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Orange County Health Department PiN# 9843137930 TMBL 3.55..4 <br /> Environmental Health Division <br /> P.O.Box 8181,306-C Revere Road APPLICATION DATE 01.29.2002 APPLICATION# rH39257X <br /> Hillsborough,NC 27278 EXISTING WELL 1 SEPTIC <br /> Phone:245-2360*Fax: 644-3006 SYSTEM AUTHORIZATION <br /> APPLICANT: CAMP CHESTNUT RIDGE PROPERTY OWNER COMMISSION ON OUTDOOR/ &CAMPING <br /> NUNISTRIES INC <br /> ADDRESS 4300 CAMP CHESTNUT RIDGE ADDRESS PO BOX 10955 <br /> EFLAND NC 27243 RALEIGH NC 27603 <br /> PHONE# 304-3900 PHONE# <br /> PROPERTY DESCRIPTION: S/O SR 1120 LOT StZF: A201•05 <br /> PROPERTY ADDRESS/DIRECTIONS LOCATION / 4300 CAMP CHESTNUT RIDGE RD <br /> TYPE OF FACILITY SUBDIVISION����'Oy SUBDIVISION LOT#: <br /> MOBILE HOME PARK SPACE#: <br /> 96LOOR PLAN REVIEW ORIGINAL PERMIT LOCATED? Y❑ N❑ WASTEFLOW GPD <br /> AU HORIZATION FOR: (DFSCRIMON OF PROPOSAL) P�J � ;'LLni 1 t+1 4�0 1. �J. p U5 ST&ry-kD1J V- <br /> AUTHORIZATION CONDITIONS: <br /> [gbn the date of the inspection,the system(s)appeared to be functioning properly <br /> 5fthe proposed change does not affect the well setback requirements, septic system setbacks, or design waste flow <br /> ❑The proposed change requires the owner to apply for and obtain ❑An Improvement Permit <br /> ❑A Construction Authorization <br /> ❑A Well Permit <br /> (reason) <br /> ❑The system was malfunctioning and must be repaired in accordance with the Repair Construction Authorization <br /> ❑The following conditions shall be met prior to the issuance of the CERTIFICATE OF OCCUPANCY: <br /> []Authorization denied (reason) <br /> ❑No field visit or EH approval is required. Change does not meet need for authorization pursuant to NCGS 130A-336 <br /> Additional Comments <br /> ♦ REFER TO THE SITE PLAN/FLOOR PLAN SHOWING THE SYSTEM AND FACILITY LOCATIONS <br /> AND OTHER SPECIFICATIONS OF THE AUTHORIZATION <br /> ♦ THIS AUTHORIZATION SHALL BECOME INVALID AND MAY BE REVOKED IF: <br /> ♦ The information submitted on the application is incorrect,falsified,or changes,or 'd <br /> ♦ The proposal is altered. <br /> ♦ THIS AUTHORIZATION IS VALID FOR A PERIOD OF 6 MONTHS AFTER THE DATE OF ISSUANCE. <br /> ♦ THIS AUTHORIZATION IS CONDUCTED IN ACCORDANCE WITH: <br /> ♦ Oran a County Rules for Wastewater Treatment and Disposal Systems as adopted by the Orange County Board of Healtb, <br /> ♦ Orange County Groundwater Regulation <br /> ♦ Orange County Wastewater System Specifications,and L) <br /> ♦ Orange County Environmental Health Division Policy <br /> ISSUED: 0`CZ- •✓+� EXPIRES: <br /> DATE ONME AL HEALTH SPECIALIST <br /> Existing OCHD 12/4/01 194 <br />