Agenda - 08-28-2000-3 - Laserfiche WebLink

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VIASTEWATER SYSTEM CONSTRUCTION AUTHORIZATION sm Orange CnLlnty l 1palth Department Envlrnnmen1a111c.11111 Dlvlsinn P.O, BOX 8181, ]06- C'Reverr. ROaMI I IIIIsb0futIfjb, NC. 27270 PIfONC: 732.01131 D57.9251 680.7731 227.2001 EXTENSION 2380 FAX GnA.1000 AI'1111r:n,I-0I ... %!!'r� cr Cl�1G /flee PROPERTY ONJNER: / Qom^' O� L? / /:' f"e•✓2 iet ADORESG' III h -lld1= 1 IP.MEli z -z- 9 R LOT SIZE SUBb1V1SION I LOTII nuutL:l ir:IU; / Lv�.nnnN __/ � .mac L� � - r ��Ar•na ,�.� _ _ I, I h1- t Ijq,l1''.VJ SYGT7m I_1 REPAIR 0 EXPAla5:9N ❑PERMIT RENEWAL I I RE ;IIIFIArr: , III 1m.ni R Or REIIROOMS _HUI1,RER OF OCCIJPANTS _ 1111111 -1( (I 'I rA :d:l 1 r1rn�_I N N n,ic -o— n.ri _�'' 111 :;Iti ?II' I li 111 I :.IrF I)F 1IIF, ��INI}C r�llE ;I YI'I? UI' !Al/1:[EN SUPPLY PLEASE CI [ECK IP APPLICABLE: PROP IS SYSTEM TYPE: I 1 1'11111 II. CI bASEMFHT WITFI PLUMBING ET CONVENTIONAL I I I'IrIIVA I I' VVI:LI- [I WASTEWATER OTHER THAN SEWAGE GENERATED M OTHER (SPECIFY) I I I :< 14:1MI11•11 I Y Vvi -.1.1. [1 PROPERTY CONTAINS DESIGNATED WETLANDS I I O 1111_R LI SITE 15 SLDJECT TO APPROVAL BY OTHER AGENCY 1_I QTI IER [_1 SITE IS SUBJECT TO APPROVAL BY OTHER AGENCY A SITC PLAN OR PLA T AND PAYMENT MUST BE INCLUDED WITH THIS APPLICATION TO COMPLETE TILE SERVICES. 1,41 ITIIORIiA -11011 TO CONSTRUCT (WIIFN LAYOUT WAS PREPAID) $70.00 1 -1 At 111 l0fft17,A1 ION TO CONSTRUCT (INCLUDES LAYOUT r-EE1 $120.00 1 711E rxl :'T)NG AND ANY PROPOSED PROPERTY LINES/ COR;JERS MUST BE CLEARLY MARKED, I.1 A l- f,DOIT PLAN OF TILE STRUCTURE MUST BE SUBMITTED PRIOR TO ISSUANCE OF THE AUTHORIZATION I f A SI f r I'I•AN UR PLAT; All 17F PROVIDED SI IOWING : TI IE LOCATION OF THE PROPOSED STRUCTURES, DRIVEWAYS, I: :fr'AVA7 fr>N : OT7 011128 IMPIZfj VEMENI'S; PROPERTY LINES; 0IMEPISIONS; AND SETBACKS TO REFERENCE POINTS.. I I I! cnra:I t fruC 17 <)N AUT1I01r17J1710N hfUST DE ISSUED PRIOR TO ANY CONSTRUCTION. AN OPERATION PERMIT MUST BE ISSUED BEFORE PLACING THE IMASTLVJATER SYSTEM INTO USE. t1IF PERMIT IS SUBJECT TO REVOCATION IF THE SITE PLAN, PLAT, OR INTENDED USE CHANGES OR IF TI(E• SITFF; j,6 TEREj I I JA V1. I F.Af) 17115 Ar'11!. 1CA TION AN17 AUT1 iOMZ@ THE. 00110 TO ENTLR THE PROP4R TY ANC) PERFORM YI rE 5EnwCE RE r, UEST ED. OWNRR % j.�r �y�.�..� —� CATE: 00 NOTWHITE BELON NS LINE Iz6' -LEIP1 YI `/ -/.7j OCPO CONFIR -MED IP11 ACTION T 11115 r711MIT SHALL 07 VALID FOR A PERIOD OF 5 YEARS FROM THE DATE OF ISSUANCE OR UNTIL THE IMPROVEMENT PERMIT EXPIRES, W141CHEVER COMES FIRST. l� WA ^lrflc : \n1 Z40G!'f, TYPE SYSTEM! C.�lai3 SYSTEM CLASS, 1� II FIOR. TRENCH SEP.!� _FT -T , 14111 .1 AI•Ili C=AI. PUMP TANK GAL NITRIFICAT10K"3 r X 2-70 FT MAX DEPTH 2,_7IN I lI•`i'up.rnl l:;Tlil ICTIQt•I C.r INrERFIICP REQUIRED (when checked) OTHER PERMIT CONDITIONS: II I.GFGR In i 111' A TTACI IGrl SITE PLAN SIIOVNING THE SYSTEM AND FACILITY LOCATIONS AND OTHER SYSTEM SPECIFICATIONS. THE S Y.'. "TIM 1I'AI.I. UE INSTAI_I.FD IN ACCORDANCE WITH CRANGE_COUNTY WASTFS14TER SYSTEM SPECIFICATIONS S POLICIES 71 e1. n I Il Y1M2A MOP! SI I.A'.L PECOMC INVALID AND MAYBE REVOKED IF.' THE SYSTEM INSTALLATION IS NOT COMPLETED twTHIP15 1'I "A7; 7I tP IPIFOR,41A Tl;)P: SUSAII TTCU ON THE APPLICATION IS INCORRECT, FALSIFIED, OR CHANGED, O^R7 IF THE SITE IS ALTEPED. L7- Z0 -71�? LIATE ISSUED ENVIRONMENTAL HEALTH SPECIALIST DATE EXPIRES RGFER 10 TI Ir ATTACH?" TEM •ISTRUCTION -AS- BUILT' AIJD THE. BACK SIDE OF THIS FORM FOR MORE INFORMATION. LM 110; 1 AI i 11 SYSTEM, OPERATOR u ��a_ SY`:TtI,: C'. n': ;IFICAT',CI: OPERATCR INSPECTION REQUIR;E.D E/jjERY �MOPITHS T1C110 rt VIEW I.REQLJEI•ICY MONTHS OPERATOR REPO TS DUE EVERT J/j � �T+1CI M IS i1� i f ONMENI AL 1 IEALTI I SPECIAI.1^ r 027