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A26 186
. . .. . . . . __ . . ._... .. . ....__ . . . . . . ... . . _ .. _ . ...._ _ . ...._ ..-� � � � .._ : . Aa�+i��n�: '/.�-�� ,. �kmour�Paid: / ,�O • • .. FlBC� . �3�-C� d • . . � �� � ��,��. ,6��. . 6,,1 T�c 11Aaa� !'�o`J� ' _ , ��3�� � � U � '���� i� ���1����-.�J�'�� � _ — � � � �C.�' �� �C �l. 7� �.�-aa-��•.,• �.•oam�i.7� 7E3Ce��-s57Ca Aluu 1[`-s''n�N FOR' S�RWC€5 0 �� pW"�Ilt 1"6QU6�f� L�: {�W[i�t/a9@O�/p�OS�Ye OW[1��: `5-i�a�n�ov� �..• N0.�'w i S Home Phone: g lq - F�S I:139u_ Addres� � flusiness Phan� 5► 4- 3 f�1. -'7�y 5 0 � o.l� ; � nj . c. a1 � o � . z� w� �a �aaan� � c� o�ar; �J �el ri,a � S M AI I l✓u b t9 J � �,t.r-�Qnti�r /� [' . 3) Prapertjl �escriptlon: LOt siz� 1�c r e. Taw�hiQ: DI i � 4,; Subdiviston: _ Lot#'.' Dtre�ons �o tt�s I�P�Y (���9 road. narne9 ar�d numbers): . Cc o o • ; p„�,v� G. : c ' Q r o�,.,•� : s o,�• � t� h�}- 1-�ati..11. 5=$�. c 5o�c.IL 1� c►�w�.r t c,k Ro a d. 4) Pro�l llae and ,�t�hu� D�scaiptiam ans�r � ot the fioilowing ques�ot� . a) �� _,�9 —, TYAe of Sttuc�ure: mo 1�: l c.. l,� .�,.o_. _U�. Dept�: b) Number of Sedcoom� . Number of cccupanls ar peopie to be secveck � ' . c) Ba�men� Yes _, No�1Nm there be �un�6�g in the basement? .. d) Gerbage D�t Yes _, No � ' � �� �Y "�IP` P�� �S. (tmw � ar ex�g ,�. Public_, Ccmttumiiy,_, SPcing _ Are•�ty vueHs on adJoinin9 P��7f? Yes,_ No �, Ityes. plesse it�Ca6e ap�rao�ma�e icr�tion an �e s�e ptan. 6) ooas me p�op.cty �in pMeviou�ly �d jur�nai �� Yes _ t�lo � PLEASE NOTE TNE FOLLOWING: '➢ A PLJ4T CF'it� PROP�TY' OR SIf'E PL�W II�IS4 HE �8W1i'ED IARI�I THiS APPl1CATtON: ��PEii7Y LINE9 AAID CORI�S �IST BE I�.EARLY YARL�. . ➢. THE �DP09� LOCATlON OF ALL 9 iRUCTURE3 A�T 8E 3i'Al� OR AAGCE�. • . ➢ THE SiTE UAU9T BE R�ADILY �1�IBI.E FOR �1i�1 EYALUJRT�N BY THE HEALTH DH:!►�tTN�IT STAF�. .., . i- heret� m�ce a�an fin tha Pe�scn Courrty H�lth Oep�nt for a s�e eyaivation for the oct-siia sewa8� �P� sys�em for the above-descnbed properiy. 1 agree ti�t the �ts cf thts appQ�tion are true and reQ� the �num f�ities tc be pha�ced on the praperty. 1 understand ifi the s�e is aiteced ar the inb�nd�d use changes, the pemut shall beceme'nvalid. ��� 3 � 3 � C. � ° -� Ovmer or Lsgai Rep�ve � Date ' p�.yp. � 10t1710't � 0 � � Aaoitc�tion Data: 10- �a � 03 Ta� R� �� Amour�t Paid• �i��-- Parcel #: � �� �`� . ����ss I�IEI� .� �1�T . . c � ��°�-� 1��aes.-�-a.�-oas�.�aa.�a.71 �3C...��. �. y :��1;i_ .. 1�� ► • " '',=i�l.►�._ �,�o.00t�oo.00 'I) PstmK raqusded by: {Ownsdaearttlprospactfve owner) _5-�..�-o-��.� l�: �. ��"r'�s Hcme Phona:�► �G, -$Sr-`? 3�t c� � Adc�ress: !��/� o S (�-r-,,, IA n 6usineas Phor►e:9 ��. -g�b -�33� . `Ra 1 p� �,y�lr a'1t�o7 .� 2} Namo atld acWress ofl'! tx�rrent owner..�.. �.1.1,.� r�a(ll.+ �,k-_.• riS . ' �i-s-tz'' S �i .�..� . �,�..` • - p�aY 6e rn � 1 '1 �{--� 3) Properly Oas�ripttan: Lnt slze: (��3 Township: Subdivlslon: Laf # Db�ediona to t�e prope�ty (Induding road nart�es and numhers): • . 4� Ptoposaf Uss cture Descriptlon: answer each af the t�l! �� i�, ques8o I . � a) P�P�d._.__� �9.� Ti►pe aistructure: �;e:�-a cJk _ C�-�1r� � dth: �� ��ptfi� �'� b) Numb� � Bedtoorrt�: . Number ot ax�partis or peoQle•to be setv • \ c) Basemer� Yea� No _ Wiil ifi�e be phsmbMg 1� the basemerti? d) Garbage Qispoeaf: Yes ____, Na _ . � 1Nafer 9uPE�lI 7�1p� Prh+�e •{neuv or exl��ng_)� Puhliq,, CammuNty_, Spring _ . . � Are arsy wells an adJaintng pmperty? Yas No ,^ it yea, please indicate �Pprax{mate (ocxt�n on the . s�9 pian. � ��� Y�' A�Y +��t prsviousiy Id�d jwis�ctlona! w�da? Yae Nc P! �e� NA7� �Rt� � r nu�n�r_• • • . — r- — - - A/C PLAT OF THE PRQPER7Y OR SfTE PLAN 1WST 8E SUB�'fED WRH TH1S APPLICATIQN. � �' PROP�RIY LINES AND CORNERS NlI3T BE CLEARLI( MAR!¢p, D� THE PROPQ8ED LOCATION OF ALL STRUCTURES ML19T 9E 5�i41�D OR FLAGGED. D THE 8RE �IST BE READILY ACCESS{BLF FOR AN EYALUATlON 81f THE HEALTH � DEPAiZTYEM' 9T�►FF. • 1 herehy make applicatlon to the Psrson County Health Department ior a site evalua�an fa� the on-site sewage dlsposal syatem for. the sbave�iescxtbed property. I agree that the cantent�'of thia appllc�lan ans true and represart the rrtaximum facBi�es to be ptaced on the praperty. I understand if the stte �S altened or the i�tendecf use changes, �ie permit shall became invaltd. • . �� �-J-�c��..� o � 03 Ovmer or Legal Representa�ve . te ' • PCND. rev. DB27/02 Z/Z 90BLL669CE 41��oH I�tuawuoi�nu3 �o� uosiad WY SS�90 EOOb/lE/Ol `--.�,�,:.�� ���.� �� �., ���T�T�� I��.�ag-���ti�.��,]1 IHI��.]L�7� Applicant: 5tan Ford Location:�' 7 � (Y� p = �ZmilGin nnrn c Ta�x M�E� � � rci�C~�I " � � s��f�����.s��o�, � Ph�s�e Sect�ioi� Lo# # Improvement Permit L, L�t LintS• Permit Valid for �Five Years _ No Ezpiration • / Type of Facility: _f Y10b� �G �(7�Y1 � New V Addition Water Supply �iVatr.-t.�c tl # of Occupants (p I110.X �# of Bedrooms 3' Projected Daily Flow ��(o D g.p.d. � Proposed Wastewater System: C�p � t n� �� C�, '��'Ci,� �' Type: .� Proposed Repair: r�1 ��Ict,-�i�1C _aS`� �'cdc;�L-Ei c�n_ Type: Permit Conditions: 1(1 S�� l( �("anK Io�u.�i'on mc.•.,� b SctrE'i L� Owner or Legal Represen Authorized State Agent: _ i n �oe,c,i Fic� _ . _ ., , _. Date: (o'lZ -'�Z Date: �„ -la - "�2— The issuance of this permit by th� Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicandproperty owner to in sure that all Person County Planning and Zoning and Building Inspections 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 Sewage Treatinent and Duposal Svsteras' (15A NCAC 18A .1900). �' Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments (_). Propose�WastewaterSystem: Conucn-�i�a���,( �ra��'fy' Type� WastewaterFlow�O g.p.d. New \/ Repair Expansion Soil LTAR: • ois' p.d./ ft 2 Type of Facility: fYlp�i � � �{0 rriG Basement _ Yes �No Wastewater System Requirements � Tank Size: Septic Tank: I�OQOgaI Pump Tank: �% �' gal Grease Trap: N I i�' gal '�5i�c �� � Drainfield: Total Area:1, 44 o sq ft Total Length 4�� ft Mazimum Trench Depth .�S in Trench Width 3 ft Minimum Soil Cover: �� in Minimum Trench Separation: � ft V Distribution Box Serial Distribution Pressure Manifold Specifications: �p" p� Q.p prc�U �d sp �� �� V L� (��' � l be rc�u ! ��d -�a bc hu-u ([� 1(1 a S a- Ca-D n v c r .� � a-�'i'r. S v,S-�-c m Authorized State Agent: � a� - - '" Permit Exnir ion Date: The type of system permitted is V Conventional _ the pernut. • _��� ; � ��� Owner/Legal Representative. Date: (� -1� -Oo? Innovative Alternative. I accept the specifications of Date: 2° �/ 2 -O �-- Operation Permit System Type (in accordance with Table Va) � • The system has been installed in compliance with applicable North Carolina General Statute, Laws and Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pe it and Construction Authorization. Issuance of this permit does not g'uarantee that the wastewater system will function pmperly for any iv pe 'od of time. Authorized State Agent: Date: � a�`��� PCHD rev. O1/23/02 , -:� , ` : _��; �;� �1l��� �� �l.s � �J l� �L. � 1Enaena-o �++ �* o�a� m.Il. IE7T�a.Il�l�a SI'TE. S��ETCI� . N �n Fard {�ar�iS , T� �P # Rac� P��� � I$(� S b ' n �11� � Section/Lot#� N �(� - fl -�� -oa Authorized State Agent � Date . � System com[�onents repr�esent upproximate�contours only. The coritra.ctor must, flag the systemprior to begirsnr'ng the irtstallation to insure that propergrade is maintained IA � . j,ni�0��''t �s' � �� � . EX� Ska� n�. 0 2.� vC ci �0. �0 i o-�f � Q� PCHD, sev. 09/12/01 . .. . . ���� � f �t'����'�� • . • . �•!.. . s. . 'V��:~iy i� ' ,' � �� �.�:���•�� . -... . . . . . 1C-+ . - � Il: ]E3i Il�l�n. ' - 7Ca'7.^33`O�mn rmm �@mL ,t7. LL�.ID. . . . Tau Map #: p' ��o . Parcei #: ��� Zoning: , Township: �� I U t� r� l� Subdivision: N � � '„ �,.,- �: � . . Sectlo�n: Lot: Applicant: l s Location• �a.C� �tcrn6r� c�c 2d , � CJ ��ration Permit � System Type (In Accordance With Table Va): � THIS SYSTEM HAS BEEN IN!�TALLED IN COMPUANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUT'ES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, - AND ALL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION - :,;: ;, . : AUT�RIZATION. � - � . `t; State Agent ti`�`_�— S'�``�ti . 5,8�� ou„k(�� p�r �.e �S-c7 a e P�S `a'o s�� �a h-8�0� . : � �`�`d ° ��`'� � (.�' b`�`''tu` - ' . ��LS� ��`.L 3d ��Om �� u� L�S�sc�d 6Y .�,L��►s ������ G��9P��Y ��V'9R�PJME��'�AL l�E.�,LT� �9���� ��� ������� ��R! ��R �l��L �a�'E ��1��9� , . q T�xtt A9a� �: d 1� �� Paeael # I"`°' Zoning Toarem9�ip � � 1 � � �""� � ° � ,�ppac�i� LJ'�-r, n� iN B�"G 1 i'1� — ��s��• �C e e r� �'� . � e" / � S�4lon. Lo� �_ Subdler�lose• i �,�s.;� �•�f `Y°J��tcr Su�•�¢•�Iv� r���usre�m�nt►-s: F���� ��ca�u� 8e�divoduat Corrnma�nity F'ta�lic Site ��ro��d by ��"g-ia-oa� GPou4ing Approuetl by � V!leAB Log ✓ � �' VVell T�g --ca-oa Air Ve�4 � � 6 �-;a-o� Hose �il�� S �' g' �a�-oa ,_��p� Co�c��a� Sla� � Mn9��U �pu99�pe �'"� � 1�,�r� 4��0� ���p�mc��l ��a «�U V�/� ���ee ��� �._D � ���� ����i��l ��� ������� !lVells musi be '9 0 f�et from �roperiy lines. � Wells r�nust be 100 feet from sep$ic systerns. V�ells rnust be �at least 25 feet from any building foundation. O�her conditions: c�c.�t �c-LI i n A,f e.a� S�Bl.�t1. (� �� P1v�s �rti n� S � �p��c. PCHD, rev. 11/29/99 � � � ' ' 1!��� li. ,i '��� � ��, \ D r illll e r I D # - - � - - - - � I ( (�) t � � I � �0'mp�ny Nr�me ���-�-- --" — - --�- r� _,,. ,, ..,,.,,, - ,� - i r,.- ,i, i, D�t�eDrill�ed � � ���Ill IL�g Owner: � f a„ .�',� ,�� �r �S Tax Map �� ParceT #%Q� Location: Subdivision: Lot # �ellfl �o�s�n-an�tta�� Distance From nearest Property Line (Mi.nimum 10 feet) Distance from Septic System (Minimum 60 feet) Total Depth: I go ft Yield: �_ GPM Static Water Level: 2.� ft Water Bearing Zones: Depth � ft 95" ft/� ft ft ��n�nge Depth: From C� to z ft. Diameter: _,�� in Type: Galvanized Steel Weight: �c�ess: •/� Height above Ground: /�_ in Drive Slioe: Yes No Any problems encountered while setting casing? Yes ,►%No If "yes" give reason: ' IVeat: Sand/Cement Annular Space Width Method of Grout: Pumped _ I�iI�¢��a� Ns�e No. Bags Portland cement Concrete GraveUCement inches Water in Annular Space Yes No Pressure Poured Depth to Ft. Weight of 1 Bag Pounds If mixture (sand, gravel, cuttings) — Ratio to ID plates: Yes _ No 4 x 4 slab _ Yes Il��nIlIln�� IL�� !�C �oe��a�� �➢a-��nng lF���n '�'o � lE'�ffaan��u�� D� �a`� �'�� ���, � . . ���� ��'�� � � ?�- I hereby certify that the above information is corr ct and that this well was constructed in accordance with regulations set forth by the Person County Health Dep �ng���an�� �ff �m�4�����u� �Cd � # ��� � ➢)�te � -.27- D� PC�ID rev O1/16/02 30� r� _ ?~'':� 1 �� 12 �� -.. , . . r.�' >.. ;i.� .;1:�:. +'1'.:�� �r . . '_-= . .��. . . � ��... . ._�:� . r� � 'T' � O!„ •.'�...i:N,:f ` �� ' ) , i p �C, Di d'lSOo�D� . , �;�� ���..�...,�. „�,� �, f��.� �r�� , 4,r� ,� j �� . _ , . � , .. � ; , � • , 4�5 n/�j 38 /N�e�'J � j�iG/ � • r * , �o; �i ;� , , * � , • S�rolyj��ly��f . � L�,� ���,, , � : , • , r o�� _ . : � � t ► r,.r�' � jr� n� � ,, • ,,/ � � � � • � ' � ' '�:�'��'� , I,�o , •, d�, . � � , ' � � . , ` '.�S � ' ' ' . ,. � i ; ►�V� : i �,.. •j I ,� ' ' .f . sl. .' . � f �' ' • � � I t � � . b � � • _ _- _ f � � „r • � �`pt ��� � 1 �� i � � � % � � . Y Y � . t � � •,•� �� � .� `j •��� �� � �� 1 , • � � . 1 � � � ` i � � . , • t R r �,,.. � � �,.a � • . • , � r � ; � � � � � . � ' ' �, i � . ' • .J��� . � � , � � � :` o � / �� • � . ' +�. r '� 't F; '' 1p�f r � �i. � �, � i E . � '�' � 1 t C. j 1 � � V ' 1 V , t � 1� r,r � + ! � 11� � � � • f � �1 � � 1 :V.' , ` ' O , � w I , : ` . � � � i'!' t I 1 , . 1 .��� f : , � � � ' 1 � ' . r : . � • d � . � • , ` , � 'I:., L .{� , , , 1 � � . 1 ; � , `,; i.� , � � � , .� �e � � • � a �� � '1' �' � � � ' ' � � ' t � i,� � , �.t d � �4 � d'� ' . � ' . �. • , . i �f ,r �i � � , �' � � j ,►• , �1� �� n , �.-Zr�- . � r � � � � ,� � , • ►' ' ' ; . � ' ' �f : .+�,` `�� � :}! �f j� ,f • . � .�� �,• �` � � .� � ,.� � � � ,� i:i , . � .j:� i. • �. • � � � . . . t � . � '� � � ' ' t , j, , j ► / .� 1 , � . � . 1 r . � ';� � •� • 1 1 � �� , .� �� � � , ' �j•r.E � ! 'r,' ' , � ' . I . .L•1� +, .e� t.�0+�+.r $ a. ' , , � � � t:! f "..� � .!� , � ', i�. ' � �� �♦ ' t• • t • �' • ��' � � ' �t � 1 ' ' � � , ' t . ♦f� , � ', • � • �� f .�� �t , . � . � r , �- � �' -�� . �' � . � �. , , , �,:� a , t . � , . . . • "� � . , , . r.�, - �:. � , ... �E•,�� ' � .t >� �i ��, � y�� ',i � t•� f.. • ���'• . ' ' � . �` '� t + � 1 � i 1 .' � �� ` � � C. � • ��k ��, fQ P�'�r '1 ' . � t t �� � �. • � �r , ' . � � ,. , �' • .; .1� ' � f � � '. I ' � � . � � •_ v .�b.1i .� .t � � � 4c+� /i�a.'.( 'i �k:�. '� � ��� .. , , � : � . . :. � .,r �� '� � •���� ,;, . �. � �l ��� � t .;; h�'f .L _ .. � _�.' •i.k . �r'!;�'�;"_ 1519�. �� .. . _` . . � :�" �` ` ! ' , � ,. . .: i�, �. •• ..• � • ..� i � 4 �+-�� 1 . 7 � � � �� `�.� -� y-. = �. � � � � � � � � .�l � 7���'�. �"` � a'7� �*'�+'�+ � �3]_ ��. � �� � a�ul. � �.1�..'ZL Tax Map # o��.P Parcel # � Existing Sewage System Report For. Mobile Home Replacement � Addition Type: Oe.-E.ac�c,d , ra Requester. �`IC�-tn Fo �`d � � i''1 �- i-tG�r r� S __ Home Phone q��s - 1� fl CQ4l� ►�rnold. Pd Business# �� �o- � Original Permit Located: �_� Water Supply: �rt Vw�L ��G.l � Septic System Designed For. � Residential Business O.ther # Bedrooms � # Employees � � � Other .� 2i System Type: �nV �� O n�`'� Tank Size: �� Nitrification Line:��V Date Installed: C�-as oa Certified Operator Required: N � On-site wastewater disposal system shows no visual signs of malfunction on � ��0�2�-�. Permission is granted ar��c. l,� i I L1 0� d L�t�c.�c. d_ Ga �aq t, � �J� � �JkC.�G� � . , (Yl � � i m (.,� ��'d�d� Kc m Wc-[ I, ��� I O a�-�� Environmental Health Special�tst Date: . � � / I � � � l / � ! � � ` / ` / / / t i / i / i � � � r � ��-. . . _ _ I F • / NF 32.00' r i DELMA E. SMALLWOOD D.B. 216. P. 041 TRACT 4 P.8..15, P. 26t N89'51'S5"E 277_ AL / � / � � ! � N � / / � �"� I - �. , � - w rn ' O Z / r � 13g 2 � � � NF _ � M' J C�� ! ' J � � rn � � e� � _ � � '� 1 _ q� / � / � � Q * DWEL�ING IS SERVE BY � � _ r� � � UNDERGROUN U7ILI IES. �� � � ► "` Z / oa � � I I / NF 2�• 0 � t � r � I � L__'_---__ _ _---__^ F�_ ° N � - --- --- � cn � -------- 1 rn / � �O , GRAVEL DRIVE __� i,, n � ------- --- - / u� � --------------�- : Z 1 � / 2g0.00' LOT TOTAL I 32.00' S89'S1'S5"W IF � IF � / � � 1 .53 ACRES 0 IF DELMA E. SM D.B. 216, TRACT P.B. 15, IF CONTROL CORNER