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A26 163
�ul-O7-98 03:44P P.02 " 06--26-1998 04:37PM �F2ElM PERSON COI.�JTY HEALTH DEPA TO 5994?76 P.01 •' . �_• •'Amount' paid 3'1J�,D0 � ; ' '7- !1}-R� i' � � . `'aecei¢t i � 1 r19/f ` ' � bace . . •, . : � �o�� �. . � . � �im � veni¢�tits Forniw(�is Lotj T Reinspoctson af Existing Syst� (L<�an �losing,) lm�ov+�ts Pe�tiit�tlni�o�+dod LAt .� Ragair/Rxplacc cxisting Sepfre �yeccem improvemencs i�ermit (Mobile H�mc :Fif aac) � Pem�it for New Vyell � _-._ Ii�t � rovetq�ts Pectnii (Addition) ' .,._.. R�placc Exisung Wc}i . - � • . . . - � ; � (J�� ,rw � -�- . � , ' � � cstkide • _„ I.ead . T. �azoosi� l...,�am�ca! ; i ._.. Pc.praleutu �.. P . � .� . • � { ; � t. te�ii ` tad b. ; T. Di�rc�sions or Proposed Suudi�: � : w�. ..- w�er tiYe�owa genG ;.�.._.. • �.�-_-. a - .�:'. : E�d.te�� ,�t.�.b t�-� �� . (Q � � ;� ?��;.---�-..---. 8. iNhat tyQe (f a�y. addiE'son� e�m�5ions, or -�. a� _ � -�------ caplaa.ernetit.is attticipat�d to thie sttucwra ar fa�eility : . � , � . ', `J : ' that this s�wag� �'tsposatl systein i; atLatded tv scrYc? me Phone #i S�t__ i_-,� !�(d q . , �, • � vsin#:ss Pho�c i�:: . . , i � c. � . 1� aad � of inen't avnec: ..� � 9. Wa�t�Y �i'P� - � ' gtivatc public II community Q. spring D.. . _ , �;�+�rrn-, � uc � Are any ardls an ad3a�g pcopaty?Ycs � Nv p. ' � .�t.: . .n. � Kr �,Y I so, i�catiEy tocatian:. - ' ' � � :Pmperty De9cii I.cc s�c: " - � • . • . �+'i'�� � � w.l .:hi "�� /_ ;� � ,. _ � �ii����iaaMv.��riLl�r��' �fPN�. ��iQ�;Q � � Par�#: ;, 3`l7 sFe� � :; Type a� dw�elt�g: '�;- � Hous�ee:� Mob�,c Iiotr�:�Hts�iaess: f� � �b� . � ' . �_ . au : . , , ' � � � � - 'Ij►p��of tiusin�ss: ' � ° : . a� . � Diroaiv� io�prt�peRY, ; _ t�ic R�d � �c �oad � � �'�"' . � ; : ;. Numbo� of �aipic>,y�es: � � � ames'�-� . < � uu_ ' : : ' � - � � - � . , .� Nu�bec oibcd�+oam� � . ; � � �r• ` � .. . . _.... ; ' �Satb�Aga Dispass�� YrS C3 NO �i .. . � - ��' Baaeateat't Ycs❑ No�'so, # of baseuzcnt fxmc� : I�`umber� of� ' ts or p�Ogl,e w b�' �#cvod: . . . . : .: . � � cL�;xsr� �yf:�. eoxri ��s aF r�aog p�a� � �.cv��a�< �L� : > opa��u s�v�r�s. �. I�7ElGI3 TIlA�GId + tCAi1011 t0 �1�' �I�S� � ounty Health Dtpartment for a sitc evaln�ciori far the�a�sice � Y �PP� . �, ; scwti�ge dis�a�:.syst�m far thc above dq�c�t�bc� Prop�ty- I�that the oontattts of ihis;apgltcat,io� ��. ��' and =cpr�ttt 1� maximurn f�alicias w��piaocd an the pco�pert�. i u�derst�na if che sicG �s�altered' or�e ; � intocided �s�ie ctiaifges, tli� pci�it shali.Eie e invalid. I undecstu�d that�befare an I�ag��� P'a�t c�a bc ; issuocl. I ctu�t: present-a sgrv�jr p]aE of sl�I�PertY to the �%alih Depi. :I.understand that;in tf� �vent � havc'r►ot . � dcliverr.,d a;s�t,►ey, .pl�;t aE tha propcRY tt� Flcalti� Depc. within bQ DAYS aftec ti� dau of tho evaIaation of . sho sice by the Huilth Dept.. c�is �ppIIica� � shatl bcoom�t void �nd alt ��hses paid faif'titod. . w , - ' j ; j . . � • • � . • + . . .' . . z � � � �4n«� Own�r Or Autborixa�d . . ' , . -f . . TOTAL P.OI � NOV-12-98 THU 05�54 PM LEADER BURLINGTON FAX N0, 336 227 3458 P.02 SURVEY MAP ADpGNpUM , Fi�s No. 98ot7o.,.�._..__.. , �orrower,_Na��.1/A:.%_►�Y ..-._._.__ . ' ' F!qL:?Y.nddres; __NG_?��.� --..�....�.L_�.....,�___ . ' ' Ciry_Roxboro � Cocm,cY,Pg�gpn �^'�'—""— sc�te N _� ��^ , . . ;_�Raericaimt..4e�d�r Home ��1e_s `�__ ---- -� ------_.__���«te 2�5�� ___ .. .. . _ aeqrass 800 S:S?ra�� ni Ho�edalg R�I..�purfingtpy..NC Z72�5� —� . . i:.. . . �.� _ !i r . . � �. � . j; � , � vo� r . 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(ecol au•s�n • .. � V � a �` N B 2654 PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IN�ROVEMENT PERMIT Not for waste water system construction. No permit(s) for Construction Location or Relocation Activity shall be issued until Authorization for waste water system construction has been issued. Tax Map # � % . ( „ Parcel # Zoning Township _ Owner/Contractor Q L tio�/Address � � �.1i�..__,n 1..� _ _ -, Subdivision Name I � t I l � E --- �. - ,�i :� � P �i �' �� e �� SEWAGE SYSTEM SPECIFICATIONS Repair Lot Area Size of Tank - SFD � Mobile Home Il Size of Pump Tank Business # of Bedrooms�_ Nitrification Line 3' Permits may be voided if site is Well and Septic Layout by Comments:�Q�,Q- � � by Max Depth Trenches �y � � c��.. � �a �� C— � �t'N15`�"' or inte �d use changed. Approved ?is �49 Well Permit Paid WELL SYSTEM SPECIFICATIONS Individual ✓Semi-Public Required Slab � Public Replacement Air Vent Site Approved L� Required Well Log _ Well Head Approved W 11 Tag Grouting Approved - ' � j � � � �,�', • 'r��,jA'�1 , . , � • .. ,.� �. = � i� -� � Approved 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 conditions on the property or for statements in this report that may have resulted from false or misleading statements provided to him in the application. 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. c:\amipro�permit.sam O1/95 rev.l.l s . . . . ' : . .:»..._..._. _ _ _ . Rebecca F. Long ; ..'. D.B. 231-570 .. �i '.I � N 81'16'23"W I — 25.75 N 81' 16'23" �y Control � 97• � 6 Corner N O W N O � O � o 0 m / � .� � c J L• � �3 O d � � 0 /s� � � '� � c a� U Control Corner � ^ �� N � �� � � `��I 424.38 S 81'16'23"E SCALE I . . � ' � . � S j • � ' . . � � ' � x � : . ♦ ' ' „ Ern est _��B.:�L. Wo�. ��,, � 252 N:_ Lam.ar �: St.;Rc ;, ; l '�'�v � Rebecca F. Long O.B. 222-654 N 81' 16'23" W 201.47 � =o o � 0 o `� N N M 0 Z , Graves T. � D.B. 254 (Life Est Then ' Ethel F. W I Cn 0 w N p � O O � f�'I � Rebecca F. Long D.B. 231-570 N 81'16'23"W I — 25.75 I t 1 N 81' 16'23" W Control 197.16 Corner � � �c -.J L � �3 0 a - � � w O ls9 � a� .� N C a� U Control Corner ' �� V � v� � � �. , , `� 424.38 S 81'16'23"E - SCALE - Ernest � Ba: _Wood; . . _ .. . -- 252 �N: Lamar `: St:,R � � f i�-�. Rebecca F. Long �� D.B. 222-654 a N 81' 16'23'' ►�r 201.47 � �, r Graves T. D. B. 25 (Life Es Then Ethel F. 61/66/1995 23:10 � 8044547843 BENNETr wELLDRILLING FERSON COUNTY �?Il'[ h0(�'tF,?'� i!;, H�AL'il� b'Ft.t, I.� ; PAGE 02 1)aiC' �- �?S,-9� (�tvner' � -- � � , �.., .�., _ �_. SR�f� .. .. _ . ... _ . _ �. . . __ . . __ � - .. .. l.c ���t'c �a� ' ec �c�nt: .5 y.T�lC� ��.�c�__�_ �'��a-�r�1 � ��.�- .������.��...�.� �- ..... .. . �_-�-� .....M _._.. . .� .�._ ._. .. , . �.�..... _ .... . . - - _- - �;��t•,r,�i��i�ic�n h';�me' I,��t #i . __ .,. .. _. _ ._. . , __,.... . ..,�. . .._.. ..._.. ..,.__ l�r�llinfi t:�nt�actor: �• ,:. . . . . --..� i���� 1�� � . �;,� ..__. . .. ........_.... _ _..�.. .. _ .... _.. w�,�,t� �.c�Ns�r� uc�jo [)i�,r�ncc Cr��rn N�ue�st T'�r,�x'r�V I,inc...,... .___ ni�t�nc�� l�r�,��t S��uit;�• <�( i'�lluti�tt " --.- Total I)���th�. aa.,'�_. . Ft.'�icici; ���� _��_ G}''�Z Staci�: Wa�c.r l�e��el. ,.._..__ _F�. ��':��er F3earinA :Lonc>: C)epct� _I�t._._.__.._.�'�•_. .._ .... .�._f`t..--. _�'t. C:asing: Depth: %r��rn _,Q.___._to�X" Ft. L�iametc,r: _�.��! ,�Il►<h�.s 7'Yl'E: Steel _. . _ � .._ _ Cslvenizerf Steel V' _ _.. . _... .---- - - IE Siccl. dc�es �wneT apJnovc: Ycs���_N��_-- -- Weight:,�.3 Tfuckness�.�� ti�:;�,ht Al�ove C�r��and:---.��%Inches [?ri�e Shor.: Ye.s v�,,, Na,_„�� �Vcre I'r�blrms �nco�mtered i�n Settin� �?�� ('uinF,? �'es�... ..__ No� v Yf ��)'�5�� �1�'�; I��SVI1: . ----� - -----------.... .._ ._--• • --•- ---- � �ic��lt: �rV�,�c: �il!8l____...'�.�__.._ Sa,nci/Cement _-- ,��h;1CfClC Annular Spact Wid�h_.. � �....._.���r�^1�cs ----. _ .... .__.�... .._ Water in Aruiulu 5pace: Yes_ __ l�o�✓��,_ M�thod; ptunped :� P`te.ssure.�__.._.__ 1'otued�.�.�, _�, 1?cpth' Ftum L�� tp_._„�v ,.G„ _ T: �=t� ... MateriaLs lJs�cl: N�. �ags Ponland Ccr�r�.7it _ Weig,l�c of l ha�.._9� 1t�5. (f mixcure � sa��d, gTav�1, c�a�tings) - Raii��:_..------ J'o.. !D Plates: Ye5 ✓ _N� -�----- ._.�.�__ ---�-� Q x 4 slab Yes �_� No.�,._, ._._ .�.. _ . . ....... ...... 1�Rt1:.1�tc ���c.� _ Ue� ..� From 0�� r�. � . /1�.�. t. .... ..._.._, �.. ..___ . .� ..._.__ Q..__.. , � . _.... _ To. _ ^ ._ Fotmati�an Descri�tiori '� � .�'. .. ... � � - . - .. ��C2�rx-.��.�� T .-�-- •-.�---� ---- _ . . . .. _. . -..� . _ ".... _ i a_--. -�,,a , ....�---- --.-�-- ,.�, ._.�...... ._ -- .__ . ...- �2�t'�c`_- , _.�._ _�. ... ...�_.._. _... _._.._... �-----. `r�� _��� . ___.. _. ... . . .�... . _._��._ . ._ . . � � i ��rR���Y c�R��i��tTNA'r'T�-IEABUVETNFC�rz�i������c.�;�� l:� ��OFz�t���c��r �Ju�l�}������ 'T��1S V�'F.[.[, WAS CoNsrRur. rF.t7 �N Acr.,C�F;7:�NC�: titiTCN RC_C�L�I...+1�I'it�:��ti �E•:�' Fc�n�rE.� ��' TH� ��RsO;� C"?� ��i��+ N�a�.:ri-; ���PAR"t'J�t�rvr. !r.�C.u. � .f��c���.... ._ ._ .... . .����''~".�� S�gnaturc of (:�ncraccvr p�;c.