Loading...
A24A 32� The District Health Department CASWELL - CHATHAM - LEE - PERSON COUNTIES .� '�� 'Water Supply and Sewage Disposal IMPROVEMENTS PEAMIT No. , _ i; 4'Q1D a;;:r 3 Y'ear. Dat - - � Owner• ,�� ',T �,� 1e �' �' �� Y�t'„�; pq Location: �' � . ., Q, Contractor: � �a -." � Wate: Supplp: Private� Public � Q t� � � � ��;.L ^ V S ` ; !" ' � A . 3ewage Disposal Facilitfes: No. bedrooms�� Dishwas}�er, D sal� ;�washing inachine, other automatic appliances' �p u''r �F d Ya' �, i e c✓1" °� � Size o1: tank: Nitriflcation 1Y�i . ,. ,: � � t Other disposal facility: �� `�rL� �,•f� N�ny Water supply and sewage disposal facilities location, installati�`�it� � protection must meet state and local regulations. Septic tank should be pumped out every 3 to 5 years and shall be mairi- tained by owner in such a manner as not to create a public health hazard. Septic tank and nitrification line MUST BE INSPECTED AND AP- PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV- ERED AND PUT INTO USE. r- ; Date approved: Signe Sani i Well: Sewage Disposal: I Counter- signed BY� (Owner or his representative) � Certificate of Completion � j `' ;' � .i t ' /��� j ,,,_,..... Date Approved: .1.� T-� By' , Sanitarian (OVER) Location of well and sewage disposal facilities slcetched on back. A�Qitcahon Date: I �� 7'43 :4mount �eid: Rec�i� Tax Man #• � Z� Parrxl��: 1 Z Z �----.��� � ���� �.1. �I . � � �� � �� �-s�..��-.m__,. __...,. .o�.��.a. a-��.�.a��. APPLlCATiOM Ft3R 5�RVlC�B • 1j Penr�it reque�ted by: (Ownee}agertt/pms�va owner'): '%!� 'rri (�� ���5'-� Horne Phone: �• - S'"�'7? Addreas:, 3.�"� C� s ���� Busineas Phone: 9- d , to x.�{ �) ; N� ,� ?��" 2� Name and alddtess af catrr�ent aenreeer; �`n�► r� i �Uw �� S 3j Pr+��serty Des�c:iption: Lat size: Townshlp: Subdivision: Lot # � D(re.dians to the property (lnduding�r�t names•and numbers): :) �- � i'n� ��a n,. t��'� ` 4) i�ro{�os�d U�n ansi Stru�turs D�sc�l�n: answer eact� af the f�ilowing questbons: n a) Proposed _, Exlsting Typ� �f Stru�ue: ' Width:_,� Depth:� b) Numl�er af �edroams: � Number �f occupants ar peopte ta be served: �� v - c) Basement Yes . No ✓WW there he plumbing in ths•basemeni7 �.9� � t� d) 6art�age �ispasal: Ys� . No s� 5 G'rc ,gt ���%x :y �j 1Nater ��P�� Tj�p�: Prlvate �_ ac e+xlsiing_ j� PubUc_, Canmwilty�. SP�9 � Are any wells on adjalning property? Yes No _ If yes, please indtcate appt�nxlmate locatiari on th� sii�e pi�n. • ' 6� �oes yaur propsrty contaln_previously id�ntifled jwrissdic�n�i wetlands? Yes,_, No � �j ���iCl[-�li�,� �QiTIC:L� ➢ A PLi�T OF THE PROP�T( t�R 31TE P�AN MU9T 8E SUBMRTE� WI'ii�i THIs APf�l.1C�►i10N. ➢ PlZOPERTY UNES AND CORldER� IIAUST BE CLEARLY MARt�fl. •, A THE PROP08ED LOC�4TION aF ALL STRUCTURES adlJST BE STAkED OR FiAGGEi'�. 9 THE SITE MUST BE READILY ACCESSIBL.E FOR AN EVA1.UJiT10N BY THE NEl�LTH DEPARTiItftENT STAFF. � � � I hereby make applir.ation to the Person Caunty Health Department for a sfte evaluatlon fior the on-site sswage �isposai. system for the abave-descri6ed property. I agree that the cor�tents of this applicattan are true and represent the maxirciux�. faciii�es to be placed an the praperty. l understand if the siie is aitered or the intended use change9, the perm� shalY b � invaild. • � �� � � �� --_,� r Cwner or Legal Representa�ve =a �-�3 Date Pc•�. ��. ost271o2 ._ � ..,.�__ _____.. , ' i � � E� x So'-� �� zo � Z i o� �10 ` ` �7 /h^a+� f� L�►�u.tLitY GkGC� � ��1 S a � a �>tv,.'�i cac�P ,�. ,�� �pitr.atfon Date: i��'�� �Z Amount �aid• � c�.�� � R���c �: �,�—�� � ' ���_�� ��II�..��1� - - . �����-� 7�sc�vS��aa-^--- .e���. 1�ao.m.I1��.. r �Tax flAa #• ��� �: 3� APPLICATt�N F-0R SE3i1/IC�S � IF THE INFaRMAT10N IN THE APP�CATtOi�l F�R AN IMPR�VE�AENT PERAAIT 1S INCORRECT. Fe4LSl�iE�J. CHANGED OR i'�iE S1TE IS AL'TERED THEAI i'HE 1MPROVEAAENT PEi2MR AND AUTHORIZ�4'f90PJ TO • ;� �j ��� �C� CONSTRUCT SHALL BECOdAE INVALID. � .�tY � 1) Permii requested by: (OvmerJager�t/prospeciive ne • h''GS�� r� (�� . Hame Phone: �i— jl�f � Address: � -e Business Phone• 3 —/�i 1� �� rnar� �3 � 2) idame and �ddress of ca�rrent ov+mer: 1r��t i�S ��2.n(� �e hk ( nT.S ' -� a rn _ a- � Q_ a�J'-t— '� � � ����. "1 � � �� u p �� . 3) �roperty �escription: L�t size: � Towr�hlp: �unniw� Subdivision: Lot# Di�ctions to the property (Induding road names�and numbers): �• c'�-o. � e. , �' - _ ` b 1 � pr� �1'15��,� ��.5 dr��c ar t-� �.�- a� �hb�w i. g�., . v 4) Pmposed Use and Structure Desariptlon: answe�eact� af the foll 'ng questions: a) Proposed � Existing �Type of Structure: ��-� �r b�i� 1 h��s e Width: � Depth: b) Number of Bedrooms: � Number of occupanis or people to be served: - c) Basement Yes . No,�,ciNill there be plumbing in the•basement? d) CSarbage Dispasal: Yes , Ido ,�- 5) 1Nate� Supply Type: Privafie �new �r existing�� Puhiic . Camm�sniiy' , Spring � . � Are any wells on adjoining property? Yes No _ tf yes, please indtcate appraximate loc�tion on the 'siie plan. . 6) Does your property c�ntain_previously ider�tified �wisdlctionai w�lands? Yes_ Ido I� PLEASE NOTE Ti-lE FOLL0INING: ➢ A Pl.I�T OF TaiE PROPERTY OR SI'T� PLAi�i flAUST BE SUBMITTE� WITH 'T6�i1S APP�lCATION. ➢ PROP�TY UNES AND CORNERS MUST BE CLF�►RLY MARl�D. �, 9 THE PROPOSm Li7CAT10N OF ALl. STRUCTURES MUST BE STA6�D OR FLAGGEi3. 9 THE SiTE MUST BE RE�DILY A�CESSIBL� F�R AN EVALUATfON �Y THE HEAL.Ti-i DEPARTMEiNT STAFF. I herel�y make application to the Person CouMy Health Department far a site e�aluatian for the on-site sewage disposal system for the above-described property. 1 agree that the cantents af this application are true and re�reseirt the maximum faciiiiies to be placed on the proQerty. I understand i� the site is altered or the intended use ct�anges, the permii shail become irnalid. � O�-�0. �� � ` �' -��a�' Cwner or Lega! Representative Date Pcan, r��. aslz.7ia2 ���.�� ���.� �� �---- �--.�- � � ����- ����-,�.,.����.� ���.�.�. ����� �'3..E�SE SEE A'i'�A�i) ��11V FOIt WE� SY"�E L�YOiJ'I' T�� #: a r� �az�# 3a �m�p �PPlican� ��'�`� ItS P�r K r'n S Subdavision: Se�ion: Lo� Locatioa: 'I'�pe of Wa�r San��lv: �Iradividual Commu�itp Public. ��uireffie�ts- Site Approved by �� � � �3 �' Gmut�ng Appmved. bp -S �- �i-4-o4 Well Log ✓ � � `� � -04 WeJI T�. Air Vent Hose Bib Coacrete Slab Well I)r�ler. Well.Approved. �g�: D�te• �°See Attachesi Site Sketcla'� WeDs must be 14 feet from pmperty liaes. WeI]s must be 100 feet from septic systems. � Wells must be at least 25 feet from anp bu�lciing foundation• Other conditions: s�s -� - - - - - 3��P s' ' � X 5 r . _� '? � 7 C R-EE K '� Q.S i'�'��aS�rc.d q-3-o3 � Wc[l Q-i� On loc.a,-�ia^ PC��, rev. 09/07/01 1�1 .����i(� ���� �� � 3 � � y �"'^ ' � `�.1� �l7�J 1.�y � 11T ir-..S��Il7i'�mm iemm �Ba1��tL.1L ���.��Y3 �r�Gs Per'K�nS isiAn P�`ncs loorou� �, Authorized State Agent SITE SKETCH , Tag Ma.p #�� Parcel # Q3� ES-E�-t-�s Section/Lot# l l'S—� � Date System components represent approximate �contours only. The contractar must, flag the system prior to heginning the installation to insure that propergrade is maintained � � ` ��s C No7E� : c,� c,1 � (.o O � ��on-� _ -� )���� . C(LC PE M���T�E 6uS H W� L�mc:, p,`n(�� � blc���"aP{. ������ a�PF_.._ — �, �-- �.— — — — � � ��PP�Y �'n` �as bccn exPos�d i n StU c�a-t �rc�.5 )Cct�p W c. ci �.¢0 ��om (— i � t , � �t wc,�c t�c�` From Sc.p�� ���� �i i i=p �- �urr1P ��� K �• . � � � (�� s�i ��, IX ��K� 3� �� � p3 , ����.� � ' ,� 30 0 -� �� Scale: � �iG�S` � , � ,�o % � � .�, Z�'� i J, � - ��� PGHD, rev. 09/12/Ol ��� �� �/����� -'= ' 1 � �/ � ��-���- ��.�n.a��'R'7f'tY7i'7i �i��� ���.��� WELL I'ERMIT PLEASE SEE A'�'TAC�IED PLAN FOR WELL SITE LAYOUT Tax Map #: 02 � Pazcel #�� Township Applican� �i' ��l cs pt r K� n. S Subdivision: rJ (��,� Z i on Lcu � �,d. (� P.�i,irboca_R.� Section: Lo� Cl, �.c rc�+ fZ o�+. c� ����n c,s bo�o�.�-5 �, T�pe of Water Sunnlv: ,� Individual Community' Public Requirements: Site Approved bp ��`� ����� Gmuting Approved by �/S �k �1'.�`1"�3 Well Log Well Tag; Air Vent Hose B� Concxete Sla.b Well Driller. Well Approved By: Date• '�°5ee Attached Site Sketch'� Wells must be 10 feet from propertp lines. Wells must be 100 feet from septic systems. Wells must be ax least 25 feet from any biulding foundation. Other conditions: �/15�, (< 1..1 c. �� GLS S�. 0�.�✓1 — PCE�, rev. 09/07J01 il--�.��- ,��.� �U.�..�� ��:�,. .. ..:J .� �a_..,�y . �, C� �U ��.J .l. �1 �l. t 1>>-- �"l:. -�J ��i�(nnX:) ��l �1 r�_'-��c 1 �r � ; �, n.5 - --, ._�' �'� DU�UOC�1 1 .U.�.1L7L�Y']LJL •� 3LT.7i7�:A.�t3 JL'A.ii�..:��. �l. �.1. J.�•C.:.h.�� tl:J�:P. 7� " ��03 . ��� �Ob / � ' �1�.L1 1���:1() �� ��:U'CC� ir �3 1— � WI1CC: n I� �.cs /�1�,�. r� n c 4 Location: �'n � 1�.� ,-.�.�, Ec -��, ��. �! ��, „ bn l , � �_ Subdivision: _ Lot IF � b��cil Coxiscx•uctiozi Distancc From �lcarest 1'ro��cx•ty Li�ic (IvTi�iiinum t(; f�e:t) �"_.._�____....... Distancc fron� Scpcic System (Ivlini�num GO icct) � Total Deptl�: �6 z—R Yicld: %_ GI'M S�a�ie W;►c�r L�:vc:l: ��_____ ll Wacer nc:arinb Zoncs: Dcp[li 10 D tt it _.�� _�� Casiub: Depth: From (� to c� Y (l. D11111CCCi': _�;. in Type: Galvanized Stcel '� �� � Wci�ht: �� ':�hickness: � I•I�i�;ht abovc Ground: ___/ � ill Drivc Slioc: ./" Ycs No 1111y �7fUVIC1'11J C11CUUl1�Cl'CCi W11lIC sc:lti�i�; c:isii�;;'? __ Ycs �No ��`�CS" �,'1VC I'C�SOIl: _. �__.__ Grout: N�at: Sand/Cemc;i�t �i Concrcic Gxavel/Cement ,�1.ru�;uiar Space: Wid[�i �_ inches Walcr ii� �..tziiular S�ace Yes `— No Nlethod o�Grout: Pumpcd z'ressure ' 1'oured `� Dcpth {� to �t. iYXatcXials Uscd: No. B1�S POIIla11Ci CCI11CI1� WC1�Ill' Q��' 1 13:�;; ��._ l'��uud� I� I111:C1U.1C (sZnd, �ravcl, ctittin�;s) — Ratio _� to � IU plates: �cs N� �� x�b s1aU �-�.'cs �__ No Urillizib �.ab Loc:�tiou JJrawiiz�; 't hereby eertify that tllc aUovc ii��onlla�iot� is cot�:ec:t azld tl�at t1�is wcll �vas constructcd in accordancc with regulations sct forth Uy tlic Pcrso�i County I-Icslth Dc:p.lrtmc��t Si�,tahirc of Cozztractoz• � il) t� ��,�-- I�:ltc: _�— �%� d3 PCI�D rcv OII16102 Person County Health Department Existing Sewage System Report For: Mobile Home keplacement � Addition Requestee: �� � Home Phone# 3j6— aj�—i`f4'-l� fv� 1��_�� �J�/�_`c._e� Business#336� s9j— 9lz (o � 'Pax Map# �- a �f-� Location/�irections:� ��3 �- �,c.%�Q ���� ' 2. �r�,,, ��� �. C S, �� I 3/�+) � � Original Permit Located ►� Septic System Uesigned �'or: ltesidential 1/ # Bedrooms ? Business # �mployees Other (specify) Other Uate lnstalled �f� ���� Water supply 'Pype of 5ystem �-- Nitrification Line v C��0�4 3�/ Tank Size /�-6- Certified Operator Required �D On site wasL-ewater disposal system showes no visually apparent malfunction on �� — 3 /—Gl'�% Yermission is granted to: ccording to the attached site plan. Comments: !� ., „� �( .������r Environmental Health $'�C.. �it/�� � _% 2— 3�—�/ DATE ...���. �,� 1�-J I ��'. �.�.� ��J �� `_' ` --� c� c0 tU��( `�C` � r .U..�3th1Y7L7L .m ��n„7�:n..�:,�T.��.��,. ii. 7.C�t.�.�.�1 ��:��:n. Owner: � Location: Subdivision: �:: ., . ;lu :� : � c� � J ��.. ;',��Cln 1J �G�(iu`�i C:) �� �1 �� _c '�.�c 1 i %�c �r �: n.5 U'c� DU�D(lv�l , �_ � - a 3 W��l �ob �1 :L� ���:ll) ��:ll'CCI if �_ Lot If � ^��,. , 1�'�cil Cozistruc:tzozi Distancc rroui ncarc�t 1'ropcc-ty Linc (Nl�ininlum I(; •fee:t) r`� .__�__.�_....... Distaucc froni Scptic System (Iviinniium GO icct) �_ Total Deptlz: �_ Ct Yicld: �Q_ GI'M S�atic Wacet• I��ve;l: /t�----- l� Water }3c�uinb Zoncs: Dc:p[h 7d tc �� i�c _=�< <<' �— a C1S),m�': Dcpth: From _() lo �� tl: Diamctcr: _(� % in �., `� Type: Galvanized Stc;e;l '� Wei�ht: �j�_ ":�hickness: ___ f�y � II�i�;I�C abovc Ground: __/ >� iil Drivc Shoc:: ./ Ycs No �1.ny problc:m� cnc:ountcrccl wliilc: Sc:tlit��; casici�;'? __ Yc:� �No (f `j�es" bive reason: .__. --•-- Grout: � Y� � I�I�at: Sand/Cemci�t � Concrctc GX�IV�IICC111C11t �.nnular Spacc Width �_ inche;s Walcr in �A.t�nular S�ace Yes `—" No Method o� Grout: Pum��cd I'rc:ssure ' 1'otu'cd `� Dcp�h {�:to rt. iYXatczisls Uscd: No. Ba�s Portlaud ccnicnt Wci�;l�l ufi� l D:ti;; _�____._ �'�11ilcls lt mixtw•e (sand, �rzvcl, cuttin�;s) — ilatio _� �o � Ill platcs: �I''c� No �� x�E �lab ,�--�.'c:s ` No .JJrilliu� Z.c�b J.,c�c:ilioi� ur:iwiu�; ( b,ereby eerii�y t�lat thc abovc ii�torn�atiot�, is con:e:ct az�d tliac tl�is wcl� was constructcd in accordancc with re�ulations sct fo�th by thc PcrSoc� County 1•Ic::.it,cli Dcparcmetic. . . ,: , A �1) !E —�y�--�-� ��:�lc _� � �—� '> Si�u;atuz'c o�' Cox�tractox• _ _ �r�an r�u nill�l��