A27 349. • ,. .
' � .
� _. PLEASE SEl
Tax Map #: �
Zonio
APPU�
Locatlon• � 7 /`�
PERSON COUNTY ENVIRONMENTAL MEALTH
Pareel0 � % /
Townshlp OI 1 �1'C- �\ � ( ..
l � UJ�nS�ac� �'arrti �
1 � �, d- `' .
o�
`A'�
Subdivlslon: �hr VY (VkS S�ctlon: �� �
improvement Permit
r:
A buildin4 aermit cannot be issued with oniv an Imarovement Permit
� New -� Repair Addition Type of Strur.ture 3'�t'+ � Wate� Supply ��
# of Occupants #•of Bedrooms ��Other
Basement? N e_�—Baseme�t Fuctures? �
I O�L
Projected Daily Flow: . g.p.d. Permit Valtd For.�Fiv� Years
Proposed Wastewater System Type:�a��,}��7'�,,-� o
Pump Required? Yes No �
Proposed Repair � ` T�n n oJ�=.�2.
Pertnit Conditions: 1�ev stisfo�;. in' ..C,�,�. mtn/JPr'� /,:,
4t1S�'Pm a,�
❑ No Expiration
� o?5%a r�-l-�`on�
�.el �s' �o,� ,�,�l�l.h
Co n."l our.
Owner o� Legal Rep�esentative S' tiature: � �� � Date: b-.� '" �%
Authorized State Agent Date: �� Go
The issuance of this permit by the Heatth Depa ent in no way guarantees the issuance of other p�rmits. The peRnit
holder is responsible for chedcing with appropriate goveming bodies in meeting thelr requirements. This site is
subject to revocation if the site pian, plat, or the intended use changas. The Improvement Permit shall not be
affected by a change in ownership of the site. Thls pertnit is subJect to compliance with the provisions of the
Laws and Rules for Sewage Tr+eatment and Disposal Systems of the North Caroiina Administrative Code.
Y Type of Wastewater System -��
Faality Typ� �-��'. e S �Gte�ic�
Basement? Yes ❑ No
Wastewater Svstem Requirements
� Wastewater Flouu�.��p d
New�i Repai� ❑ ansio� 0
Basement Fixtures�Yes 0 No
Septic Tank Size: 1 � tT U gallons Pump Tank Size: N` +4 gaUons
� N
• Total Trench Length: �0 feet Maximum Trench Depth: �� inches Aggregate Depth:� in. C�� �
i�ir�;�iu� .
� Soil Cover. � inches Trench Separation: � Feet on Center
�
Other.
Pertnit Expiration Date: o�� 0�
Authorized State Agent:
Date• � ' a� �
The type of system permitted 0 does C7 does �iot difFe fro the type specifted on the appltcation. I accept
the speciHcations of this permit
Owner/Lega! Representattve Signature: �- Date: ��� �� �
��� �.�-ill'10 1�(�(.�-i:L. b �Cnl.l�.�,1�i(l W`i�1 U�.� PCHD, rev:11/18/99
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vrun r4v_ �(1/�12/S9 �
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Applicatlon #: �
� . � Tax Map #: �- a � •
Parcel #: . �___ �f% _._
� Person County Health Department ,
Environmental Health 8ection
SITE SKETCH .. .
3ubdivision/Sectionil.ot#
� 2$ OU
Date , � �
represent apprarlmaie conloura anly. Tha contrActor neust flag the systeni
�e lnstallallnn to ln�r[re lhAl Proper grade !s malntalned. __ �
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i1/� � s .e�.� ,
. �ar,M, bZQ� .
Syarem
P�rson C�unty �leaith �epar�m�nt
n ��y ��vironmenial Heaith Sec#ion ���
Tax Map #: ��� ( Parcei #:
Zaning:
Subdivi:
Applicat
Locatior
Township: �
ction• Lot• 2
Operation Permit
System Type (in Accordance With Table Va): �
THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORT!-1
CAROLINA GENERAL STATUTES, RULES FaR SEWAGE TF2EATMEiVT AND DISPOSAL,
AND ALL CONDITIONS OF THE IMPROVEMENT PERMlY AiVD CONSTi�UCTION
AUTHORI ION.
�� `",��`��
Authorized State Agent Date
������� ��.
� � ��� `e,
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�tl vV�
Tax A�ap #: Parcet #:
PCHD, rev. 10/'12lg9
PERSON COUNTY ENVIRONMENTAL HEALTH
PLEASE SEE ATTACHED PLAN FOR WELL SITE �LAYOUT
Tax Map #: � / �� Parcel # � � �
Zoning Township �C /� %� �A[ `
AppQcant �J�( i'11'! !n �%, i'1 S / �� .
Locatlon• �% /� p (�o6L��� .�� / �' (/V I ru S' �L^ �G(i�'r'• /��.
— Q v�
1 �
Subdlv(slon• �� n V" �� S��on• �O`
TVpe of Water SupplV:
Re4uirements:
Site Approved by
Grouting Approved by
Well Log
Well Tag
Air Vent �
Hose Bib
Concrete Slab
Well Driiler:
Weil �ermit
�vidual Community Pubiic
Well Approved By: Date:
**See Attached Site Sketch'"""`
Wells must be 10 feet from property lines.
Welis must be 100 feet from septic systems.
Welis must be at least 25 feet from any building foundation.
Other conditions:
�
PCHD, �ev: 11/29l99