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A25 182� � H O a � w U � a . � �_a . _.__ _ � � �j �— �� Improvements Permit (Established/Recorded Lot) I_ Reinspection of Existing System (Loan Closing) ts Permit (Unrecorded Lot) ts Permit (Mobile Home Replace) Repair/Replace existing Septic System Permit for New Well Improvements Permit (Addition) I Replace Existing Well � 1. Permit requested by: :ome Phone #:. usiness Phone Name and address of � ��N�.. � 7. Dimensions or Proposed Structure: Width: 8. What type (if any, additions, expansions, or replacement is anticipated to the structure or facility �,hat this sewage disposal system is intended to serve? it o�ier: 9. Water supply t}•pe: private ❑ public ❑ community ❑ spring ❑ Are any wells on adjoining property?Yes ❑ No ❑ If so, identify location: Description: Lot size: . Tax Map#: - Parcel#: �� Township: �� n�' a� � �� . Directions to property: State Road #& Road iames, etc. 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: Garbage Disposal? Yes ❑ No ❑ Basement? Yes ❑ No ❑ 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 Department 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 ❑ ��. .��e.� l_ -�.1 � �`R�r � r �.�' � ' Signature Date �� '� 7�7 • w . � <� 5� 1�� • � . ,, i I p H�� `-" -� � r �`(,f�/ "!� � � � w� S� � � � rr�-e � �s,' �.�P � � D ��. ,� �� 5�.� 13.3 � � ; ;[ . .. FACZ'ORS-Sif'E EVA137AiiON ';i: . ,': ARF�S 1 = . `: . AREA 2 :;;' A�A 3. t�EA3 .. .' : _ _ __ l. SLOPE (%) S S S PS Q�r�� U U U J 2. SOIL TEXNRE (12•361N.) S �^ S S S (SANDY, LOAMY. CLAYEY. NOIE 2:1 CLAI� 5��„ ,- � � PS PS PS �ri„„ y►- U U U 3. SOIL STRUC'iURE (12-36IN.) S S S S (CLAYEY SOILS) s�� PS PS PS U U U U 4. SOiL DEP771(IN.) S S S S S 3/ N PS PS PS �� U U U 3. RESiRICI7VEHORIZONS(IN.) S S S S (iMPERVIOUS STRATA. ROCK) S N p' PS PS PS U U U 6. SOILDRAINAG&GROUNDWATER S S S (EX7ERNAL & INTERNAL) PS ��m� � U U U 7. SO(L PERMEABtLffY S S S S (PERCOLOATION RATE) PS '` 3��, PS PS PS U U U 8. AVAILABLE SPACE S S S S S O'� PS PS PS U U U 9. SITE CLASSIFICATION(SEE BII.OW) SOIL SERTES S-SUITABLE PS-PROVISIONALLY SUifA6LE U-UNSUITABLE RECOMMENDATIONS/COMMENTS: SITE CLASSIFICATION DIAGRAM (Include: Soil areas, property lines, roads, streams, gullies, wet areas, fill areas, wells, water bodies, slope patterns, etc.� C:WMIPRO�DOCSIAPPSEC.SMFTNANCE.PC :,, AAP � HF n � r1L�truA G, aac�Er ae 2z4 r �e3 �(� /Q.. y� uv.• JUNE i995, F NE ~ � �� ,� . �� \ � �� - � . , , �� .�� ` � '�rJ ��. `, �,��. � �. ��-k��c� t� �� : s �� t � _� tF ' G'„�',�� . ., _ --- .�. � ioTw `.;� � .� i � - :, - .e� , � ��J � ! 1.0o Ac. \ � �- � ,�� j ._~ -- • - --,.._----.-- _._.__._-- ---• - � °r ' � �� .� •�, \ � u� `, . �♦ ' �'�, ' 6' . ,�� , ` �, O• h0 � � ,�.,�' � r' � -'" / ~T ` � s� I \� ~� �+ '7 � • � 4 � ,,\ pF `\ w M1'� ��?. � `\ _ _e.� � \ � �. �� \`'i�00 C. ,�� ' �� -�. a IS � �� V \ :S `{r� �.,,,i, � I5 N6 � �� m�� Op. 141� P. 3H �S � � �� _� ,J� � ,`\ D :tlay o aukcEr �' r• 72f � _� - �a�� r°s�°� �U��.�r 1� �/�T �� t �� 2�w r �=2- �t � ._ � . ,�:�- . , . ,..� � • � � � � APPLICATION FOR SERVICES ;, : Services Requestec�. .; , .. <> _ _ . > :�<: p Improvements Permit� (EstablishedlRecorded Lot _ Reins ection of Existing System (Loan Closing) _ Impxovements Permit (Unrecorded Lot) _ Repair/Replace existing Septic System � O � � W U � a W d z Improvements Permit (Mobile Home Replace) +�Permit for New Well Improvements Permit (Addition) _ Replace Existing Well ; .. ;:> Vt'ater Sample to be Collecteds .: � ; ., _. .. _. . _ Bacteria Chemical _ Petroleum _ Pesticide 1. Permit requested by: . owner/prospective owner/agent:,/ ; nw �od �• S�^� Address: � D � �.�,r $� R iS ome Phone #: S9 �- 5�3 � usiness Phone #: - 7. Dimensions or Proposed Structure: Width: `�'`�' � _ . .. -� . _ Lead 8. What type (if any, additions, expansions, or replacement is anticipated to the structure or facility that this sewage disposal system is intended to serve? Name and address of cunent owner: 9. Water su ply type: � - . D Q,�� private public ❑ community ❑ spring ❑ -�.i.�-1� rnorf.N.� �wl ' rw �. Are any wells on adjoining property?Yes C�No [j. � ,�„ If so, identify location: 3�.-�-� �-� �� i'�"°p`'r�� oY %Jb�J �1 Property Description: Lot size: I a-�- • Tax Map#: �1� C'�-h�> n<-�' 9 N�� ' s 10. Type of structure/facility: Proposed: Existing: C3 Parcel#: � Type of dwelljag: Township: �-•- _-•-- L�--- House: C`��Mobile Home: C� Business: ❑ Directions to property: State Road #& Road mes,�tc./� / ls�� - %ilJCi'm�-�w�l.fc..w � Number of occupants or people to be served: � Type of business: Number of Employees: Number of bedrooms: � Garbage Disposal? Yes ❑ No G� Rasement? Yes ❑ No� 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 Pet'SOn COunty Health Depal'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. s Authorized Agent Permit Issued ❑ Signature Date ^ - � Permit Denied ❑ � � Plat Observed ❑ ;` . : FACr9xs-s�reEvntvnnor� ;;. , :; . ;; :Xxe4t; ;: i�2 ; ax�3 ;; ?�+d ...,,:. _ . . . __ _ _. 1. S1APE (%) S S S S PS PS PS PS U U U U 2. SOIL TEX?URE (12-36 IN.) S S S S (SANDY, LOAMY. CLAYEY. NOTE 2:1 CLAY) PS PS PS PS U U U U 3. SOILS7RUCIVRE(12-361N.) S S S S (CLAYEY SOiLS) PS PS PS PS U U U U_ �. SOIL DEPTtt (IN.) S S S S PS PS PS PS U U U U S. RES'IRlC17V E HORIZANS (INJ S S S - S (IMPERVIOUS SiRATA. ROCK) PS PS PS PS u u u u 6. SOiLDRAINAGFJGROUNDWA7ER S S S S (EX7ERNAL & IMERNAL) PS PS PS PS U U U U 7. SOILPERMEABiLTTY S S S S (PERCOLOATION RA7"E) PS PS PS PS U U U U 8. AVAII,ABLE SPACE S S S S PS PS PS PS U U U U 9. SL7ECLASSIFICAiION(SEEBELOW) SOIL SERIES SSUITABLE PS-PROVISIONALLYSUITAIILE U-UNSUiTABLE RECOMMENDATIONS/COMMENTS: SITE CLASSIFICATION DIAGRAM (Include: Soil areas, property lines, roads, streams, gullies, wet areas, �ll areas, wells, water bodies, slope patterns, etc.� C:�AMiPA01DOCSAPPSEC.SM FINANCE.PC N01•31'03'E 25.33' � � � �� C� � � ♦-�— � � C0� COF . � I // � � TF /� PLOT PLAN FOR LINWOOD JONES � i � i i i 'i •' g,IR GRApH f Inch � �0 /f. � IF ■ . t PERSON COUNTY HEALTH DEPARTMENT � WELL AND SEWAGE STTE, LOCATION IMPROVEMENT PERMIT Tax Map # l� .� 5 Parcel # /�Z Zoning Township ` ' Owner/Contractor ►! n �. a o�� f7. �o � P� Dat ��- �� Location/Address S/Lt� 13 3 3 -� S�.-e� /'� 3 L,_�o t �n ►-f _� v s`f 6e�� C,� �; 0944 Subdivision N Permit Void after 60 months. Permit Void if not in compliance with zoning regulations. Pertnits may be voided if site is altered � ten d se c anged. Well and Septic Layout by Comments: Date 7- �a -9� Installed by f`Jl /x� L��IS Approved by ell Permit Paid [�' WELL SYSTEM SPECIFICATIONS 3ividual ✓ Semi-Public Required Slab �blic Replacement Air Vent �-� � �" � � n te Approved ✓ Required Well Log �' ell Head Approved � Well Tag 1� . . _ � . Comments: "� l — I � Installed by, 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 condi[ions on the propeRy or for statements in this repoR that may have resulted from false or misleading statements provided to him in the application. Neither Person County nor the environmental health specialist wazrants that the septic tank system will continue ro function satisfacrorily in the future or tha[ the water supply will remain potable. r.�amipro\permit.sam O1/95 rev.1.0 . � , .p� 8iiplir�ttQn C1a�gt ,� %'aZ.S� � � � �,, �!`�: �o� � ArnouRt Patd� ��.'Z�j 7'ax Meo #: , f o ' � w�� • i � � �� o ►3 ��_ s �I�IC�.S �1� - -.,_- � o �-�-�-� ��.��.m�.�,.-.. o�.m.a.n g-�e�a.� APPIi.lC1lTIQN FOR 3ERVIGES Hcrne RePlacomatt/Adddbn) � S15Q.0013�200.00 1) Permit reqeaested by: Ownerlager�tlproapect�ve owner); t� � w0 Home Phone: 33l�- rl -S S/ Address;i �/ Business Phone�33 � -so �-��! ' !� � NG �2) Name and addross oi curre� owner. � � o , o �rea rttu � ' � ' o , N. C. 27S7�f (� 3) Pra}�erty Descrlption: Lat size: �i1cR�' t Township: Subdivisien: Lot � 1 Directions to the property (lnduding road nam8s and numbers): �ts NG-59 he�ru ��ac„�� 4) Proposed Use and Stracture D�scrtption: answer each of the followin ' questians: ,. 'a) Proposed _z„_,/ Existlrtg Type af Structure:"� N4xl�...f�c.�. �m�., Wfdth:�'_ Depth: �8 ' b) Nuinber b1` Bedrocros:' � Number of nccupants or people to be servecL �_ '�� c) Basemeni Yes._.�, �Nc �Il�r,a be plumbing in the basement? � d) 6�rbage Disposai: lfes . No 5) Watar 8upply Typa Private �ew � cr exist(ng`� Publi� rnmunity",, Spring � Are any wells nn adjoining prope�fy? Yes No _ tF yes, please indicate approxtmate Eocatlon on the 'sfEe ptan. 8) Does your property cnntain prerriousty id�ntifled Jariadlctlonal wetlands? Yea No � QLEAB� NOTE 'THE Rp�LOWING: � 9 A PLAT QF TH�e pROPERTY OR SITE PLAN MU3T 8� SElB11A�TTED WlTM THIS AP��lCATiON. ➢ PROPERTY L1NES AND GORNERS MUST BE CR,EAI2LY MARiCEQ. � � 7'}�l� PRQpO$ED [,OCATI�N OF ALI. STRUCTUR�S MUST BE ST/�(Ep OR FI.AGG�D. D THE SITE MU9'� �E REiADILY ACCE$SIBL� pOR AN �1/ALLlAT10N BY THE HFALTH D�PAR'PI4IENT STAFF. ' . 1 hereby rnake app!lcation .to tha person CcUnty Health �epartment for a sit� evaluation for the on-site sewage disposa! system for the above-describe� prope agrea that the contents of this application �e true and represent the maximum faci[ities to be placed an the prcpe . 1 u erstand if the site Is altered or tt�e IMended usa changes� the permif shali invalid. ' . k�� Owner or Lepa! Represe � � Date . PCiiD, rev. o8I27102 T0 3JCd 021I/1N3 AlNf10� NOS�13d 808LL659EE 5Z �0Z 900Z/60/£0 N Q. � � � w c� � w � z W 3 W O r7 � N 0 n > LECEuD NF' � NAII FOfl1� NS o NAiL SET 1F � IR011 FOVNp Is o �RpH SFT YP o WTFfELA7tCAl 707Mi �M wrc�r t��JL!"! w■.r ^t r�[�e�w oorrnruN e► �..��,� I�iM IIaI! 0/ IK M�a`�d�Y r�� ' IS lpI1I1O !� t!OM(�l. M7f R�1 Y� ��y /d R�IlTu1f0� ,w I� Mli AIfQ �f _ � MIKi.�Y I��Il .1_ G��pI � 1 Ji1�L o't�oR "" - ..ui�ro� er"uao, �%�L—�/y�y�f -------- \ % � \ �. �71lfAu C. 4AK:FY ,,\/ 0N 22� P )D3 � / n Girs3 s111m. S£�1m uD o.lr[n. �Htf fs � neniy[�i nAr. �ar rw nc[awrtar. u�rs o� wrnc��xccs. � � D�UiYE7o115 zi: s u�v�t s*n[cr vo eox itte� ROXBppp �(�7ry �a� 27373 lNof Sp►-en7 �. 2 �.00 � oownac a saoYa C.l. IN. P. SN iatx olua�w ruta caxn I. """�M�II�{m •-.,.___. tUlfli11�4T IMtS �� A.�fvl�ld� 0/ lup �ItnIM �a�ni ►IMtf n iwp �,q �y M�f 1 ...�_..� �1" I![ili�pm'�.W SIItK� '��V+a�.�_. PLAT OF SURVEY WILLIAM G. OAKLEY CUNMlNGHAM Tlyp., pERSON COUNiY, M.C. JUNE 1995, HAMLET7-JENNINGS d ASSOCIA7E5 NEaI C. kAMLETf 1-2465 L � j j "�' = lN qMx� !M . e� !!. �� -�, � .� �rtirq, e °•�. is,; ,?+ �n ��i ueo,�y� f E A L ,`+p�'l tA f�.4'� y,��'� � I � NpT� s� `f o�� °UBLt�� 4 �M „M�1, � v �. .AlLc'wam 'rO� +' ra.i ..J nur'uw :.� aaiv. nur mis cau�[!� AM IC1WL !1[F�fltll /IIOY =�r �K Vm n AJpr14p1 �� IIIlPI Rtplqp 1� �ppR �_, r+a�__ [re.��enu��.rnc�wou�[t "�TM�"otux.f�twrtr pI �� K K[M�l lMttllm Wy 1. � p/Ml R�ll� Of 11t L 1 �T( 11� IIfaIWf10RlRp IN pQ �t� TMI fx Aall� 01 /f�Ciflp�`�{ L4. Y��Ip. q�IIIY IwI _ RURD t! I�S• IiMT MIf �t�f ��S � KiI1TL1m lN0 fU1Rtw. �LL1 Y-� ru�.� u �irn r.t. a-x u �D voK a m�f nr wo �tmwtcte •`oom. .�mm � at��rc �1rr �K ou Daanla er M rata�.� 4s*�ypf K�f7TUf p� µ�� yp�4 TIIf _M•p,�� IIKn ��0 ��IfIK f4t. MIS J.. a+-..JIL_.. �.o.. n •.nnr or —L[... n� ,�.4.�Q e.�- � �r�, �,� Rr7niunw 11rG �..�.�JiN---�. w Cwr��la� [sIR7 1F — �� . 1 � `�.�.rti � 1 � ^ ` � � �.� � • .:3. �'�e�l.�-i1L'a�zai.��► �J-rn�,s�.� ��m.�i��a. �uifl�ing Add'a�ons/ I�obi�e �o�ae �e�flac��e�ts Tax Map #:_�� Approval Requested for: Applicaut �. Address: Phone #'s: Parcel#: 6 ga � Mobile Home Replacement Building Addition �� Permit Located: � Yes No � Installation Date: �'l�l�—Q Design flow: � d(gpd) Current Contract with Certified Operator on file (if required): 1'! � Water Supply: `i� Well Public or Community Wastewater system shows no visual evidence of failure on: � o� �`-� �P -(date) � (Applicant's signature if site visit is not required) Comments: /��li vl'7'Q��'( �jrV( �%� �,t /+-t 6�C.� � � `� (�Ilkc �-2 � : r��dit�o�eplac��ent App�-oved � 7 a�� Environmental Health Specialist Date `� 11/1 �/O5 or � ,e � �o vt�� We cUer- �� c� �+ � � � � [,� ~(�-e C�,�-��-u c �� t �� • N ��y'�� /��T�y�� . . . , ' -�+ � `1J � �1 V � JL ' . . �. -.33�13`�"""^"" `O3'n.�A� � ��o�.�� STTE PLAN Name CL�v "' ' ��`�' �Q ' -' �� Taz Map ��sParcei # � o � g Secrion/Lot# � Authorized Stau Ageat Date � System rnmpaaeatv srpresear sppro�ee caamurs aalp. The coau-rc[vrmuat9ag t6e sysa:m priot to begraaiag r3e iastmllatrba tu ;^g••r �tP�Pu'gr:''deiam�iataiaed � S�`F ��`' �``s'�- �� - � � < �� . �� a� � _ ��,.�� 5��- _ �.?� t`� � 5 � �'� s'�. �� ` �rc� �cC rfs � � � w�� s� �,;�� w Gt�e ��► . � Sa,ti,,� loea�'wt . , A�j �r�� e.5 �I`�"+� �-�n°[�- �G[� ecC • s��: I/�a �1� � rcfm> �. o�/�z/oi � l'li1t5UN (:UUN'I'Y IiNV11tUNMI:N'I'11�� IIL:AI.'I'll WELL LOG Date:..L`_ `� - S ��('(�i�,�(Z, SR# Owner: � � �� ' � Location/Directions: . , Subdivision Namc: 1u�� F ' Lot #� I Drilling Contractor: 1►J E� A SO � �� WELI, CONSTRUCTION Distance from Ncarest Property Line _ Distance from Source of Pollution Total.Dep.th: Ft. Yield: � GPM Static Watet Level Ft. Water Bearing Zones: Depth _ Ft Ft. FG Ft. Casing: Depth: From�_to� Ft. Diameter: � Inches TYPE: Steel � Galvanized Steel � If Steel, does owner approvc: Yes No � Weight: Thickness:�..� Height Above Ground: Inches I?rive Shoe: Yes No Were Problems Encountered in Setting the Casing? Yes______ No ;f "y cs" givc : cason: Grout: Type: Neat Sand/Cement _ Concrete Annular Space Width �Z. Inches Water in Annular Space: Yes No______ Ivlethod: Pumped_ Pressure_ �'o�� ✓ Depth: From � to � Ft. Materials Used: No. Bags Portland Cement Weight of .1 bag,__.lbs. If mixture (sand, gravel, cuttings) - Ratio: t� . ID Plates: Yes�✓, _ No 4 x 4 slab Yes No I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH REGULATIONS SET FORTH BY�THE PERSON COUNTY HEALTH DEPARTMENT. . , ... � .. ' �-�6-�6 :�, . , Signature of Contrac ,_ - v1t� ;: