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A25 209_ ;r�yi�. Si.^,�97 �)��_ ,� � � �U � _� 3:_l��C�"'`:.? __�� i:.��., N..(f£ : ' �:ii: `� � . y- -�L �i-- — ;�c .:r'�"i� nt:' � j�-.�C:_t 'F � � W � �--��--.��, p � � I��-�� �� c`�Y ��� _ .�_ _ ��- � --�--=�--�--- � ;� � -�-�-�--�,� � 1L—=.�:�.-e--�.u–.�:>�<��..��.�y.�..,� �,..:11 1i��L.�:._:.,�IY.LL.li�� .�Pc�'�.1r,�kTlt�rd rt'>�Q 5�:ti`J�C�`.'r i�npra�c,m:;r�ts Parmit (Racoruad Loc) ;'��O.UD lU I�nprovernc:ius Pamui - $150.OU (i`IobUa Home RepiacemanL'Adtliuoi�) ' � hapairlReplaCa E:isting Sys[em Fennii siti.] , ::: �Vi.11l'tfilltC(IV�VVlf�:.plaGdnlaili) �?''�..iU '- ConsUu�:iun �uthunz�cion i'cr Sapiic Sycw,r�o $1 �U.001$200.00 P�rnu� hevision Fea - :�7:i.U0 �� �`'t-�'_��ti: t��� ��;�7l�i�9 I'r; 7N� .�r r��i�C.�7�t3iv ��=�G� �.+� 39FJ��ku��sul�i�lf' r��tu�6l' i� dti'.i� t��n'.� _�..�� a�:! .�_=;^: i.� i,'r�f,i�ti:���_:�tti fti-1� S11"c iS �L7�3:e� -f; J� ivi 7�;� 1�v'd�'�f3tl�3�r►iEi�i7 P�k�:s�V��" .4i�D :�13-fi�1L'is�yL� �'t:.5;`'i:� ����� � y*�13�����iA�� B��Cfli�u.�� ItvV,4L1�. — -- . �j i �—> Y'o:;'ii':llt 1'v�ya:r:�r,;;v�''� f: tlJWvit5ZC1a�::Vfi7[%�ifO:+��b�C.TIVJ: u�i11V'i�..'G�: � �'r', i-'sJ�;�� r-i��;r�r: � h:�dress: � o � --'S2 Eusinass Phuna:��-'�"�� ���--� � iV::�c`,1:3 u�hl� �ia:l�i.ii�Sy 07' CLiifY27iY OVJi(YdY: � � - � ��Q/ ��O � cn,Jc�� - t��. �o� l,��2�1� � s _ 3j �r��:.i►y ��:s�ri�.sti�yti: Loi size: .�dLk�Totivnship: Subdivision: Dis�cti�rs to th� prop�rty (Indu�ing road narn::s and numb�rs):�,�-,� � �t / .� � i _ � �' _ _ r � ii - ^�� -- � � j t} :3Tit:.7�cs� Us� anj� �.rucYura �es�,•r��:,tir��ti: ansv��er e-ch of the " i{owi g�a�t;oi�s: � ( .�) Pioposad r/ Existing _, Ty�e of Struciure: . � Vvidcn: �8 Oa;�u-�: �d bj ��lun�b�r oi Bedroon�s: � Numb�r ur" occupants or peopl� to b:; scrve�: c} 8a��ina;ii: Yes , No ��1Viii 'ti�er� b� �lu�nbing in tl��e t�asen�enr`' d) Gaio��a L isposai: Ye� _, IVo � �) '��:�,:r�y ����N�� '�y�::: Private �new � axistin��, Public_, Communi�y�, Spriny _ ,�re any �vells on adjuininc� pr�p�riy? Yas_ �lo � Ir y�s, pliasa indicaia up��,o;:irn:��a �oc:-it�on ori ri�� �iie plan. �,, C) LG:i� j/0'atl' �i�.��l�� CGY7i�1Y'/ �f�'�,�9�C1];;.'� tl��:i'i$SYUcx'� j'UlY'6SL'���C1�Y�Gi('�a� 4i��ti�1.aY'i�:; :' �iBS_ iVl�! �t �'}':� •'' f`u'.�J! � �'i i'�C ��J"LiL�`17���1v: r n��.ri.l" ��= i�1� F�'�����: fY O�: S�1"� Ni_.;�r� iu9��Y �� �i���a�ti�Y'I"�i� V�,��7� �"t-i�:. ,�tl��L:ti�,���vov. / �KCJYJ�Rl-`r' LIi��S ,��1D CG►'�i�lc `� i�ri� ;�' �s� CL�t:�Y �vV.�fi�G�'�:;�;, i 7i-�� r'i:�Jt�CSIE�7 LO�C�TI�Gt�3 d� .�:iiL 5 fCL� :'l"f�u�� is�diU�Y i�� �T.�.i4:i'�S ai� 'r=U���G�':�. %' �'�-i� S11'� 1��17�1" �� R:�.Gii.Y .�V,����:�,."+l��L� �t`3�,�i" �t�:;,i,ll�1"i�6�1 '-��`�'�i-l�c :i`1.Lii-d 1�n�i��=.�.7i.'s::1v-i �,�'.�:�=i=. � I n�re�y ni�i:e application to �ha Person County Hea�th Departmenc ror a si're evatuation ror tr�4 o��-�i« s�ov:.,;U ui�E�os�! sy�t�r�� ror ti;c �dov�-d�scribed propeiry. I agre� tnat tha cenfents ofithis �ppli��tioii are tru� and repres�n� th:: m;:ci;�iun� ra�i{izi�s to b� placeci on the property. I undersiai�d ir the sire is a�iered or thz int�t�dec� use cn�;ng�::, ti�e �::i��,�c ur�:�;i �c;.Gili� in\�<:ii:i. ---� -- � --�.-�- --.��5 na r Lcaal �euresent iiv� ai� ,�i:; ii:, r�v. U,:;271:+'_ ti I � LEGEND NF • NAIL FOUND NS o NAIL SET • IRON FOUND � IRON SET MP ° MATHEMATICAL POINT EOP EDGE OF PAVEMENT .. p •12-29-04 R . 44d.98' L . 97.a3' LC � M03•S7'20"E 97.63' � 3, �i � MORRi3 E WUCLEY 081Ti P A34 � ' C / i � � • D�� �� _ ,_ / _�"- - � 2�� �' 1 �C ,�� . A �• � ,� �► /,� 1WiVET LEE ROQE'1tS �,� t� DD 1�6 p 6a2 �„ • � �� asrse�2a-w � g �Ps.as� / , i � ' M ; r�sEt n DEi71P Sb1►� q. 5� 1 10 � � 11RlPN � i ro EAsiWOOD i ��pp /� � �b ,�pC.�' 0� � � � � � � � �. . /v� + / �,/" `� ss4•erarw � 2493� 6p• R / ,� . -� J i�c.00� S� ,�40 �- 367'13'3b"W ��"'�}8.7C 13'���;6• t`��L 6s��- cv � � � �d �� i ���� ��. ����J �� �.a � .s �1 � � ���� ��.���m�„ ,r„-�:, ���.�.Il IL 33L ��.]1�I�. Applicant: � �� W��UC� � �ermit Valid for x Type of Facility: # of Occupants� Proposed Wastewater Proposed Repair: � Improvement �ermit _ 1�To �zpiration New �Add Projected Daily Flow Permit Conditions: �P�P S � 0� �� `►�' �^ Owner or Legal Represe Authorized State Agent: T�x fVba�p ' � � �rce�l � � � SUbf�'IVIrShOtl Ph�s•e-Sectian L.ot � �Vater Suppiy �l g.p.d. Type: Q Type: Date: Date: ' The issuance of this permit by the Health Department in does not guarantea the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that all Person County Planniug and Zoning and Building Inspections requirements aze met 'This Improvement Permit i� 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 Sewage Treutment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Enviranmental 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 Construci Wastewater System (Required for Building Permit) * See site plan and additional attachments (�. Prop,o,s,ed Wastewater System:��l ���c�CSi 1 Typ�a Wastewater Flow 3� � g.p.d. New x Repair Expansion _ Soil Y,TAR: � � g.p.d./ ft 2 Type of Facility: PS. Basement _ Yes No �astewater Systean Require�aents 'T�nk Size: Septic Tank: �_�ai Pnmp Tank: gal Grease Trap: gal �rain�eld: 'Total Area: �C9c� �q ft Total Length (9 � ft 1Vla�mum Trench Depth � in T�ench Width � it Nlinimnm Soil Cover: _� in Minimum Trench Separation: ( ft 0•C ' �istribution: �, Distribntion Bog Serial Distribntion Pressure Manifold Speciiications• '�� � � J�L���^ -- Authorized State Agsnt: �/C�r Permit Exniranon Date: The type of system permitted is � Conventional permit. �wner/�egal �epresentative: Accepted Date: Alternative. I accept the specifications of the Date: PCHD rev. 11/10/OS R -�" .� .� . (336,� ��� :�-�:7675 . ._ . � � � � . a � � -� . : . E �x ��r � � � � . � . : . L-- 3,�50 ._ "� 1 inch — ;40 it . . �A� . �' � � � � �-�. . " . � . . . ., . . _ : . , � .� � �' � � � . . . . � � � . � _..._ fi. c� --�. . - . : . : . � . _, � �. . . . ' � �S � �; � � a . . �. � .. ' � . . . � . � . : � ,� , (� � . � . � � � . . � - ;PLAT C�1B � I� • HAIVL�R. '. 3 O 3. - . . � " � . • '!Yled in � aurdg It�gisttr�af ori. tha . �- � � � � I . . GORDON SOUTHERN . . . . , . .:.. �� °1 ` •z� .Q.�ie� q :�� a ccac� : � . : � -�-- � -- � � . 1 . . � � .. . ' > � � � : : : � � 0 � � D.B; 237/25 . . , _ • . . � �. � � '�- . � � . . .1 : �� � ' � �, :. . : _ " . _ �. �: '� � . . . � W . _ . ' ' . . ' : . . �� �r c�,a:�, .nBQ�ear or �oa: '�' `� z _ . � � � CONTROL { . . � . ` � . . . � � . . .. . � . � . . � � �-- S � � CORNER � s �. � y� . � . � . .. . - , ". �� � � � 1 �' � , /1 � � . . ' . . . . .. J .. y a � �4� 15"f . , '�� , �' b � � . � � � � W . . � � � �3��0�' . , � { R � �' c� ; : . . :.` . .. . � . : . . -- . _ . . .. .. - . � . : .� � � � a �. `� . . . . � :� : ` N � s& , � 8 = � � � . • � . . . . . ' � . ' .. . . ' , 4s,��H ' i . . . t ! 1+ � . . "'� . ' �� � y � , . • . . ' . ,. � � E' . � B . � . ' '. . ' • ��P � ' . . . . • . �Ss,s�. ' ' . ::I • �' �'.� p � ;J:. 5 , _ . . . . �'� �j � ' ' , . . , � , � _ ,. 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"J . . � H , ROI. ,�60`' : - : .. V�� , ER. . . . . . . � ! � � ... 0 0 cV � � , � , � p ' � �:: � . Z� �. - . .. . � ��' 02»� . 51' , " �., 58.,�2g��4� . , ��° 3� a� . . � W . ' . . '. . ' . � � , N N . iv� �- r � � � M Z '• � � � � �.$i � �� qD' � � I . - ROBERT WALLER D.B:�.260 808 . ��: , lV � �nw p-6ox � ouFt� Pafe_ � . S6�°g ��; :: : .� .. , . � : . � � �`, �� � ��� . :9�..- . _ . . . , � . � �� ��� . .. . � :5 � . . � d 1 � ���. . . . ' � �'a. � � �' (Qb ,� . . � ` � � . � .h�" . . . � �. . � . . . g �. �e� rYL►� � � 1 ,;,�, �y`� � -� . . � � ��P���t �p�'`i .,��• . . _ "' . , -: , :. :: �:�_ ;: - Q " ,�� . �•It'i�xj hAr;e5y cerlifd Eha! .l am(wa ara) Che o+nii B. , �{� � 31.68� t D � " � , . . .Pf°P�f! �shou�t attd described heteon 'ivhic)t �ivaa ^ � _ °, metus) by. deed �cd:ded tn. the l�rsqn Lbeit►tg. !�4 ie �. . . . .p1J4cs 4n . Book : .; ��q . �� . � Jr��.• � �3 � th�s pian oj assbdivi.ttott .miti► �mc+') 1les. c�taeri�, " �` ' ; � ��� , ' . � . »tinimu»s 6uildf'ng� tdnes: cnd•� d¢d{catd al� _ atL t�` . � -sasemsnta.` Pa*ks.: �ar�i olher� apsrt :s�lae�§ ta: • }no6Li� • b ; � �:. � =; tr�iae as tmt�d riertJi,er. �I{tueJ � 4jj/ thut g _ � . • ' showri he+eoa. ts +uiiTs.in tha §�sbdi t+egviation: �scsimf.... - • � � : • . . °� �'�°� c�t� .�+�th r��„a. - ,- .. . . . . . . .. . • . ' .... . � s � .I. .. ' .. . • y. .. .N . ., 4 . , . � . .. �� � � I h�6y oest£J� fhnt ths subdtv�sian ptaE � r,�„�ori� � . . has be¢n grv.nted fi:sa[ agprvva! . parsua�nt !o thad�� Cou�reiy . � - Ss�bdivision Regulatio�ns. . . . . . ^� � . � . a'�lO� ' ,'� . �� F/�RM Por�.p . — ��..�� _.. �� S I���.� �� .�i,►.� 4.. .� . . .. . . .. :. . .. ...... . . . : :_ �� �..� � � � .. . � . . :. � .:. ' ' �-' am;�-�����n.a��.��:�L IC��,m:?1.�71�; . WELL PERMIT - PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT _- Tax Map �" °� � Parcel # �"��� �— Township: Applicant• �� r�- � W ��{ Subdivision: Lot # Type of Water 5upply: �Individual Requirements: Site Approved By: Grouting Approved By: Well Log: Pump Tag: Well Tag: Air Vent• Hose Bib: Casing Height: Concrete Slab: Well Driller: Well Approved by: ****See Attached Site Sketch**** Community Public Liner: Installed by: Depth set: _ Grouted: Date: Water Sample: 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: Date: PCHD rev O1/27/04