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A27 346
J U� ` �, � Amoun t paid � J�• Receipt � � �0 � (�° �F a3 O F� O _��': ,_... ,.� :;� Person County He�lth D�p� ��2� S. Morgan Street �- � - q �j t`�oxBarO, N.C. 2757i� D a c e Co�rier �02-33-15 r T�aTInN FnR SERVTC�FC �� �.��... ...s:i..�r "-C� ' ^�.<:J:s�an: �.1, �t?I'r r•"'Ji '.�%Serviccs;Reques%d:.. . , . :., . =.::.-:K�-•_�,.-- ::�r:.?'�.��d.:, Improverlents Permic. (F_,stablishedlRecorded L.oc) Ir:�arovements Pcrmic (Unrecorded Lot) ImQrovemcnts Pcrmit (Mobilc Home Replace) I;np�ave:neats Per,nit (Addition) Reinspeuion oi cxisting System (Loan Closing) R�oair/IZe�lace existing Sepcic System _ Pe:zni[ fac New We'.I _ Re�lace E.;is:ing Well w ,�,t.- .. rcv '• ^ i. "r=:" 1.:. "".� rr:'. • � -•- " • ^ •'�:.i�s'��_"7: t,c'� :.:.s�. 1�.: y�• _ �rwc.;.r z;=. ::��-.�;: :`�:.:�,:;:���.: �:s�•�4:': '--�YVater;Samole:to�be�Collecte.._�.�,:s'�:'== �- ����t;�l�,.. - -- ���:: � ^ : _: �r.. _•.'�:? _ -_i,..,;�i=�.re�i_ `' I _ Bac �ria l Chemical I Petrole��,:. _ p���:c;de ._-. T ��d I. P�.:r.it re�Leste� by: . _I ,� a�.v;;�; �pres;:,�c:;ve ;,wne:'=,�a�aC:�. ,� c�C'ci�S Adcress: � b bv ky � � ��..(��,�n�,a N �-_ a �'Sb 3 " � U Ham.. Phor,e . I- 7/ � usiness Phone n: � � �Zv � 7. Dir�ensions �r ?:c�esed Structure: Wic:�• �5'0 SC 36 �- De�t .. _ 8. W:at tyoz �:t �ny, accitions, expansions, oc c�aia�e:nene is �r.:ic:c�.e� co the structure or `ac;lity c;�ac .: is se•.va�- �:s; c��'• system :s int�:�de� :o se^�e? �iame and address ot c:::-:en[ awne:: 9. ��ater sueelv :;'ce: ; • r--� i ��P , �,� � co::�.munity❑ sprin; � :- ' p�iv�... . pL'o::,. ;� , Are any weils ca adiciain� orope:ty?Yes �`�o Q : If so, identi�y lccacior.: ' � I ProoertY Desc:iotion: Lot size: ' � � ` . Ta : Mao-�: �'�' � � :�3:CG:a: � � Townshio• d � � V� �''�'� . Direccions to property: State Road n& Road iames,�tc. �' r � I Co o l�tc,l eG� 10. Tyge of str,:c:ur�.��acility: Proposed: EXISIIIIa: .�s C T�ee o� dwe�li^� f House:�`rriabile �:ome: Q Business: ❑ � Type of business: Number of Emoloyees: Number of be�rooms: 3 i Garba�e Disposal? Yes ❑ No Q� Basemen[? Yes ❑ No�so, tt of basemenc fixtures: i 6 I�Iumber of occupants or people to be served � CLEARLY STAI� ALL CORNERS OF THE PROPERTY AND THE CORrIERS OF ALL PROPOSED STRUCTURES. I hercby make appiication to the PerS0i1 COUIIty HCalth Department for a site evaluation foc the on-si[e ;:.• sewage disposal system for the above described propecty. I agree that thc contcncs of this application ate true and represent thc maximum facilities to be placcd on the propecty. I undcrstand if the site is alcered or the � intcnded use changes� the permit shalI become invaIid. I understand that beEore an Improvements Pe� ve note ; issued, I must prescnt a survey plat of the propcccy to ehe Health Dept. I undecstand that in the evcnt dclivered a survey plac of the property to the Hcalth Dept. within 60 DAYS afcer the date oE the cvaluation of ::::; thc site by thc Hcalth Dcpt., this application shall bccomc void an�all fccs�aid focfcitcd. � ,, `•:� _ <; w � ;,� • � ��'Y z - , �k ;�r { � _ . .. �> ( Y-: _ . . Owncr or Aut f1 ` F . ..(:w .,.�l��is'_ � . Agcnt . . - .. .� , �.' .. . l/ x,; t . .�.� s�;: �b° •�. � .t �t -Y. � �• M�. � `'-•`�. �i �i' r :.� r � �I • �, •� � �7 3�.[�,;� �1- ,,:'; . , �'t'.. ; �. .+, . . �. • �,1`..._...�-s S � 'ir� ' : ��•j'��w-' r ��,��% . �� � � x � .� � - • " . y. C , F. ;,. Y � , 1 •.t• -.. ^� �� ���A �� �� ���".t�.� ` ,/ ,G,'�� ( f , � »�� .�, �`tC;� j}�' •`�r,ye,� °' . . � •I rJ��':;,ir�. �: ,f��•i",4� �, � p�( � �1 ,.�I; �� , � . �>°�.,, . � + ,,��� • y , ,.y. ,�.� ,..a: a,,.� ,I��t 7!!�: , � S e j ,' . + •f •,:.. T�ii C .�?�,. ' A, � �"' , 1 �;_ , �:�';; i�. � ,� �, � a �,� . ..� , . ' � � " Qe0.ar8. . . � 'rw � C " i, : :., �. ' ,: , t �t �� � ,. ti � • �, +.�� -� K � t� ' ► �.,j� �{ . j. � r �.�� '� ��+ !�rp�t� 1'� 1� •�� e �ry�� 1.� � �� � .. '7� �y� - Y 1 � � C.' � ti. " . :{.i s. LL� 1+,�+�. ��. � .�i. � } � .�s ' ' . . . . . � yu;1- 1►•'y�• , �� �r r •'•t� ��v,.,J�., ."rt, � �.. rv � �. a�� i .�f {� ' �'� � d�ti- y' � d � �,ty� r• 'r., � • .. f.. �,� . , �: .a° . . .. • . .k 1 � 'C� � !- i�1 •'.�* . ��� M • f� •�,�' . � �, •.' L !�_�' ti i�j �•y� } � :. ��TTr ��� �;• �' '� � 4 � :�'. � , � �': �: 1 . � � � f ar! � , ` � . t .y t11 �� �� �' .. . �i��� • , 'i M ( .�, 'j'� �� . 'C .; ' � tis� �f } �, a . s i ' '� ,{ l 1 �� . ,-. ..: 'r' t '�;'���y. . � .J' � , � Y,��I�i- ��� �' O ,►' . � L t ; 7 . �r j a � ty'r�'1 . . t _ � f E�^. '� (� {� �y ���1p7r. i��• '�� : �� � � i 't �Yl'�: '� ,� • TM �' . � '� � ' • ,�j„�j�• � " 1 . S�l� J��iil�� . +Y � � �•i+ r . : ' V � +�� f'��' *� ' � �.' � `.. . �� �:i � . �, iL.+C ��•7 .lr�: .�,i ' 7 ..t�j.• {'.. - �I�r ' .��' �.' • . . . , - • { ,. �,fi. � � ,.. , � •• ^ .. U�� �G ,� 1� a . . � ,��. ��.` � . . . ' . . � � � ' ,^ ��� I \ .� '�r• y • ` . •''. . ; •� � �' � f � �y . . . , ' �: � ' t � � Y � f . , . ` � � � � \ 7�m� h �� ' . ,r{� r � � • ,. � �t� ` _ , � +P' � . JL'.I _ " iF' ' . 1 . j v ,��! ' f ' ' • . 1:ii `.. ' �•: ' . ;.,�r � ^ � • r. .�.:. — . Q�°: � y - st.� �' rr.ut D.B. �91-69� �..�.�.,_�, , ��+. . .. ,. .�tti..��, � .F . . . -`/ ' ,;�• � •,:ij. ., � � ' '° Stom9f k �,�� � . � � �'�•r : � �, +, �� , + s ' ' L� �{1d�t� ''r' �'s,,�; � . ,' 'Yy �'� �yt, � 1' '� � ( 9. h �. ,1 ��,� � . Sb� • Q �arl 'r � . .. � ��(�+.'� ,,• . •� . �' `.�~ ��� J ` .. • r . . :.��, � � ��j,'n 'i'i • ..� + � . , . ;� �: : � r, � , �; •: ,� , . t�i.j?� � . a . t:', `�' , ` � � : � : .'; 4� � '�tlnp `�•,, �.. • � S' , . s � ;�, tf>� ,� �w: �i�" � i� r �'i� '�. �{{���i:� . �,,.�- r. � ' , '-.�.i �c.x .. . Jt� � ► . . ' , . � �i'`•�� . 7 ' . , ' �' �.�5 �ti��13a�,.,t ' . nS � , ti' I • ,0 1, �y� •• . ... ' .. :.' ` �iy,U� ' . i �Y 4 �1 , . • _ A6�. :; . . . , h � • � :,: oo f � f;�. � • - , , .�r,�: ;s �� :�. .� � �1 ��� �`,� . .� . . i • �.� � '�� � ' ' � I( •t:' . ;t, . t , r ,r t � � � . . r: .� . � �. r «�.��) �'�` ♦ ' � ��- � .. { - y � r��• . 'H•' :�.� . 3 �,�y� a� .. . ��� . . . . t �. �::• � � ' !� .i{x', � '� / .. . f.�.t ,`.. .. �9 ► �' t, � f r'a af; y . 4 .� � ' ,� �� f r � . `y�! . r ' . - . •,i' _� � ' . `A ) t '`f � � � • �� - '.�. �! • `' � � j<. ti). �� r,+ . � 7 ' 1•w •� ..t� _> > a +. . . •� J � �� I�V :i. �,. . •� � :�'1�. ��� � :. �,;� . �, ',;'y• *;r'� � , , . � , l:db �!e!'ts, � '� �. � ' � T(m�t 8 ' j� ' �� � �'��/�� �`� S� � .. . 1 •I .I . t • .y � �. r-� � IrUo �� .� N�� w J j,.;� ;:•-`�;, �,e.: w�� i�� 1 ^r'� ..� ' .. '. . ,. � , � . , � � .• ' . ;�� �pV° �!i' ' .� .•' ' , � ' � .•:� •i'�•�f.l� �; . i. . , • � .. � 'J •� . � • • �'��; ;�:y ,;Z L �YBQ��' , �t��','�'. • ' S88'89'J�8"E' ��.�; � �;.;. ,,«-;,''; . _' . � Tt,tat --� a�:.�a' .�d , T�e� — ss�.oe' :+. �. . •:, ,. . . . �� .. af.�E � �; • .�^..~'•,::�'/ • . . ' .. ' • ' . . � ' � ..; ' • '" �•,� .• . � � � �t � � � I , i'- � : •� •. • •; . •,��. . . . . � "�' �. �' � � � � f.00 . aorrs . � � ( T.��t 9 , :.'.s.. ; . : : . � , • ' • �` r: � I 1.�� acrsa �_ " � ' .. � Sl1�'s�'8.�"�'� , : . .. . � � � I : ► , ». , :, ., ...� „ � � . . � . � � � '•- . ��� 4 �� �.1�! � �i! � � �_. — "--- � � � � � � I���-au-���,-,Y„ ���.�.]L IF3L��.I1�.I� Applicant: � Location: 5 �'7 N' . T�x M�� P�rcel # � Suihciivision �� • Fh.��se,'S�ecGion'Lot # — I�tppovement Pe��it � Permit Valid for �ive'�ea�s No Ezpiration � Type of Facility: ; �,,, ; � . ``. New �ddition Water �upply �� 1�� # of Occupants ��t;u(o • of Bedrooms � ?rojectcd Daily Flow � g.p.d. Prorosed Wastewater System: u,r� � Vc? (1�-�D,�.C� . Type: ��'b Proposed Repair: ��.e m(J t��VPfli-�ov� c�J( Type: i-Tw � Permit Conditions: Owner or Legal keprese Authorized State Agent: Date: Date: '7 �a—p5 Tl�e issuance of this permit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicanbproperty 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 jor 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 Construet Wastewater Syste� �Required for �r�ilding Permit) * See szte plan and additional attachments (_) Proposed Wastewater System: ��I/���iDr�Lll ��/`�9p Type�(2 Wastewater Flow ?�g.p.d. New �� Repair Expansion Soil I,T�: �. � g.p.d./ ft 2 Type of Facility: ? ti5� 5 F� _ Basement Yes ✓No �Vastewater System Requirements Tank Size: Sep�ic Tank: � gal Pump 'Tank� � gal Grease Trap: � gal Drainfield: Total Area:1 DU sq ft Total Length �� ft 1Vlaximu�'Trench Depth � 8z[� in Trench Width � ft 1Vlinimum �oil Cover: (r� in Minimum Trench Separation: �_ ft Distribution: pecifications: Distribution Box Serial Distribution �essure Manifold Authorized �tate Agent: P ermit Exx The type of system permitted is the permit. Ownea/I/I,egal lE�ep�esentative: _ Date: � �"� �S Date: '7 '<<}� -�!� �onventional Innovative Alternative. I accept the specifications of Date: PCHD7/30/2002 � '��1��,� ] J.Y. �ii. �f.�l✓ �� t /� ,/�� �}' ��J' ��,� �11' �/' 'V �� Y. lE�-�na-�,** ,•,�„ �Bsa.�.11 IE7T�.m.Il�1la. 5���. 5��.''���. Name Om fYl l � n5-�� Taa Nla.p #.j,��,.Pascel #�y b Sub n N' � Section/Lot# 1 a 7-a'� �[� A orized State t � Date . � System com�fionents represent a�bpnoacimate�contours only. The contractor must, flag the system prior to begr.'nning �dte irastallatwn trr insure that propergriade is maintained . ' � � ��1 � .,,� ' • �. '�--- ,.,. • —� . . �, � � � . �� . �•w.. _ ;`*i , �� � � :��� � � �' E3 � � �� � p w '"� • Q '\ � �� , �� � � ��. � � .,�� � � ;� � �� � �. �'° � � " � � � , _ `=� � I C�� _ ' 1''=5�� : ��':' S ":�.�.. ��: ��•...': . . .. ::�. . � .����:�.';: �.`':��.� :.� . � �... :. . . .':... �'�:'� ::,.:•�:.. .� � � . . , �T'•^.:'Y t :�..�.,�m� �7•��, . . � . :...: 7 >• .,:::: � .^... ..:+! :.; .. ,..v ;;��71i�s71G;.t�y�'ryA,`tir�i'���ie�r%9 �A+� SBi9::Wi:i91''JL �;' �;�'�►-1L�� '. ... ....; . , 7�,� ;� - . :. .lA:�•]1i3; . ., . .,;,.^--„—. rh:'+^.-;:` . .. . . � : •.. :... � � . : :. . . . . .. VV�LY. PE121VIIT � , �'I,E�E SEE AT'�ACHEI) PI.Al�t FOIt W�LI, SIT� I�YOgJT Tax Map v�� Parcel # .. Township: ��:��' �� \` Applicant: ► �� mU �"'� ; v1� ���C� Subdivision: 1�,� !�► �� .H.�� _ Lot # / � � �' Vi' Typ� of �atea� �upply: <�Tndividual �equi�e�ent�: Site Approved By: Grouting Approved By: Well Log:. � Pump Tag: ' Well Tag- � Air Vent: ' Hose Bib: � Casing Height: � Concrete Slab: � Well Driller: Well Appmvec� by: � ****3ee Attached Site S�cetch*�** ca;�'� '1��! � tf�, 'N�:.��t�Tc.�_ � � �'�'t- C'.� ll.�r-� j��_ Community Public Liner. ' Tnstalled by: ' Depth set: � Grouted• Date• • Water Sample: � Date:. Wells must be 10 feet from property lines. � Welis must be 100 feet from s�ptic systems. Wells must be at least 25 feet from any building foundation. Other conditions: PC�ID rev Ol/27/04 , zs •zzzi � 5o'RAo,.�'- . , eo •sdz� � 0 � e�..00, sz.dos — — x�aa.c.e=ssao��r az�°n';e� , 05 Pasodo�td '_' �� . ��h�' � � Q1:�,� I � ��,��� . �, I � ��5, � a ,� . a � � ' � M ?� / �: d n"� �2 . biw , i s;,�� � �riWdbS y ; --r�„�E Q� � � I �, �� � "(�tixr� 4� � , ��,r►j � 7S„��'� � A� --~�-----._._. �� -' a �. ,,, .�7..00, 62'.6pN ____...._„� .. ._..� ���'L/L � ,��`J'1{�7�� \, ,�� � � �l,�� � :��. � 7 �% o �, n � h ,,�� °� � 1�, Q� �3 ` '1 ?� � b " 't!� �j ,�21'�''"^�'� � . \�_ l �� y . 4�� ��,� ` , `� � �l . � � ���� �''s o� '' ; ; ` � ��� -� J .���� y f ' _.. �' '�' 7 �� �,. r�{� ��.�' 7J�;�� N �a >�s .: .r��,�.s ,,�� � �a ;�£ �S't�� .. � sn � � ��s �..' ,a .? o � �5�� � � �'�7 �