Syp� Br� ��ole ' Iod�r� Str�s ALv�n� All Ct�s — � !tlarm Float (elevation) — "P� On" Flaat (elevation) � ` •'pucQ OFF' Floac (���on) _ r•• i 8 Szri�s Z�ellcF • 0� �4`�(�.Zv p �E�� � pUMP BATING Pump Hus Be Rated To Deliver �S aQ Gallons Per Hinu[e �• Against ��Feet Of Tota � ' Dgnamic Head iTDfi) . � ' � �. , , . . a c � • • � a d � • • � dd d � �. ' . A . s a � , • . � . • • • �is �k� s�all. be aE a st� �oUe'a �P ��' � �rl 53311 l�e I.ea1c �tr�3 Q�r-5i.� . � � PUMP SYSTEM DETAIL SHEET See Folloviag Shee[ For Additional Specifica[ions, Notes, And E:cplanatioas. � �� El�v�i`onji'� ��u^K � I (� ` -I- . B�" = I (o � $� x Zo�o " a o� a � �to�-�. . . . .. . :�,�,`�,5� : I������T � . . . �; .. � .:������ ��.���� �. ���.� ���.�� � SITE. S��ETCH � Natne ��e nn.e�►. C.o�-w� Tag Ma.p # Aoa v.Patcel # 03 y Su di i n ����.5 � � Section/Lot# 3 � � a-,o--03 Authorizecl State .Agent � • � Date . • � System com�ionents r�e1tiresent a�b�iroximate �contours only. The contmct<trmuat, fTag the systemprior to beginning the iristalJation fo insure thatpm�'iergrade is »uxintained � • � , m� � ��` .. . � 2� �I a' u b U� � • So' . . pZ SZ ' ' ,. � � ��� n�+ �,��� �-r-� � � �u� �F s��}v.,. �- � 3 � r • F � �,��h u� s��s!-e.,...� . . � �`�,,,� 1 � _ � _' — � ��� _) _, — _' — � � + 2xfS�hn9 , Sw ► 3� , � — — — � x '�`ti �• �co� � _1 � � � � n ' �VJ' L�- � y v' C,c�.re S�o�.�d ' bt �a�Kc� i �... r'c��av�. ( o F� c�m N-�o _�ry �nd Prc,��.n-� d,�' . O �•� h � r U' T`�7 � C�R �S '+-O b� � ��Q.z c�-f' loa- o�.c� a.. naw �-+� �07 bec�-tx�r�-,� is -i�o be. bu.�1�-. ��ccP �ll Qa.r�s �oF 'SyS�-m I 5�m i n i m u,v�-� '��prn {�S�MCt1'� ,Cu.� � __ . �ama J �n� 5y5-�cM� :. � � Exi,s�� ny� S�yb�c n'� : ul�vwcd : . � . � � : S i n5 o F�naf ��cncf� �� .. �. . no y . . c�n Z - S �3 . � : . � 7� t-4� � : ���.sf I���.��� �-.. � � � �lJ � � � I���-aa-��.,.-�-,.���.�.71 u33I��Il�I� Applicant: cn r1�Q, rc. A ct'cS Ori V � Ta�x M�a,Eo � � � P�rcel + � S�uhclivi.s�ioi�, � Ph<��se Sect�ion Lot # X � r'C, �ri vt- NOTE: Qc,QIaGI n�. 2 dc.�r'opn, �mH �-'� �'Z 6cd�oon, ��cK b�t l� Gw.�..c,7nS�f It�� 5/-r� P/7�1- / Improvement Permrt s�.�P y ��1� �^ �r. Permit Valid for V Five Years No Ezpiration Type of Facility: `(c. c�m i I tI W c. ( 1 n New Addition ✓ Water Supply # of Occupants a # of Bedrooms �_ Projected Daily Flow �� g.p.d. ��,� Proposed Wastewater System: EX�`� nq I(D O' X 3� . Type: � Proposed Repair: EXf r►�o� _ Type: Pernut Conditions: Ct.c,t� nl �� Owner or Legal Represe Authorized State Agent: TanK�S lS'mi`n �cd bt F� �c rc�-c i ✓; .� uc,�t da �-►a9i -��� St� �u.Scrncnt ,�, Date: �.02 • o � Date: �-� p-�3 The issuance of this pemut by th� Health Department ia dces not guarantee the issuance of other permits. It is the responsibility of the applicanbpmperry owner to in sure that all Person County Planning and Zoning and Building Inspecrions requirements are met 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 for SewBe Treatment and Disposal Systems' (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 will remain, potable. Authorization to Construet Wastewater System (Required for Building Permit) * See site plan and addirional attachments (�. ��p /� Proposed Wastewater System: �XiS�� n Type� Wastewater Flow �.p.d. New Repair Expansion _ Soil LTAR: 1J /� g.p.d./ ft 2 Type of Facility: ����, �L F�.m �' Iy Q c,� � rn� 5� Basement _ Yes _ No Wastewater System Requirements Tank Size: Septic Tank: �� gal Pump Tank: � gal Grease Trap: N I f� 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 Specifications: QU.rr1p TO �X I itc, SKc-�+ rovidcc Authorized State Agent: � Permit Expirati Date: Serial Distribution Pressure Manifold �Liit��, �O ptc,i �l'�-a-'�'�Di1.S Date: oi-1(7'C� U The type of system permitted is Conventional Innovative Alternative. I accept the specifications of the pernut. Owner/Legal Representative: Date: 'f � a' d 3 PCHD7/30/2002 ���� �� �1� �� ����\� =�� ' s s � � `�y � � � � �� 3S.'a'�73 ��s 3ish �a"+e-�+ � 3�'�'��. � �� C.�_ 1L'�. i rR � � �U%GDi,�y �.�; ¢ 3 ����; � Tas 1'�Iap #� i�arcel # ✓2 � . . � F.�isting Sewag� System I�eport For. i� Mob�1e �ome Replacement ��%���� Addition Tqpe• Reqnester: �� r�iJ �T� Cb ti.�.c_�-!-�'►� � Home ]Phone# ✓r' %�- �77� 3S �� ���.r�.�� �'7�. Business # Z7�z - �-�'�?1� - . — i�I ��c% ��G ���D � Original. ]Permit I;ocated: � /V � Wates Suppl� Septic System �esigned For. � Residenrial Business Other # Bedrooms 7i # Employees � Other � � - System Type: �D�l� 'F'ank Size: �f•!SD Nitrification Line:� �� X�` � I3ate Instal%d: �•? Certified Operator Required: On-site wastewater disposal spstem shows no visual signs of maifunction on Peunission is granted Comments• �� ���9�-�1/� �/,� /�-�t�K/ Gf>�� _ �C �%.���,o .T�i�.f�,� i/t�� pC�� ���/.� . JEnvironmental �3ealth Snec,ialis Date: Z � �