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A40 163j ' . _I 00 . --.. G� /� Aaplication•�ate: � -1 � � 2 .. � 3 Q D ' �()'"1 T� fl�a � �V �mou��aia: . ._ �-13 . . , . � 6 � . . �� . ,���-� � ' ' � . . �� � . . eJl2� � . � � � �� ��,��. ������� � . . _ . — — � �C �-�'�E`'`�' . � . . . . ��.��� --�-�.�-�� �Q�:�. . . . �,.- - �..� 9) Permlt reqtte�tsd imy: �Wnorh9enttPros�ve ow��: 4 E� �� /y`TK�nSv�-v ,. Home rhone: 9.. —�uZr'{ Addres� �! e= Business Phor�� 33� -3b3 _�g-�rs' " oYhu�o .t�. 0275 '� . 2� Plame and addnss � c�rr�n# ovimec: �►�u: _� ��ov-� J . � �warnY ��a.�uu�. „� 3) Property Qes+�tton: Lot size: •�_�Ac,�'cw�hip; ��+� Su6c�visfon: ��o �5 � Lot�:�_ Dit�tio�s to th� P�P�Y ���9 road.names�afnd numbers): 5�9 S � No.o�r-• .¢✓�s . /.� X% � � I�v4,�i� 6 � /� � 1 ovrr - a�— / �-v�=co�6v N C" � :4a��%k� �EFI's �v% �S ' ' Ons r i ' %lis �- 4) Propos0d Ues nd � fD�cal�iort: answ�r �fi otthe fio quest�on� � .� . a) Pnopased'�, Ex�nS Type ot struc�ure: �'n�►� 3��� �%� _ll�. � Depti�: Ya b) Nurnber of Hedroom� .� Number of accu p a n t s or {�p b t � b e serv e d: _� , .+ • c) Ba�rtenC Yea _, No _lA� t�e be phunbing in itte basenneni? . d) Garbage ��t Yes _, Nc V ' � � w�' �PP�Y'rilPa PrivaEe '�(ne�w ✓ar eo�edng ,�, Pu�_, ��SI � SP� _ Are•any v�le on adjoinir�9 P��l? Yes,_ No ✓Ityes, pi�ase i�ie appto�rt�te loc�iori an �e s�a pian. 6� Do� the ptop�rly �ntain �eviousiy iden�d jur�nai �� Yes _ No � PLEA9E NOTE Ti�E FOLLOWING• '➢ A PLAT OF i't� PROP�TY` OR SiI'E PL�1N AHIST 8E � WITE� THlS APPLlCAT10N: � PlZOPEii7Y L1NE8 AND COR�S �JST BE CS.EJiRLY YARl�. . - ➢. THE �OPC9� LOCATlCaN OF ALL �TRUCTURES trUST HE �1'AKED OR AAGG�. • . � THE SiTE �IU9T HE READILY �ICC�S5IBLE FOR �1A1 ENALUAT�N BY THE I�iE1�LTH DE�l1t277HEiN't STAF�. 1- hereh� matce appli�tnn fio the Person Courrty H�ith Oe�t fbr a s�e e�vaivatlon for the ct'�-e�e �Be df�pasa! gY�m for the abave-de�bed propefty. 1 agree #hat the canbents af this a�ppQc�tion ar�e true and re�or�sesd the mawmum f�itles fia be ptac�t on the Prope�'iY. 1 erstand ifi #he s�e is ai�ered ar the int�nd�d u� ct�anges, the pemui shall I�xcrie invalid.� � <3-I��DZ Owner or L�al Rep�e - �� PCHD, rew �on7m� � 3FJ�RING D757ANCE i-24-3a-4 120.13' 1-51-15-u ]21.I6' 7-44-57-w 120.43' :-18-09-�: 120.53' ,-24-02-w 140.20' 7-11-33-�: 99.83' �_,a_m -� iiq_ai• C OUNTR �..c,r� .`��J:�Ci7 . SY iCCO:E60C! � nded. v`-G�p �' � T��T'E S ushy Fork 7wp., Person Co., N.C. . 1ay 1986 , Haf I- Hamlett 9 Assoc. SCole I ° =200� - o - - - Neal C. Homlett RLS 2465 LEGEND , --r-:ron foYnd � --�-o--ItOn f�t M—�nol� founa na�nail s�� r • / oQ �' ♦ i� i� . ' r .o� �orw . r t,on�. e � I � :l � � y I 1 � � \ I � '. • U��) 6. Oerls � � 'i Oe. �sx.o.es ' �ien:o N.tse� � �O• � � I DE.IS? , p 0• � Caorlta 8. Davis, J�- ; q � � � i � ; I s I � RoftNll� ce�nr.r • Eata / wynr 7a. 4 v �/ � Appiication Date: y 13 . Tax MaQ #: Amount Paid• Recelat #• Parcel #: ���� � I�I�I�.��� -= + � � �.�-��� ���.a-�--� ----� ���.71 �3]C�.m.I1.�7�. APPLICATJON FOR SEiiVIC�S � 1) � Permit requested by: (Owner/age�rtlprospective owner): �irtJ7��G.�-.- ��z�.� ��L �l° y Home Phone: 3�� 5-^► g��� L Address: a �cH � � r., t� ��� . Business Phane: 9/ 4 C�7 3�3 I� �°�� � a � L Z? � 7 3 � 2) fVame and address of camerrt owner. i1 �• s'� �,� h<,- �° ,r� �/,... r Irtil� �� � r h . %nJ � / .5 ', f'✓r �'�T r'rt. IC �dl/1-+t i��xh�,,,,� � r 2� s? y G�Y 3) Property Description: Lot size: 3.�l (� Township: ��s►� .s,r)t Subdivision. � Dir�ections to the property (induding road names and numbers): �f � sd�y� l o �`.�� .,. 1 e ,T f- �. tv t,... c i � 5' � �.r�+— � � � i- � � C� w 1'-� �t �y��� 5 f �.�c $rv.: � � Lot # � J 4) Proposed Use and Structure Description: answer each of the following questions � a) Proposed �, Existing , Type of Structure: � � 5 �r o�� -t Width: ��f Depth: c� �► b) Number of Bedrooms: � Number of occupants or people to be served: �_ c) . Basement Yes�,.,, No Wiil there be plumbing in the basement?� y�c:.�� ,�.-, d) �arbage Disposal: Yes No � 5) Water Supply Type: Private �, (new �ar existing�. Pubiic� Cammunity . Spring _ Are any wells on adjoining property? Yes� No �,If yes, piease indiqte approximate locatiori on the 'site pian. � , . 6) Does your prope�ty carrtain previousty identified jurisdictional wetlands? Yes_ No 1C PIEASE NOTE THE FOLLOWING; ➢ A PLAT OF THE PROPERTY OR S1TE PLAN MUST BE SUBMl7TED WITH THIS APPLICATI�N. ➢ PROPERTY UNES AND CORNERS MUST 8E CLEARLY MARKED� �, ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STi�►i�D OR FiAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMEiVT STAFF. � 1 hereby make appiication to the Person County Health Department for a siie evaluatio� for the on-site sewage disposai system for the above-described property. I agree that the cantents of this application are true and represenf the maximum facilities to be piaceci on the property. I understand if the site is altered or the intended use ctianges, the pertnii shall becom invalid. �� �✓�-- � �<,/C�- ! i3 o c Owner or Legai Representative Date � PCND. rev. 06127/02 / T�� T ` � \ ` (� S T��x I�-1�� ' �' F�:rcel � � 1 1 � ' � � S�uibcilivis�ion � �►, 'i� � � ' � t� ( .� � � Ph��se S�ctioin Lot r t ��, - �- I I 1-- I� I.. �� . R . . . � �ll � .��� , i Permit Valid for '\ Type of Facility: _ # of Occupantsllro� Proposed Wastewater System: Proposed Repair: Q � � : Improvement Peranit No Ezpiration Bedrooms � � New �Addition Water Supply Pro�eeted Daily Flow � g.p.d. � � Type: Type: Permit Conditions: �02 � ',2,.. ��e� ' Owner or Legal Representative ' •f• � � " ��--� Date: �f /3 d Authorized State Agent: i�.. Date: ' ,. The issuance of this permit by the Health Depariment in does not guarantee the issuance of other peimiits. It is the responsibility of the applicant/property 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 for Sewage Treatment and Drsposal Systems' (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 Construct Wastewater System �Required for Building Permit) * See site plan and additional attachments (_). Prop sed Wastewater System: � u Typec�-+1� W� water Flow ��.p.d. New� Repair Expansio � Soil LTAR: . 3 g.p.d./ ft 2 Type of Facility: �� .� Easement lC Ycs _ No Wastewater System Bequirements Tank Size: Septic Tank: �'1� gal Pump Tank: .f�� gal Grease Trap: gal Draanfield: Tota1 Area: t � sq ft Total Length �f7 ft Ma�mum Trench Depth � in Trench Width �� ft Minimum Soil Cover: C� _ in Minimum Trench Separation: �_ ft(� ��` Distribution: Distn�bution Bax Authorized State Agent �'�� ' Permit Expiration Date: �'. Serial Distribution � s��e� � Pressure Manif d ��� '�-S� lia�►`� , � C���a�r i _� Date: �� a�'�' �� The type of system permitted is D� Conventional ovative Altemative. I accept the specifications of the permit ". �j� Owner/X.egal Representative: / `� � ' �` � Date: � C3 /v � PC�IDI/17/2003 ���. S� ���.� �� ~ �'` � � �J � � � 1��r�.�a�c-��.n�rn.�aa�.�.11. ���.r.a.Il.�l�n. Applicant: � Location: � � , �� S 1 �'�`' P�`gs / Tax Map r P�rcel # ' Subciivision �,,, i � � Ph�se Section Lot # # of Bed�rooms Operatio� Perrnit System Type (ln Accordance With Table Va): r� THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AND ALL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION AUTHORI ION. 1�-�--�� thorized State Agent Date Installed By: cJ '��� Date: ��—�"'ay � � �� (G� <<`�� �s'� pr�cSS�r � � /Zr�rn�c��L�• �. ����2�� S�PP�r I ��� r_� ._i� � r ,�,�.��r�=.��-�� ii��. _ �, �,�_- ti�•_,«i �. --�i� 1 t e t�•� ��1��� I f ��li�1 s__ t;:]; I�`� a: �` ' t .. ��i �l� i,rf I-�.{�?�=°=,lt'." sr� ! T'�+T ! ���•.+if l�.�l�= ��t�lltrlL���(C ;qr:;,��- � iti �~ :11rr��� �j� �I o-- _�t.=: - f�Y_ •.�_ .t ;• _ H �f ' �� 1• : _1.=. `i I• s I � ,��-r_ • ����_� - i.: �� _ ��.r_ ♦ itc ..�� - •1• �/ �I► � � t= � t_= � 1 i= � �►.l=�f��� -:�,� c.. � I �� � ,� _ '��e��= -:II• lt�si� j �fi�� `/��i-_,�=:fi y�'c�} •: ��• ��ci1t:,�\�Y� ��• a _.L�'.'i*=��t �-j��= �_=•If�=;41'=����'_�I�i • �':�.}:�.�����i �tr��:l ��r .i-.�.�.� 1i c;:':`_.� i �tc t• t�i• �_.:;�= sl:� -��a� •�_ � iflL _` � _ _ 1�._ '��f--_�t�`I��L`3 � ,.�i��`l=�E�;i"��i:T':,-��, � ���.c- :[_ � ��c t e�1- [F=1t= �..tE=:= if'= �r•'i�lit�L-I��ti . . . . . . ... .. _ .. ���� �� ���� �� �, �• • . "' _ : ,� � ���� . �. �n,-�m�c-acaarn.�r.�►.a�aKn.�,s►,7L �-�a�:cn.IL�gn . WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT _ ���- ✓�t`�l� Tax Map � Parqel #�3 Townslup: i Applicant: _ Subdivision: Location: Lot # . ���.� E,r�L`� D�-� r�� �� . Ci►''�5 r�. G'���i�'�� �r�i�� ✓ Type of Water Supply: � Individual _ Community Public Requirements: Site Approved By: Grouting Approved B : - � t� Well Log: Pump Tag: /� _ Well Tag: �% Air Vent: � Hose Bib: Casing Height: Concrete Slab: Liner: Installed by: Depth set: _ Grouted: _ Date: Water Sample: Well Driller: �.� Well Approved by: Date: , � � �'� �i _ ****See Attached Site Sketch**** � r1 Wells must be 10 feet from property lines. . Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any building foundation. Other conditions: PCHD rev O1/27/04 Page 2 of 2 ���G( � �l� � � �-�� . ��� � �t� Profile View of Pressure Manifold for Level Site Installation (not to scale) Plan View of Pressure Manifold for Level Site Installation (not to scale) http://www.deh.enr.state.nc.us/oww/LOSWW/manifolds.htm 8/28/2001 0 NEMA 4X Simplex Contml Pazul � �-1 4" X 4" Preesaxe Tzeated Post j Sloped To Shed Water 12" Separation F12CtlSCE� COYIdSIIt ^ b" Cowr •� ' � Acce» Comer � •• • : � � .1 i � • � r . J .. ,• , ` j e ' - �� . . ` . 7" . ; �,, Openins Filled �th Anti Siphvx Holz laxud C Gmut � In1et From Septic Tank Port amsnt �� � d" SCH 40 PVC Pipa � Check ' Valvn � Higk Watez Ala:m L��nl (6" Separation) " Hi=h Lavel- Pamp On �..��„` ih ' ��� �VaporLock ,, Drawdatim Hole � � � i�P �� � . 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' � . � � • � �!' � . •� � ' � ' f � .r 12/08/2004 18:20 336-388-5940 EVANS WELL DRILLING �'�'EL�, C�N5TRUG7'IO�i R�CUR�� PAGE 02 �uril� Ca�uh��;� •:kp:�r►nwn� �f isn�•ira�tmcnt and Natural R�suurtcx - Uivixiou ur�Yatcr (?aal:i� - Gru�:n�M��cr 5ccti��n ��� �i.t cc��"t a.�C'i i��e;i�ul��lui�a�.� Nnnt� (i�r�n�� i LLtih�' *' E� C�K7iFiCwTiOn r � n�t ►�•t:i.�.cUaY�:,�c-rc»cc•�a�r.�s�•;v,.asF:,,��s wel} Driilinq Co-�InC ��cone��36�-388-2504 x-r,�•rr: a•r:i.�. C��a:�•r��c:crta� ��Ftc��Ctyr._.__�....�......�4�S��CIA7lU �v# 1'EildI1TR .,� (ifn>>pli¢nbl�l uClpl+litabla) � 1. `V��,[, IFS� iCltirrL A)�Plicsbl� �3nx): Rciidu�ti�) Q9 MunicipaVPubl�c C� Ittdt:.qt�a! D A+riCulwral C7 tituaituri,:y. 0 1i.cc�vcry O Hcs� 1'u:ti�p v1'•r�cr lnjcuion t'� Ocher ❑!�'Qchcr, Li„t Usc 2. W�I.L LnCA'!'{C1N: �iCi�tL'S!'ruw'fl: �Q,r1-�nrn Z`uutllY PWricnn_ 26 Tj�r _.t1e C�pek T,an� 1SIn.� 1x�nr.\i�ruA.a,�. C�amuunuy.5uMlivi.iau, i.�Y:�u.'l.,pC„Je� 3. OwTiL'ft: Kristopher Kuehn AdJ�t:.. ��j Turf j,F' r���, T.ana SS«;,� �i R.�,u: �u.� ' Ro�cborp. NG�7574 C�t� �r 7.•r.•,� S�i+c c�p �..Wc t�)- Area cu�[,t• 1'IipA� �nt+er •�. DAT� UR1LLlU R_� n—na _ S. TOTw� ll�P71�i: � A n b. DOk$1� �LL K�!'U1C�: �XIS�!\G 1�r't;Ll." YES Q NO fi� 7. 57'A'CIC WnT�it L�Yt;L li�iuw •ro�� �r�:�„��: '� � k�'T. i��:t �+� �rn�� •rop orru�r� s. 70!' Qr CA�1NG IS ., 1 i•T. AUoYc Lv,d Surf�c�� �Cop w( e•�u�� �rr�ntpr�ed •Uvr �eluw I�n�t �orfuc rcquirc� a t`aylaaev iq MtCvf�roec »11b !SA 1CJ1C 2C..d11;. 9. ��,�i� cy�,n�;:1.�.r Hr: r���� c�� 'rf_5�t' A i. r tD. WA'1'Clt 10;�t�;y ��lcpll3)• Z5� gt Il. !al51NF[iCT[ON.'fypc _ _ Mnount 12. CJISING: wai[ 77�iak��c�cs �ptit: Ui1»�c�rr nr WciLh4'Pt. 1�tatvia! 1'rou�_ a 7'u�.�,3__ Ft.-.614 1g,�„� ,s.}�..L� I�ru��ti 7'u -- t'�•_r...— � Frui,t,�„ ro r•:. ~_�.• i}. 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S!t C':�lti :C� 1:.�:f:�.....t•'n:I � :�'U:��i •ltiti 1�GI FO''LE' •'T� ?;,� i��'�.:t: L�:1dll�' I'iC_L`, !7CJ��lt1Cl::. . / si�;nat�►re oi (: unu���ur _ � - �`�'.��� LU w �3. �., ti,►c� __� .�%�.�� . : ���•� . . .. PERSON COUNTY HEALTH DEPARTMENT SUBSURFACE WASTEWATER SYSTEM MOlvITORING REPORT 1131`i to-l-�`i� 1ISL� 1��0 fb3 Date of Inspection System Installation Date Type Tax Map Parcel # o� (o �Tl�ttzl�c C.I"�Gk� �.-�.1, �(�o�c(5•►� � la C.. �1`IS 7`{- Property Address Instructions: Check yes or no for appropriate items and explain in space provided for remarks and comments. If an item is not applicable, indicate by "NA". If an item is not or cannot be evaluated, indicate by "N" and explain. Note that this monitoring form is not totally inclusive for all systems. All maintenance and monitoring items specified in the permit are to be carried out. INSPECTION RESULTS COLLECTION SYSTEM: Evidence of leaks ? Tank risers accessible, free of infiltration and surface water diverted ? Septic tank needs pumping ? Inches of solids: 10-I�," Septic tank filter cleaned ? EFFLUENT DOSING SYSTEM: Require3 pumps pres�nt & functional ? High water alarm operating properly 7 Floats, valves, etc. in good condition ? Control panel & components in good condition ? Effluent free of excess solids ? Inches of solids(pump/dose tank): �'3 Elapsed time readings ? Counter readings ? Drawdown rate: YES / NO REMARKS � /� .�-cE-�lc,� i..�ll.. c�.�� ��. k�'� � � ❑ ��F. "tV l�cr'Rc�Ct. i�' c� S�cP't�` �Cw�.... , t� � � � 'Tp 't�. �rX.�kyc'-c� trk�'� Tfl�il. t�u�Ci�.'R- ❑ � � L �� ■ r_� ■ � ■�� DISPOSAL FIELD: Evidence of efflue�t surfacing ? �. Evidence of effluent ponding in trenches ?❑ Surface water effectively diverted ? � Diversions/swa:es properly maintained ? ❑ �ege±3ti�e cever main±ained ? [� Protected from traffic/unauthorized uses ? � Distributio,i uevices ui �ood condition 7 ❑ Field free of settled or low azeas ? � / / / / / / / / ■ C. ■ ■ ■ ■ i! � PRES�URE DIST�UTION SYSTEM: Tumups/cleanouts/valvesltaps intact & accessible ? ❑ / � Pressure head properly adjusted ? ❑ / '�Q COMPLIANCE: Compliant Non-compliant Needs Maintenance rSii�iTivlvr'w Cvivi2vi��1TS: EHS �4�c.1L /-� _ �c'�� ■ .� ��� • �+�rr.�+.�.� s�a��c. �r 3.�.c,►�c.,.\ rir�a�ww 41('E � ��++ (�,�1 SS� `P�4� `���'t�z�"1,.