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CDP File Number 36093 County ID Number: EHPR-10-09-2219
*Site Modifications ❑ Open Fill Sheet
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
*Permit Conditions
The issuance of this pemtit by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
The Improvement Permit shall be valid for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to
Sit Plan scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the
VV site for the proposed wastewater system, and the location of water supplies and surface waters).
Plat The Improvement Permit shag be valid without expiration with plat (means a property surveyed prepared by a registered land
surveyor, drawn to a scale of one inch equals no more than 60 feet, that includes: the specific location of the proposed facility
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and appurtenances, the site for the proposed wastewater system, and the location of water supplies and surface waters. Plat
also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy
of the recorded subdivisions plat that is accompanied by a site plan that is drawn to scale).
The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of
the system to satisfy the conditions, the rules, or this article. This permit is subject to revocation if the site plan, plat, or intended
use changes (NCGS 130A-M(f)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring,
reporting, and repair (.1938(b)}
Applicant/Legal Reps. Signature Required? Y s ONO /
Applicant/Legal Reps. Signature-.- Date:
CT /
*Issued By: 1896 -Lucas Sears Date of Issue: 1 1 / 1 6 / a 0 0 9
Authorized State Agent: OValid without Expiration?
OHand Drawing ~ Import Drawing
**Site Plan/Drawing attached.** TotalTime:(HH:MM)
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Page 2 of 3
CDP File Number: 36093 County File Number: EHPR-10-09-2219
Drawing Type: Improvement Permit Date: 1 1/ 1 6/.1 0 0 9
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Sheet:
COMMENTS: FILE
Landscape Position Group Texture .1955 LTAR Structure
R-Ridge I S-Sand 1.2-0.8 SG-Single Grain
SS-Shoulder Slope LS-Loamy Sand M-Massive
LS-Linear Slope CR-Crumb
FS-Food Slope II SL-Sandy Loam 0.8-0.6 GR-Granular
NS-Nose Slope L-Loam SBK-Subangular Blocky
HS-Head Slope ABK-Angular Blocky
CC-Concave Slope III SI-Silt 0.6-0.3 PL-Platy
CV-Convex Slope SICL-Silty Clay Loam PR-Prismatic
T-Terrace CL-Clay Loam
FP-Flood Plain SCL-Sandy Clay Loam
IV SC-Sandy Clay 0.4-0.1
SIC-Silty Clay
C-Clay
Consistence Consistence
Moist Wet Mineralogy
VFR-Very Friable NS-Non-Sticky SEXP-Slightly Expansive
FR-Friable SS-Slightly Sticky EXP-Expansive
FI-Firm S-Sticky
VFI-Very Firm VS-Very Sticky
EFI-Extremely Firm NP-Non-Plastic
SP-Slightly Plastic
P-Plastic
VP-Very Plastic
Sketch o valuaLion