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A26 8r �— — I �� L �'�� ; ;� ��:_, r % � � Person County Health Dep� en�. � Sewa e System Improveme s Permit Date: —- This Permit V� qi�d t�er Years - �„ Owner: ,/;nn� �',�,�.L! ��wf.;til.,�.u,�..�.::e en� ��n1 � ,Y�/�C d/ Subdivision Name: _ /' �� # Lot Size: Type of Dwelling: Water Supply: Private: P�blic: � Semi Private: If not Private Tax Map# � Parcel # of Water Supply or Name of . �� Supplier# Bedrooms: Garbage Disposal � Basement , �- Basement Fixtures INFORMA� QI'di� C��, R'IiIFIED. �Y $Snit�ln� 1Z.','�Y'� ��a' J%�r'F'.,r5;.x:ti� owner or ieptesa�tative REP�,IR: � � REEVALUATION: � Size of Septic Tank: gallons � Nitri6cation Line: � � � h�,,.. �i� � �� I Depth of Stone: 12 inches .� � ,,;P ' Ma�c Depth of Trenches: OPERATIONAL PERMIT: yes no Remarks: ------------------------- Date Well Approved: Well should be 100 fG from any sewer system Bl' Sanitarian Date Sewage System Approved: �—��F - 8 y' BY P�J �.� � Sanitarian � � CERTI�iCA��OMPLETION � Contractor. ` � -------- --------------- � Sewage System location, installation, and protection must meet state and local � regulations. Sepdc tank should be pumped out every 3 to 5 years and shall be maintained by owner in such manner as not to create a public health hazard. Septic tanlc and nitrification line must be inspected and approved by a member of the Pecson County Health Departrnent before any portion of the installation is covered and put into use. L.ocation of sewage disposal sewage system sketched on back. � . . � � ; � � (OVER� i-�> i' ;= �� '�"=t- �� } ` t _�� ;"� : ,�l i�� • + �,. . ! tiJ � o, � a. �. , i � ct�h..�s.,.� . ` . .%iJ�' \ �)�::...i , • � . . � �7 . i �, � o"l.s+',•_., _ L'—a--" , NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located at later date. Note location of water supplies on adjacent lots. 05/25/06 13:21 FAX 3365992925 T{qIN'S COUNTRY M �j002 Application Date: Amount Paid: Receipt #• Tax Man #: �arcel #� ��.�� - - — � � c� � ��ivlC�i� ��y .a-s-.raa-:aa-aa�c�a.�aa�rz�1L 1L 1La��x..1L�]La APPLICATION FOR SERVICES 1) Permit requested by: (Ownerlagent/prospective owner)� � �� Home Phone: 3� �- 7 D� Address: 3�g� < m�� Business Phone: � 9-��i �r �+? A�:��- - Lj.�%,�'? � 2) Name and address of current owner:� � � i�-�• 7 3) Property Description: Lot size: �� Township:�� '��.Subdivision: Lot # �1��Directio t th property (Including road names an numb ' s): c,i�.,�� iit S�r,G�v�-,. Il? � �.yi, r�5 G-c S"7/_I/ �Es1 4) Proposed Use and Structure Description: answer each of the following questions: a) Proposed _, Existing �, Type of Structure.}3,� a��, o Width: Depth: b) iVumber of Bedrooms: „�, Number of occupants or people to be served: ��. 5�_ c} Basement: Yes_, No � Will there be plumbing in the basement? d) Garbage Disposal: Yes T t7o _ 5) Water Supply Type: Private�(new _ or existin , Public , Community�, Spr+ng _ Are any wells on adjoining property? Yes��No _ If yes, please indicate approximate location on the site plan. 6} Does your property contain previously ident�fied jurisdictional wetlands? Yes� N�X PLEASE NOTE THE FOLLOWING: ➢ A PLAT QF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APP�ICATION. ➢ PROPERTY LINES AND CORNERS MUST BE CLEARLY MARKED. ➢ THE PROPOSED LOCATIOlV OF ALL STRUCTURES MUST BE STAKED OR FLAGGED. ➢ THE SI1'E MUST BE READIE.Y ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT STAFF. I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-desc�ibed property. I agree that the contents of this application are true and represent ihe maximum facilities to be placed on the property. I understand if the site is altered or the intended use changes, the permit shall become inv�lid. ,, _ _ or Legal Representative �T = F�ls-Y� lo Date PCHD, rev. 08/27l02 � �� ' � �'� � �; I'� � {!� .�,� . T�x h1rap . . �rce_I = . ' � �� \ � � S�ubd!ivis�iati Pha�s•e Se-ct+ian'Lo4 � i � �. �r� �� - �� - �� r Applicani Location: Improvement $'ermit P�rmit Valid for _�ive 3lears _ No Ezpirafion Type of Facility: # of Occupants # of Bedrooms Proposed Wastewater System: Proposed Repair: Permit Conditions: k.�Ll Owner or Legal Representa_ tiy Signatqre: Authorized State Agent: L/ New Addition _ i�ater Suppiy Projected Daily Flow g.p.d. Type: Type: Date: -O� The issuance of this permit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicant/propezty owner to in sure that all Person County Plannmg and Zoning and Building Inspections requirements are mei. 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 `Lrzws and Rules for Sewage Treutment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the 'Enviranmeutal Health Specialist warrants that the septic tank system will continue to function satisfactorily ia the future or'that the water supply will remain potable. � Authorization to Construct Wastewater System (Required for Bu�ding Permit) * See site plan and udc�itional attachments (_). Proposed Wastewater S em: ,�}L1 SI �Q Type Wastewater Flow _g.p.d. New _ Repair�Expansion _ Soil LTAR: g.p.d./ ft 2 Type of Facility: � w� nS Go->rrlrv, (��C�r-�- _ Basement _ Yes �D, No Wastewatea� Sysiem Requi�ements ��y� � �� s- -� a� Pnm Tank• ' Grease'ira • 1`+�t7" gal Tank S�ze: Septtc Tank: � gai p ga1 P• �rainfield: Total AYea: �- '�q ft Total Y�ength�Xi5�li�ft 1Vla�mnm Trench Depth -- in 'Trench'9Vidth —ft M'inimnm Soil Cover: � in Nlinimum Trench Separation: � ft �istribution: — Distribntion �og �Serial �istribntion ^Pressure Manifold Authorizesl State AgQnt: Date: Permit Expiration Date: The type of system permitted is Conventional Accepted Alterna.tive. I accept the spe�ifications of the permit. Owne�/.�,Egal �t�presautative: - Date: S =o�S- 4 � ' PCHD rev. 11/10/OS ;. � . fti. ��.s� I�'I�I� S�1�T . � -- �� . �. ��.� ��mn��. SITE PLAN Name�� \ Y�� VJ\a �� Y� Tas Map #�. Parcel #� �S div�sion . Secrion/LoC# C(th�tv �i �� C�p Authorized State Ageat Date Sysrem compoaents irpresent appraavmau conmurs only. The coarractormustilag t6e systrm pdor to begianing the inst�//arion m insrur that pmpergnde is ma�rained - r�,us-� Pw�-�. o�� is-�"� . �Pk; c�an� anc� CrU�� w�b QnC��Y�F dci -E-an�, J �,�5-�C�\ \ 1 �tx� �� fal � `�� k w,W-. no �-�-� I�e � �-t� O.nd �cx� � �pkc `�� S� _ nv, N �� ,s � � � tn�.\�s�Q9.S�-c� w� � ��5� �s � � ��. ��` � c� � ��,�,-,��o � `�� , ,Sk��,��' � " Ys��c � u� v�'� �`�� -, -o , }�s 5 u- � � C�nver�ienc� - QS-�z>�e �ri1� ti n ��o�� (�kS O�We � �3 �" �� s�� n,�� --� �c4le �� m ��c�� d mS �CQiIkS �� --�� -t� (Z��(oc�� rcxn, n... o�/�z/oi -�; �� l � �e � m;-�-� A 12 9 2 PERSON COUNTY HEALTH DEPARTMENT ' � WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERMIT Tax Map # Parcel # Zoning Township � � ,r�,,n,; cYA r�n Owner/Contractor N 4. � Da e(2�� -%� Location/Address 5'7 "`� �i • S.R.# � � U � a Subdivision Name � Lot# Pernut Void after 60 months. Permit Void if not in compliance with zoning regulations. Permits may be voided if site is altered or intended use changed. Well and Septic Layout by Comments: Date Installed by Approved by WELL SYSTEM SPECIFICATIONS Individual Semi-Public Required Slab Public • Replacement � Air Vent Site Approved Required Well Lo� DC � 9'g Well Head Approved Well Tag Grouting Approved -�jGY_ Z�� 1 � Comments: �� X 10' � � Q.� '-' _ - ' ` '�- ` Date v � I stalle�by �KA l� U1 i 1 1� M Approved by This repoR is based in part on info' n�i�io provided the omeowner or tus e representative in the application submitted for this permit The environmental healt}t 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 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 to function satisfactorily in the future or that the water supply will remain potable. c:�amipro�pemritsam O1/95 rev.1.0 ORIGINAL �� i�;•rt ;'i' � ' , /� � ''�� . �� 1 Person County Health Depa en . "�� S�e System Improveme s Permit . � - � Date• This Permit VQid �� Years , w �. -11 : �\ , : .:.:s.� �: . . Subdivision Name: Lot Size: Type of Dwelling. Lot # ....,�... ..Yry. ......,�,. . ��,.... Semi Private: If not Private Tax Map# ` 3 Pa�el # of Water $upply or Name of . �� . Supplier# � Bedrooms: � Garbage Disposal ' Basement �' Basement Fixdires �o , , �i G �n-�Y S�j�j� + '� J�};�!( lU:v� owna or [ep�rsmtative. REPAIIt: � " REEVALUATION: � ------- --�_--------------� Size of Sepdc Tank: __1� I gallons r � Nitrificadon Line: � � h�•� ��^� d °%�� Depth of Stone: 12 inches � � •�:r _ Max Depth of Trenches: OPERATIONAL PERMTT: yes no Remarks: Date Well Approved: Well should be 100 R from any sewer system BY 5anitarian Date Sewage System Approved: �—�4� -$ y' BY A�� .u�c..,.... Sanitarian ,� G CERTIFTCATE OF COMPLETiON � Contractor. ° � -------- --------------- � Sewage System location. installation. and protecdon must meet state and lceal � regulations. Septic tank should be pumped out every 3 to 5 years and shall be maintained by owner in such manner as not to create a public health hazard. Sepdc tank and nitiifiication line must be inspected and agproved by a member of the Petson County Health Department before any portion of the installation is covered and put into use. Location of sewage disposal sewage system sketched on back - ^, � (OVER) _ . --,. " �. - ,'� i 1 _ - '` `== � � :. . - - • - ; -=� , . ... � j ,,'� h a�,, �'�-� . NOTE: Make sketch supplies, etc. Note sp at later date. Note lc (1) ,, . � _.....___.._...._..e.----_�.__,,..G.�.,..�........,...._„_.. � . . __ .... _ _ .. installation showing lot size and shape, location of house, septic tanks, privies, water problems existing on lot. Write in measurements in order that installations may be located �n oi water supplies on adjacent lots. . fr 7r}' �2� y Application #: Tax Map #: Parcel #• Person County Health Departrnent Environmental Health Section SITE SKETCH � �� z� � � �v�,�� -fr�,� d...�f 1��.lQcc6��r� Applicant s Name �ll�j,(,� Subdivision/Section/Lat# . � ' ;L - -��=lW . A thorized State Ag nt Date System components represent approximate contours only. The contractor mustflag the system rior to be innin the installalion to insure that ro er rade is maintained �o i �- i ��'�, . •� i � � , � �f�c ` �� 1 �l�Q , (� �' c� - :� .1_ r r ' I� . tirou.rnd �� p 0 �,,,��t� �ou�1 5 �cLt''� �' PCHD, rev.101�12199 � � �� .� ' � � � �lJ �� J.L� �v�-n.�"cfl �'�+ n'i+'n Q� 3� ��.� �'� � �. �. ��La Applica Locatio e i�x M�p � � P�rc � Su,bcilivision Ph�s�e Section ot # # of Bedn�oo � � s . � .� � . _:. ;i -�= System Type (ln Accordance Wifih Table Va): -`�i� THIS SYSTEIUI HA►S �EE1V IIVSTALLED IP! COMPLlANCE WtTH APPLICABLE . NORTH CAROLINA GEIVE#2�L STATUTES, RUtES FOR SEWAGE TREATMEiVT AND DISPOSAL, AND ALL CONDITiOiUS OF � THE IMPROVIEMENT PERMIT AfVD COiVSTRUCTI�N AUTHORIZATION. � � . y �k7,,yu� �� . � l, /�t� � Authorized State Agerrt Date I _ -. - 1 . - � ��,:�:a a NC 5`1 Date: . Co � � ( OC� . �� '�y ``'y � � �4� . �,,�'.� �.� �, ,�P Jlzq I L^iD �p-�s lo�c'� S-t� Wa PCHD, re�. 07/29JQ4 � y � ��C��a�� u'��..��T {��Z� �0 - � Tax IVIa� # t�atp �arce! # Sys%m Type (Tabie Va) Owner/A�plicant �'�� C�,� �n-tru��r�- Subdivision Address/Lncation Sec/Phase Lot # � State�ID/date �-�Ua Capacity �--�-�-�� Tee and Filter � Baffle '� Sealant Riser (ifi applicabie) Tank Outlet Seal Permanent Maricer Pur�n� Tank � - �a ac�i Wate roof /Sealant Riser Checfc Valve/Gate Valve � Ant�-si an o e Fioats/Switches Alarm visable and audible Electrical Com onents � Rate m ; A roved Pum Niodel � Blocic Under Pum � Pum Removai Ro elChain . �Distribuiion:Sys�em � Serial Distribution � ressure ani o Low Fressure Pi e A r. Pi e ItAaieriai and Grad� Valv�s � ' �ita�t�cation �ra� Trenct� �dth� ft. Trench De�th in. T,renci� Length ft. Trenc� Grade � � � � Trench S acin `� Rocic De th and uai Dams/Stepdowns etc. Pressure Laterais � Hole S�acinq � � Required� Setbacks From� Welis From Property lines Surface Waters Pubiic 1Nater Suppi Vertical Cuts (>Z ft. Water Lines Ve�icle �Traffic � , �EasementslRight of 1� . Other ;� . Easements Recorded Ccmrnen� pci�d rev. 3/13I01 P�RSON COUNTY ENVIRONMEi�TAL HLAL'iH WELL LOG Date: �- --• S C�t�i(� lYlf� f�.Y 1V1�1K- �IY► -I1dSR# .. Owne:: . p Location%Directions: . _____-- ----------�t — Subdivision Namc: ' � - - , Drilling Contractor� ��k�N � � � ��M S� � WELL CON�TR CI'I Distance from Nearest Properry Line Dist.ance from Source of Pollution ' Total.Dep.th: F� Yield: J� GPM Static Water Level Ft. Water Bearing Zones: Depth�---�j t. Ft. Ft• ��t ��es e th: Fr�m�_to � Ft. Diameter: Casing: D p . ✓ TYPE: Steel � Galvanized Steel If Steel, does owner approve: Y� ;; N°--- Inches Weight:_'1'��5� • �' Height Above Ground:_ Drivc Shoe: Ycs No . --- Were Problems Encountered in Setting the CasinB? Ycs _ No______ ;; "ycs" giyc rcasor►: . . Grout: Type: Neat _ Sand%Cement Concrete _ Annular. Space Width l��ches Water in Annular Spacc: Yes____._ No,_,_ Method: Pumped � _ Pressure__ Poured •vr . Depth: From O to 20 . Ft. Wei t of 1 ba lbs. Materials Used: No. Bags Portland'Cement__.__ gh g— If mixture (sand, gravel; cuttings) - Ratio: to � . ID Platcs: Ycs � No a Y s st�h v� ✓__ _ No ,�- I HEREBY CERTIFY THAT THE ABOVE INFORMATION TS CORRECT AND THAT THTS WELL WAS CONSTRUCTED IN ACCORDANCE WITH REGULATIONS SET FORTH BY•THE PERSON COUNTY HEALTH DEPARTMENT. . , '�' ' 6 � . �-� v Signat�lre oi Contract � D�te � � i�i:i;::ur�, c�,�►r��rti�.. i:lVV.I.IiUNP:::N�i•��. iu�n�,�:�� i�'J:;.l. I.uc; ' ��LG. ��y� =S/.(• � W I1 Gl . _� , r1 S�l1LL,�( �n �� r-� • �AC�1Ll011 �11'(;CL1UI1�; __ . ._. ,��y,�� ,� _._.._.----_.. s�� f _'• . �"""� . . ........ . .��-� �--.�."'.�.•--. . ��: �;!�v1si�j-, .N;�,r,�: ... ........___ . � �i1l�nb Con � -��-.._. . . _.__._.._ . u.. acto�•. ' ��_ .. .___ .. .:� _ ... I�r.:.I -- - -... .._.._._._ ---- ----- - - _ _ _ __ 1... ...� . -` ac �� _ �=-- ..—/��..�_- --`. Disc��cc from Nc.u�cst �� -`` ..�1.( (_.:(�).N�_l_I� 11Cl�'It�jV�....�._ Pollution °1"'��y •"'�� " ._ l,s... �?(ti�s _ ,L�ist�incc �ro — � �" `' nr".� - m Source o�' � Total Illep�; � �Watcr • ° � �'t. �'icicl:. • , C��Bearzng :Lones: llcp�li �--. . �_... .._ (.�1'Ivl ,St:i�ic Wa[er Z,eyeI . � ��j�u�: � rzo � . ..... _ ► � � m _.-�� i. . . .S ��t �'�'PE: Stcel ----�--.__.tc>. -.�.! _._.._ (:� ..---- �_Ft.__�,�t. .Uiait�cicj; � X.f Siccl, �p� --�--�-�.._..C;:�lv:i�iiiccl Sccc1 c.,� � Znches s o wn cr ri��pr� v�:: �'�::: �-_. . ��.b'�lI•. • J � '.�11lChJICSS, -----Nc)—_ . . .Drive ShoC �Xcs _ ----- __ Nc��.l�cighrAbovc Ground: 2 , . Wc,rc: I toblems ��icountc;��c � :_ _..._. _�_ . ••--1-`_.�1'ich� � . �l� ., ��„ �, c „�i ,Sc:t[iiii; [lic C,,siJ�r�'� . Grout: y blv� i'c.isc»i:_... _._ ,� �'cs-------,_ o Annu1 Ncat ,S:�lic1/C'c:,i�� — �—` ��Spacc Wi�Jch ---�. _ ____--Coric � ..,.,:;;, Wa [cr ' . ' . . . I, �chcs rete ' � • . ::�� --�_...._..... in A.iult�l•ir Sp:�c:c:: y _.-- �'.,:ti,: . Mct�iod:� �'w,i � 1��`'- .. . ._.__._. No �/ . ... Ix:c � �c i1i: —�-._... ....._ 'r'c::;::ui•�• -..., .....�- . P .I�rom =--.._... . _ t �, uc-ccl I�ai' `"_." ---� .., ... � � � .. -_. ------_—. � �.• . . • . , , CI'11� �SCC.�: � d -�.._ 1' [. : .r No. �I3aLs .('c�r�l:ir,d Cc �bll'1'itwc �sZnc1, �r;n�c:l, cuttir�i;'ti) - lZ•�'nc.nt.�.... ____ Wc��;ht o.f1.ba . : � cs: �''cs` v ' � . ti c�:__ _ �— �--._ltist:. �� << ----__ �l a.. - ----. to .�.��-, X t ::IZb XcS_�-- � _.._ Nc� .._ . .. • .. ' :; _ . :, - -- � --- .�_ .. --- �,.:. ----'.---_----•_...___..... _ 1)l� 11 • . � D�_ ...._.. ._. :I.(iyC� I.,C)C� _ � �rGm .� . h: •�,�_ _ ---.._----.__...._.... ��c7rt1] � ��_.____- � ----� ...:.,_-•. _....----- �I10 �CJCi] (Ipn .� _ �'.��. `�', � _ , , - - _�_ 1L�'-�- �� % j /�G-� �.�- _ .r.1 � � � --- .. �c� _� �r� ,r�� —��. _.....� ---._...__-_. .._.. ... . ___ `._ z ��x c��zT�r-�� r��..�.�.j� -.._._.. ._. . ..___.______--- -I .:; .:::. �,1� () VL; �NI=UI�M�1'['.[ON :[S CO �'� �S wELL W AS CONS`11� UCZ'l:l.) ( ::� . � �'�RT�-I fiy.TI-I� P�I:SON c�:pU.N" • , iV ��C:CO1��l7,A,N � : �RECTANDT�;J%�; . C L W�TI-I IZEG ULA'�'ZON$. S,� .. ., t 1 I�11:AJ.,7'(�I !�L'PAt:TMCN"I'. � � . t.t,,,,� . . . . �=�- �/; .� � .Sil;ri;i(urc c�l' (�onr� ,�,:tc,r -�__�:__. PERSON COUNTY ENVIRONMENTAL HEALTH PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax NIaP il. Pareel A Zoning Townshlp APPIIcanC Yl �iiV��l�IV Vt �Y Y l t� T. l.�b�`�vr l l� y '"`i�'Y I �f� lv f�,�� f.�n,vi �� s�- ��- �,��,rr�� aao�• --�7—� � , „�o� Subdivislon. Sectlon• �O� Well Permit T e of Water Su I: ,�, Individual Community �Public Reauirements• Site Approved by ✓ lYo� Grouting Approved by.� � S 3�'� 1 Weil Log �� S � "��4 Well Tag Air Vent Hose Bib Concrete Slab Well Driiler• E u�S ��. � �-- Well Approved By: � Date: **See Attached Site Sketch'�` � � I�c�( �" �e�5�' (�' � �� < � lna�l,e loi� �� o�' � `� . elis must be 10 feet from property lines. ells must be 100 feet from septic systems. Welis must be �at least 25 fest from any building foundation. 1� � I.o� �'0� �v'o,�v� �.��del��V'�� as t�� Other conditions: PCHD, rev. 11/29l99 ��,�.f �I��.�� - � � �� ra�n�roaanaam�rndmIl ��¢�a WELL PERMIT (New_ Repair_) ,��oa/ �/f7' Tax Map: � Parcel: /(�/ Subdivision: Applicant's Name: � „/ _ � Mailing Address: � 2 7 Phone Numbers: ZG,� 7�/�— fola i Z _ Location of Property: �� a, iQ� . Lot: Permit Conditions: 1.) See attached site plan for proposed well location. 2.) All applicable State and County regula#ons governing construction and setbacks apply. 3.) Permits expire S years from the date of issue. 4.) Issuance of a permit does not guarantee a� otable ater supply Other Conditions/Comments: �X/�ri � ��is„� r,��yr �, .l� A/i��i � �' , i .L /1 w f i/ � //' / � / / �L I / � .� � � � � / � �Tew Well: EHS/Date Location: Grouting: Well Log: Well Tag: Pump Tag: Air Vent: Hose Bib: Casing Height: Concrete Slab: Well Driller: Pump Installer: Approved by: Additional Comments: Date Sample Collected: EHS: Person County Environmental Health 325 S. Morgan St.,Suite C Roxboro, NC 27573 Certificate of Completion OLiner: • EHS/Date Depth: Grout: �bandonment: Date: Method/Materials: License #: License #: Date: Date Results Mailed: Phone:336-597-1790 Fax:336-597-7808 11/26/13 VV �1.1� � c p�v�[�� r�-�c ti r . 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't �'`� `�: � � ' A , . .-� _ 4 r�c_ r- ti , � . , �.��} � �� \j��j �+j�� j i � ��:�. ; s'� "` � � .�' ,,,,,`�',,� y�:*.: � < 1 " ��,� -� �� k , ��`�`-" � : � � , % �?"!�`� �t� �'�?� "v�-'•�'� ,. � � f .�t . ,� � ., . �� ,. • . ,�' � _ , . � ,! d gv i� . %,, � .. 7..( % . D . � ,: 7.✓ , �. . �, � ' �� ,t'�{ � �� `" �i > i .,r�� ` . � i . , ., � �'��i, ��.r� �` � �� .'. � . . . �� ' � •..G�� . � � � . �' � . ^ �- \ . . � � t'�1 F .l� �A } . ^ �. br, _ , . � 'i.�J;, , . �} . ��'.�;:.. �- . i � x ,�� a . . . . � t t � : . � � ,,.,�"" �a �� - � � �x' z' � ' *`'i ,r�' i�'e �� <�, � i F .� ,,,�•.�""� �- � � �i � f ;�� ' �Yf / �� #� �� ; __ i: ; � ��, , . . /��j . ;�„ ` , f � �� 11 O` f� �` 3 �'� + ��}� ,k r•� ��4�:� �K i . ' l � � ' '?' � d a 1^ ` � � . Ff Ff t F , � � � ��Z : 1 �# . � '� � .. _ �� ;: � � : .,. .. � :: � �-� ,,s"'.,w�"w�_ s��` .. t �<�;�.': '�`, r � � � �� .N( DOl F i�,,''�;�c�� [�-C;I� Cdy o( Rox"bui,�,� . .. y � - .. . �� vs � �- ;, , - , , Legend 9/1/zoi� rv �� r o R L E G A L u s� E-911 Addresses Person County `nv�ronmen#a� �'.2��t�1 �� " 7�` �� n Easements �� 325 S. Morgan Street Feet — Conservation SUItG �i y�r �� o iso 35o sao �20 Easement ROXbOt'0, NC 27573 ��1�� o 0.03 0.06 0.09 o.iz UtlGty a� �� '�,/ � Miles /��'d�� L'�L��-�i��1�1� V►'�Z•L � l�iG% 1v� �0,4/i � t�i�� — AI� other "� A�,�.��i �f�s�<<�.i� vrj'r�c.., r-i _ _ . �' GLL E' 4�i a� �vl�`i h�'�'�� i� s Person County Health Department Existing Sewage System Report For: Mobile Home eplacement - tio �y �� Requestee: � /�-%� ��%��"N"`� ome phone# - c� �f-��-Q �.�4 �g�� Business# ,/-�o'o-g6 $-g�,.2� ` rf��- � 'Pax Map# Loca�ion/Uirections: �`�/yG�-��l �'�' � `��/i�•�� 1�' j -�-u�� /�' ' �� Original �ermit Located � / Septic System Uesigned For: _ Kesidential !�- t3usiness �� Other (speci�y) # f3edrooms # Employees Other __ Uate lnstalled ��"V Water supply � `Pype ot System Nitrification Line Tank 5ize Certified Operator Required %1%� _ On site wast-ewater disposal system showes no visually apparent malfunction on � 'V� � Yermission is granted to: Comments: Ettvironmental Nealth .$'�OG. c ; � � �� DATE ` � Person County Health Department Existing Sewage System Report For: Mobile Home Keplacement _� Addition ,.�a Requestee: Y �_ Home i'hone# ��959 (�i,/�._ c �'f/� T �–��) Business# � � 'Pax Map# �lv "� � Location/Uirections: �� 1`'lt�L( C1'Y� � � � 1 A \ i �/ ' Original Perrait Located � Septic System Uesiqned For: ltesidential _l� � Business �_ # tiedrooms # �mployees I . I i ��: V7i�" r , � `. � Other (specify) Other __ Uate 1:nstalled � Water supply � A J 'Pype of System �Y , Nitritication Lit�e Tank Size Certified Operator Required �� On site wasL-ewater disposal system showes no visually apparent malfunction on 1 1� �� Yermission is granted to: ccording to the attached site plan Comments: i�� L : � ' / � i� Environmental Health $'pr�C.. ��i��' ��/ _ /'—__L��(� DATE � `. _. ti. ` _, . - . N-2! -23 -43 - W 17i6:06 " �� ,::.. . � � 92:50' - .. S-15 -04-25-� :� \` �. �,;�! � � ,� _� R�v� . ' 6�.' � � Sulou J. Wagsiaff � D.B. 165-385 h . ' t. : N_�g _.34.-46=W ". 210.00 � � t - ' , - ,. . 152• . _ . . 93'. 61.4' . 2d s . � 7,. . 18J' � • , ISBB� � _ . �2 7.1' i5.6' , .�, C�j� .:25� �3, 21' ��s �� ` _ .,_'__..._ ,17.4 17.3 2a' 1.31 aC. �. , S tor. � 169.04� BI S -20-47-24 -E w. 2a.� 48.5 StOr. sn�a � �r l�E� „� 90.00' -20-47-24-E :I:.;(3�e�,;hereby ,�erei�y t}�iat � a3��f� �is�rner.(s3 �o� ��h�. property sho?m. end � `�a�soi� �r,chiLh��was` conveyet� � ��.��. �reco=ded i.n� zhe ; F�rsau . Co�aty �.ReB�� Iige�.s��lffice'�a-$oQ� ° �:: Pa�e� a' , .r; _,;.. ..a .- p _' :,�A�..of subd c..--�— � V� i Vv . /�- � a� - J� l!" � � � A ' . W�" � �� `Y`'�Q ' �,�� . � �� .% �R � � ( �(�G' �4� �� S�'--� �-° �