A27 340��� sf ���.���
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Applicant: �
�
Tax M�� � • Parcel #
Subd`ivi�s�ion � .
Ph��s�e Sect�ion Lot # i
Improvement Permit
Permit Valid for �Five Years No Expiration
Type of Facility: �,� �.��,�1-r -� E=-C-r t�=�� �e_� New �Addition Water Supply in)� ��
# of Occupants �` ti1RX # of Bedrooms � Projected Daily Flow NSO g.p.d.
Proposed Wastewater System: C�.n,� ►.�--r��.�� Type: �' A
ProposedRepair: /�,c�c�n-r*�v� iCC �+av���;`-��J ��.1>. �=: =- ����.� Type: �C�T�'<<'-�
Pernut Conditions: -r. . <-r. , C�r.� C^���;c12� (�'��A ZtJ�r1� +�� A�.-�. `-�'ir ��`_ Y,� -
Owner or Legal Representative
Authorized State Agent:
Date: S � � "� �'
Date:
The issuance of this pernut by the Health Department in does not guarantee the issuance of other pernuts. It is the responsibility of the
applicant/property 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 SewaQe Treatment and Disposal Svstems' (15A NCAC 18A .1900). 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.
Authorization to Constru t Wastewater System (Required for Building Permit)
* See site plan and additional attachments (�.
Proposed Wastewater System: � otiv �-r-r.c1.�A L Type T� � Wastewater Flow'-4S� g.p.d.
New � Repair Expansion _ Soil LTAR: O. 2 S g.p.d./ ft 2
Type of Facility: `�rt � r�-r = P� -r ��-�'�"' � Basement _ Yes � No
Wastewater System Requirements
Tank Size: Septic Tank: � gal Pump Tank: � gal Grease Trap: � 1�_ gal
Drainfield: Total Area: ! RZO sq ft Total Length (n�{ (� ft Maximum Trench Depth � in
Trench Width �_ ft Minimum Soil Cover: (_ in Minimum Trench Separation: � ft of G
Distribution: J Distribution Box � Serial Distribution Pressure Manifold
Specifications: �'� ��C�, !J �a�c �� 5� E6��AL L�►.�c�� N l_-ri.`�5
-��z,► l r,� � `�-rT� �_.�,r=-TC.� -
Authorized State Agent: �/
Permit Expir�lon Date:
�
Date: � O
The type of system permitted is � Conventional Accepted Alternative. I accept the specifications of the
permit. � r� -
Owner/Legal Representative: � Date: �' � � !0 �'
PCHD rev. 11/10/OS
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�LI, PEItIVYIT � ,
�'L]E�E SEE A�'`�A�ED PI.Al�t T+'OR W�I�I� �I� I.�YO�JT
Tax Map v�� Parcel # 3yD Townsltip: ��. �� ��i \'
Applicant: l t`��tv� c
SubdivisionG�-(�
T nrotinn• . 7 1 �11n �'
�i'
Lot # lo
��"IR ���r�
C'._.c311:� ��^.
Type �f �Vater Supply: �.._�Individual Community Public
�equ�pe�en�:
Site Approved By:
Grouting Approved By:
We11I.og: �
Pump Tag:
Well Tag:
Air Vent: �
�iose Bib:
Casing Height:
Concrete S1ab: �
Well Driller:
Well Approved by:
****3ee Attaclaed 5ite S�cetch****
Liner.
�Installed by:
Depth set: _
Grouted• _
Date:
Water Sample:
Wells must be 10 feet from property lines.
' �� Wells muat be 100 feet from septic systems.
Wells must be at least 25 feet from any building foundation.
Other conditions:
Date:,
PC�ID rev O1/27/04