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A27 58Application Date: b Ig_03 Amount Paid: .O'D Receipt #: ,_ �'� l 3� Tax Map #: �1 Parcel #: - � ��_.S� ��.� �� - - .- --,_ � � � � °� � �� ma ��.a�� APPLICATIOtd FOR SEi2VICES IF THE IIVFORMATION IN THE APPLICATION FOR AId IMPROVEMEiUT PERMIT IS INCORRECT. FALSIFiED, Q CHANGED OR THE SITE IS ALTERED THEfd THE IMF'F20VEMENT PERMIT AND AUTHORIZATION TO �r 0�J CONSTRUCT SHAL�. BECOME INVALID. � ,,,,� (�Q c:s�� 1) Permit requested by: (Owner/a ent/prospective owner): � (�'�- Home Phone: - � Address: �� Business Phone: (� � 2) Mame and address of.current owner: �� G�/J 3) Property Description: Lot size: Directions to the properiy (InclU,d 4) �. . �� i�-�. �� . v_f 4 . c � 5 � Township: �' � Subdivisiorri'�� Lot # Pro�osed Use and Structure Description: answer eac of t�e! followin,Q estions: �� 2� a) Proposed _, Existing Type of Structure: �"Cl��"1 - ocQ��sLW�dth: I�P Depth: V� b) Number of Bedrooms: � Number of occupants or people�to be served: � �p�. c) Basement: Yes , No l/Will there be piumbing in the basement? d) Garbage Disposal: Yes � No 1� 5) VUater Supply Yype: Private �(new _ or existing�, Public , Community , Spring _ . Are any wells on adjoining properly? Yes_ No � If yes, please indicate a�proximate location on the site plan. 6) Does your property contain previousty identified Jurisdictional we#lands? Yes_ Ido_�/ PLEASE NOTE THE FOLLOWIPIG: ➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED 1AlITH THIS APPl.ICATION. ➢ PROPERTY LINES AMD CORNERS MUST BE CLEARLY MARKED. ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE ST�4KED OR FLAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AfV EVALUATIOfV BY THE HE�ILTH DEPARTMEfVT STAFF. - I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for.the above-described property. I agree that the contents�of this application are true and represent the maximum facilities to be placed on the property. I understand if the site is altered or the intended u e changes, the permit shall b me invalid. � � ^ �^ �sr `��, �� Owner or Legal Representative Date PCHD, rev. 06127/02 r l PLOT �LAN - S�TEI��`y � iNAYiVE i�A� LACE _ _� �� ; aa� � __ - ILOT 9 ROCKWOOD HILLS - � A __ M ` �3 � � A Auolication Date: � 3Q�� 3 Amount �aid: S'� �a��;pt #: 2 7�� v � � � �p�' �� `i � l �� .S� �� - - _ = � � �.T�T'IL" �Y" � aa�a.a-�s��a-*-^-�• .a��a.71 7��mII.�I�a APPLICATIOId FOR SERVICES �ot) -.; 2os:eo �b. improvemerrts Permit - $150.00 (Mobile Home Repiacement/Addit3on) RepaidReplacs Exisfing System Pertnit CONSTRUCT SHia►L�. BECOME IMVALID. 1) Permit requested by: (Owner/agertU Home Phone:33��$�02l00 Business Phone:3�(�" 5�.- 19.�j'G Tax iVlap #• � "'2 � Parcel �: �q (NewlReplacement) - I ❑ Construction Authoraation $�5D.4l0/$20�U0 �Pertnit Revision Fee - $75. �!� o f?� (� c.-� A-• CC:tf�L °� cg11�'I2on1 h1-CC l-�2k. � e t`� �2. P-e��Cl�3 o.2d -- K9t 2'7 S'�Ss 2) i�lame and address of.cvrrent owner: �..� �- G L,L,C �� -�jc��(�jy �.ovic� � .5�12 GLAv � �,1 � . �Y�30�w �'1��. 2'1.r'�3 3) Pro�serty Description: Lot size: �JJ��Township: O(�� /Subdivision: Directions to the property (Including road names and numbers): � W E:. -. 0 Lot # -- CI bedr�om , 4��%��'�� d) Progaosed Use and Stru ure Description: answer each of the following questions: a) Proposed cisting ype of Structure: "� �G:� F ahc �� Width: � Depth: � b) Number of Bedrooms. .> Number of occupants or people�to be served: �_ �� c) Basement: Yes . No 'Wiil #,here be plumbing in the basement? d) Garbage Disposal: Yes � No � 5) Water Suppiy Typ Private (new _ or xistin /�, Public , Community , Spring _ . Are any we s on adjoining property. es� No _ If yes, please indicate a�proximate location on the site plan. 6) Does your property contain previously identified jurisdictional wetlands? Yes,_ NQ^ PLEASE NO'TE THE FOLLOWING: ➢ A PLAT OF THE PR�PERiY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. ➢� PROPERTY LINES �4ND CORNERS MUST BE CLEARLY MARKED. � ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAKED OR FLAGGED. ➢ THE SITE-MUST BE READILY ACCESSIBLE �OR AN EVALUATION BY THE HEALTH DEPA►RTMENT STAFF. I hereby make application to the Person County Health Department for a sife evaluation for the on-site sewage disposal system for. the above-described property. I agree that the contents �of this application are true and represent the rrraximum facilities to be placed on the property. 1 understand if the site is altered o� the intended use changes, tFie permit shall become invalid. k �.�. ,n -, Owner or Legal ( :7 -� a 3 `. Date fCND, rev. 06I27/02 . � L � � o � � d � � L �� h a C� C� -� i � L � �'- � �:��:s�r �I�I�� - �� ffi��.,,,�.��.��.� ��.a��. SITE SKETCH Name �b%y �'S�'�aron Ciur K �Tax Map # o�� Parcel # J�_ Subdivision Koc-(C wood . I-li Il5 Section/Lvt# Authorized State A�en�, � Date Systent compottents s�epresent beginning the iristallanon to � ao�.90 ` � r ��a � '3 y -s� .n . ntours only. The contractor mustflag the system ps�ior to prop rle is maintained L b C � � . � C � • J J � � J �� ' �3 ¢ ~ � v -� � ¢° `J'� , J �' � � w Z� � 3 �� .. 9,�0, v Jo `s\ '� ►-- � � � � � . Z O �.vv� � � '�K- = a � ci � ",� o� � r�� o . o .�. : _ � v � d �' b i� � '� C• � �.� �,C �, 4 � "' -d S � =-°� 3 a� r �n I� a r � 0 �J'� Z u � J � � c�. c 3 � �j � H � `- u' � w�• a: c � 4 p �- 4 � � � ,, _ ,c � ,�i � � j , Lc � � v � � SJ ,;% J 0 .Q _ . L � T � "3 �h 1' T '�' _ ^ ...., `a(` � `;; �� ,�, _ �„ � � ZIL,SO � '� .. Q' ..� ; .� .� r Scale: � ��= q0 � J . � Y3 � � . � Q / / PCHD, tev. 09/12%Q1 m Y � F O a pd �b�`°�z�� 1 ec�e`� . � �� / 3-a6� �� _ � .. Improvements Permit (EstablishedlRecorded Lot) _ Reinspection of Existing System (Loan Closing) Improvements Permit (Unrecorded Lot) _ Repair/Replace existing Septic System Improvements Permit (Mobile Home Replace) _ Permit for New Well Improvements Permit (Addition) _ Replace Existing Well ; - : ' 'S�Vater Sample5to be Co1lecEed Y ¢. y 5 >.; _ :,>,:: _ .>_.._ .. .. . . ; . .. <. u .. ..... � ..,<. _ Bacteria _ Chemical _ Petroleum _ Pesticide _ Lead 1. Permit wner/prc Ad s: � � w - o , � �v�oC,l -l� lLc ;ste by: , � ive o}�} agen n M 1 �G�rsd:l.c Priru � Home Phone #: �gi� �S9 q��`� �� a usiness Phone #: �� 9 7�SS�� a . ; 7. Dimensions or Proposed Structure: � Width: �� Depth: SO 8. What type (if any, additions, expansions, or replacement is anticipated to the structure or facility that this sewage disposal system is intended to serve? address of current owner: 9. Water supply tSpe: � /� �� Q private C�public ❑ community ❑ spring ❑ -a �y �,�. ��, Are any wells on adjoining property?Yes ❑ No ❑ � r, i/�1 . C, 2 i�'� 3 If so, identify location: . ..,r.,.., _ . Tax Map##: Parcel#: _ T.........1,:.. : Lot size: �Z ��F��; . Directions to property: State Road #& Road lames, etc. � / � E� '� �� r f�i `� v r�J ^��]�" 7�" G(�� N� ' � i T��-L r/-- �..► w i^ s�:t. � Number of occupants or people to be served: 10. Type of structure/facility: Proposed• xisting: ❑ Type of dwellin � House: Mobile Hom : ❑ Business: ❑ Type of business: � �� Number of Employees: /� umber of bedrooms: 3 Garbage Disposal? Yes ❑ No I� Basement? Yes ❑ No C��o, # of basement fixtures: CLEARLY STAKE ALL CORNERS OF THE PROPERTY AND THE CORNERS OF ALL 'PROPOSED STRUCTURES. I hereby make application to the Person COunty Health Department for a site evaluation for the on-site sewage disposal system for the above described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the property. I understand if the site is altered or the intended use changes, the permit shall become invalid. I understand that before an Improvements Pecmit can be issued, I must present a survey plat of the pr perty to the Health Dept. I understand that in the event I have not delivered a survey plat of the property t Health Dept. within 60 DAYS after the date of the evaluation of the site by the Health Dept., [his appl' ton shall become void and all fees paid forfeited. � � . — Sig�d Owner or Authorized Agent Perrriit Issu�d � Permit Denied,❑_.�,/ Plat Observed t_W' Signature Date 3 �7�� , :� RECOMMENDATIONS/COMMENTS: STTE CLASSIFICATION DIAGRAM (Include: Soil areas, property lines, roads, streams, gullies, wet areas, fill areas, wells, water bodies, slope patterns, etc.) C:WMIPR0IDOCSIAPPSEC.SMFlNANCE.PC L: DAk� W/NSTEAD, JR, e.s ao. - . V • o� °o� � �' �•� o � .. ��' '� ao % . • ` -� 6 � . �o- va• ,��Cl�fs. � A � � v • � � . � .- � � a w U � a � � � 0 f,9u ~ PERSON COUNTY HEALTH DEPARTMENT ' WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERMIT , Not for waste water system construction. No permit(s) for Construction Location or Relocation Activity shali be issued until Authorization for waste water system construction has been issued. Tax Map # � � r% Parcel #_ ZoninQ � Township Owner/Contractor �'�,_ ��_�,��,�c.v(l�+. � "�w �� I e.'� Date 3 - .? � � ' 6 Location/Address .� `/ N o v�i �v ��vt h� � /��' �e ,;, C✓'✓vr �� _pf' �/ w y , � S.R.# S'7 /Ucyd� Subdivision Name ' S S Lot# SEWAGE SYSTEM SPECIFICATIONS Repair Lot Area " S�' + SFD Mobile Home Business # of Bedroom� Permits may be voided if site is attered or Well and Septic Layout by Comments: Size of Tank �( U �� Size ofPump Tank ,urA Nitrification Line �{C��J rX 3 � Max Depth Trenches�� " nged. Date - - Installed by � i M r l Approved by Well Permit Paid WELL SYSTEM SPECIFICATIONS Individual �_Semi-Public Required Slab Public Replacement Air Vent Site Approved ✓ Required Well Lo� _ Well Head Approved Well Tag Grouting Approved - _ Comments: Date ed by Approved This report is �ased in part on information provided the homeowner or his/her representative in the application submitted for this permit. The environmental health specialist is not responsible for false or misleading information contained in the application. The environmental health specialist is also not responsible for concealed conditions on the property or for statements in this report that may have resulted from false or misleading statements provided to him in the application. 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. c:\amipro\permit.sam O1/95 rev.l.l � s - a- �a �°��- g .�- - S� � �,�Q,r. . ��•.��. � �\ �. �:.�`= `.� ! � STEVEN PLOT PLAN WALLACE / � 1 � . .:�t. -v • p i�i.i;5ora i:uura�r�� i.iiv i i;ur�rn�i� rni. ni::ni.�rii � '� • % � 1 ��:_ (�1 .. �- � . (..>�vi�e�:... . -- . �..__.___- -_._.._.._--... . _ , I.c>c��lic�ii/I ircc:tic>ns: _5.�._..�'J ��i/ ____.._ SIZ�1 "f�-- -�--��2Q�"u�... /�j,.��° ,,liy�_,L`Gc2c,.� � --.._----..._------ .. ---------_ _------ --...--. ---------�-----._....__ ._..__.._..__... . -- -- -�---- .'ul�clivi,iu�� N��i►�:� __._ ... . . .. .. _ ------- __ ._.__ - __...--, _ __ • _ . ----.. _- � . _ _ . _ -- -`Y. 1:>rillin� C'c>nlractc�r:-��i . 1� _-----�-------------..__----------�_---- r..c�� 1 �- ��- -� ��_�.�� - - - ------------------------.. _..--------�-----.____.__ W[� 1.1=- c_. (�NS'f' It UCi'IC)N —�------____ 1)is�ance [ici►» Nc�ues� )',c,l,er�y I.,inc-----L(�--------- Uist�nicc iiO111 SOUICe c� ��t)��ll11011 /%� [� f -- ----"-.._._-- --- --- '1'��al I)e >ii�: l ' . 1 __�_.5 _._--- 1't. Yicici: �� , Wa�cr I3eaiin > �-{ Nt Static Water I..eve] b Z.�ncs: I)c �tl� �J --------- a� � . [ ._,102�_._____i'•t. /��.------�'�- � ------------- t. (oQC��sing: 1�e1,�1�: I�rc��n � � to ----- --------�--}'t.__ ----l�t. --- --- �8 — �'�- 1)iai>>c1er: � �I��'1'f:: Stcel ---- ----- ---__---��alv.��iz.ecl Steel ----1a.L�( ---,-----lncl�es Cf Stc�l, cic��s c�wncr a��r<�vc:: YC5 _.-._.�'__----.------.------- W e i � 1 � t : �--------- - ----Nc � ----- - --- ---- b 1_.��65.��-- 1'liickncss: Dl��_.I1�i�l�� Alx>vc C�rc�un<1: l�rive Slic�e: Ycs Nc� _/�__. lncl�es Wcrc 1'rol�leins Lncoi�ntcrcci in Setting ilic Casing'? Ycs__--- ----- --_.. . . _ _. ._ I i j ..y�s" �;ivc: i �asc�ii: ._ 1`l0_�.. _. _ _._.... ' (.�rc�nl: �1�YI�: I`lcat ----------------------------�--------------------------- --- ----- Sancl/rc�i�c�it Coiicretc�-----�--_._�--- A>>nul;ir S��acc Wicllh ------------ ----.-- ' Wat�r iii fl�inular S��ace: �'cs ------�-1nches -- Mctl�oci: 1'un� �c:cl.__ ---------- No------------ 1 __._.___ 1'i cssure I�ourccl � I>e��tli: I�rorn -------- __ _ ---�------ «� r:, Materials CJscci: 1�to. I3•� >,---�---, ,-- 0 � �,s 1 c�rtlanci Cc,n�ci�� y IF rnix�ure (sanci, � ._._ Weigl�t of 1 l�a�_ �/ __ll�s. �ravel, cuttings) -� Ratir�: ll) l'l��cs: Ycs ,__._.._.__.-.-- ---- tc� � __..—_____.---- ---------_ ___ . � �1 x �I sl��l� Ycs---------- I'1c�-------------- �..---- —�--- .__._ _ __. ___-------... __.--- -----_..__--- ----- ------- -- RII.I,ING I_(X; ' De >tli =:-___ ---�----- - ----------- - - - --------- -------- ------- r��,,��__ �•�, -----------------.-------------.--------- -��- Porn�at,io�l I)escri �tion �:�:- - - -- ---- � . --- - - - ---- ----- --- - �- -- � -----p—:— ----�Z..---. 01-- ------------ ;;_L ___ .., --- _ _..__i�3_ �� I --/�-- ----- .--��.------- .--��a�__. ----- 5 . .__.�� . ------- - - _� �_5 . _.�8�--1.._ ._ . --� [�..__.- -�- --.1�3 ..._ . _ _.- - ��C�i'u� ._ . __. _ . _._-- -- -�a _ ----- �- ��.�---- - . - --------- ----- - - --- -- . ._.__ ---- _�--- .- ---�------- - -- �---- - - -- - - � 1��_.----. .��-_3.____ _ . ��._�.__....`__. --.._.__._...__._. . __... . _.. -.- ------..____.---- �� - _....._.._. _.__..._____�__ _..._.__ ._ _. --- � I I11:RL13 Y(�l�lt'1'[[� Y`t'1 IA"I"fEII� Al3OVl? INI=01Z1�1 '' 'l'Il[S Wt;i.l, 1'YAS COiJS"I'IZUCI'1�1) Ir1 Ac,(�OItl)�T�CII(>>��•CC)ItlZt:c�"I'AT�11)'1'I{A.�. FOlZ'I'l l 13Y '1'111: I'I:IZSOi�J ('O11N'fl' I I);�11: f'[ I I)L'l'AlZ'I'1�• ��• 1 I II RI:CI)1_.A'1'1(:)i�lS SL"1' 1 !� fJ 1 . . _. _. /' Si�;ntilui� c,'�('� �c/�',. ��2'� lo."o�� ,�;. - , �� . . a � �� s I��.�� .. .' 1 1 � � ' �� I��-a.a-��,.-� ��¢�.11 7F-3L�.�.I1�11� Applicant: � {� �"�' �J �%a Location: S�L) (ara . . T��x M�a,E� � • P�rcel # r 1 S'UI(J 6i'I V t•S�I O il �• i�• Fh�s�e Sect�io�a Lot # � ' • Improvement Permit � � �`JD�'�' `� ° F �' `"c add r'�'c�n Permit Valid for j� Five Years _ No Ezpiration Type of Facility: �x i5t� n tc� rc�rn u/1S� 0 New Addition � Water Supply �li S�t� # of Occupants rra , of Bedrooms �u.l Projected Daily Flow � g.p.d.T�� Proposed Wastewater System: PC� m n�,nn vc�-b�Onu I � , . Type: �/ Proposed Repair: /� " //��E� Permit Conditions: L�� Sf� c/ �nhf�t.t( �SvSftr► cn f��-�cu� ac Fr�.rfcd v CKS, n, (lccs Pc�.,te T�r�K d- Mar� i% Id_fp 'OrcS S�t�c. d �s� 'c� 1 d 9l= /lcv Sy�.S E�•^�. Owner or Legal Represe tati e' t�re �� l,�i 1 �C �h��— � Date: ��- � Authorized Sta.te Agent: Date: ) J-�� 3-�3 The issuance of this permit by e Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicanbproperty 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 Zaws and Rules ,£or Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorilx in the future or that the water supply will remain potable. Autho.rization to Construct Wastewater. System �Required for Building Permit) * See site plan and additional attachments (� �. � 3� ��r'"� ad d i-t��on 'E ro F��c� aZ.E�I Proposed Wastewater System:�u� Ct�nu en £��o na- � Type �� Wastewater Flow ��g.p.d. New Repair Expansion _ Soil LTAR: :o�S p.d./ ft 2 Type of Facility: �� ' Basement Yes �No Wastewater System Requirements Tank Size: Septic Tank: E gal Pump Tank: � � c700 gal Grease Trap: �/ l�- gal Drainfield: Total Area: �.Q � sq ft Total Length o�� ft Mazimum Trench . Depth %� in Trench Width � ft Minimum Soil Cover: �_ in Minimum Trench Separation: I ft Distribution: Distribution Box Serial Distribution � Pressure Manifold � , Specifications: �; (cO' nfc� S F� Authorized State Agent: �.. F- Permit Expirati n Date: � :c-h'„a .4 o-�h`c. T n /C, Date: � � "/3 -t�3 The type of system permitted is V Conventional Innovative Altemative. I accept the specifications of the peimit. , � C.�� Owner/Legal Representafive: � Date: P HD7/30/2002 ��j; l {'�J �� . . . � �' � � V `7y.! l V �p ��11� . � ' �H3'B'A.]C'4D'�'e'ti'+'* 0]CA�1A.A ��BffiL.IGJCa. . � � SITE SKETCH �� e 1�7 �i'S%1ct�'Orl Clar .Tax Ma # 0'?7 Pa�tcel. #�_ p b'vi ivn cK t.� .-I i Section/Lvt# (' /O , �I-I�-� Authorized Sta.te Ag�n � Date � � SystesK contportents nepnesent a,�ipt�v ima ntours only. The con�ractor must, flag the aystem prior to beginning the ir�staldation to insu�e that;�irop ta ri�aintained �� ,, � C Ci � . . � C � , . � v � 0. L . � Q v �h � �g ' � ►� � _ � 3 � � . -- � • o -d �" � v J� u} v � �� -� a2 " ` Z 3 � �' � • , � �n . . � �y, 70 , v J c ` � * `n �� . , Z., � 6 ' � J M . c �b , . . �K- � c� .� . V � � °� . . , €� ;,, ' L � �' 6 �- ' � - - - II , � �� . ' �0� •90 `� �' € . a ;,l °y , :'� . . . . . • r yi � ?� — �� ;; � � . • . ., � . � ', a � ' ' � � � � -- o �� . c J, o • � � � � . � '� � . � � � q d �. � � U u' L �'-- � � - - a 1i LL � a" N -h"`i. • � � 4 � '� v � � • o �@"� j ' C: �- � °_ � � ' ' "' . • ' v) � r 3 O � • -� S. ".c� -g 'U C � . • . o � p �� " • � , o L � 3�'£ : '� �` -- � � � £ � � . �-r� _ �._ - �. _ .� , � � �. � � � ��-. . . -o� c � °- �'' � � � c �, � � � , = -� 3 4 0 �° � �'r°� ' � � �-� a v, . . 4 L M '' �„ Vi C Cq. A(�. � 4 W er ' I !P' v �' ' � J x � .� .� � o t � , � l� j. i'� 0- � � � `�/ J � � � �� '(; 1' T T �.. -a� . ` o�i i' .� ��. � I ,.� ,�iy `� N . � • Z��e�50 `� . . .._.. . ... � .�/, �� . . a�l�' `,' � v � . . .. '� �� r � . . � . � �, �° � � 2�°1��, � � ., / . r,^ � � . . Scale: � �i0 � . � ' ' � � PCHD, rev. 09/12%Ol ry+cr�mev� �� .�� 1��.�� ___.. _- �-�- � � �� ` �E;�-�-�,m--�-��aa¢�.0 �.�.�.�.,E�. Owner• cI�C1�b �' ��a n CIarK Tax iVlap: �� Parcel #: S8 Dat�� a "� �.ane �'ap Tap (Sc�) Tap �low Liane 1L�ng��a ��o� I�oot # Diameter(�) { m) . (ft) � �/a SO .s oo . oa�s 2 la o� �o. � oo . o 3 4 5 6 7 � (coo 8 9 10 � �00� ft of line x 65 gal. per 100 ft = 000 39,000 ; 100 =�v�0 gal 75% x 3qo gal = a�Io7� � ga1 per dose . ta gal per minute (gpm) = F'low �8ate �riction �ead g.oss: • 89 ft per 100 ft of supply line x�_ ft of supply.line =100 =• ag ft • 9 ft x 1.2 = �� 008 ft of friction head 1VIanaifold Size: 3� q " Force Main Size: a " PVC �otal Dynaffiic �eaci = 10 ft of Elevation head +�ft of Pressure head + � ft of Friction Head = �TDH Pump Requireanen¢: � 8 GPM @ � i3 ft of Head �rawdown: ��al per dose � 21 gal per inch = � 3�� inch drawdown ger dose 2qa�s �e� �� o��n . ��• :. . ... .. , �w ��rs . , , �i► u► u► u _ ' ' ' ' r � ;. i .,. _ . �._. �.. 9mamr I � S � � _ � � - �. � : 1 � �„ ��c�»�o�oo ��*��f��i�� i�+��N��Nl��+��lb. a v: 1�ianiiold Siz: l � Taps hiax Na Taps flff one side �or 3�j» 4 9 nc.� L � nc Ex�str��, Syst�. 16GPm l3' ia�ad ��{udrac�do�^. q» 16 y ' �n �a+ 2? 12 � � � ' - • � �`low per Ta Siue ILltuerial r�a:ti• G�?r! -� " Sc}ied 80 �•� r,� ` Scited 10 i.: ' ; :, �c3:er130 I (l. i �•, ' Sciied 10 i=•= s, See Attadted 9ieeC Fot ELeCtrlCal Specificar'ans 1 ) 6" = 11� = 111 = ►il 111-��1=��t= �ru=i��=�►� / .'aT' -• ' 1 �•� . � • . Ih�dergro�aul Cable In C.anduit pi[h SviG�ble Sealer In Boch Fi�ds Of Canduit �, _.�� - . _ ... .. . - ,.I • � ' �' � / ■� �l� •• \�) �� Ir • • ■ - • • � •��- • - -'■ •. �i • � r ��i • • lq" : : t. :. �-� :�..�t �.� ._ '�I� ' �— � • � � .. . _ [i. . _ �i :��' � _� Subaersible � Effluent P�mp �•� -8'rCaicrete q l�aatodc i 11p � � • • ' • d . � . � d j a � : .. .. a d , � • . � • • • • �T{'1'lC��I.�1L�5ha11 be Ccf 3 S't� � �� lt �' I.� � � � J.t� lt�li7.1 �.Lr.�� tJr'�I� ��1\�• � '� • ' �� 'J .�• �� h_: _� �r«■ iaa _� � •�.r�• :� . . -� . _� . .�._ �- _ �� 111 =. t tt = 1!� = 1�1 =. 1�! =. �� — ��i = 1�l = itl_ =.. ��I . 111 = lu = it� = t�t =��-.-�—"'�—`= • • . . � :r...�: • � �• > Gallon 'f�k . _ . � � .� ' . E—Supply Line 'fo .i;T `� d r Diareter ScheduTe 40 PVC ..• pi� • 1�1 PlirQ Re�ie�). I� .. , � • Cs3Ce n�� 'ihceaded Union • Q�eck Valve 3/16" SyQ�n B�� ole ' " �oa�� st� �a� Au c� � Alacm Float (elevation) "� On" Float (elevationi ' ' "Pu� OfP' Floac (��on) _� , pUMP RlITING PUMP SYSTEM DETAIL SHEET � Pump Hust Be Rated To Delzver � Galloas Per Hinute Against �Feet OE�Tota Dqaamic Head (TDH)- See Folloving Sheet For Additional Specifications, Notes, And Explanations. 0 �� ~ ' �� . � �� A�a � � � � 5�_ o �.o�.K,wc.�t, I �'i t l.s IE�.�.s�mm � ��¢�.11 IE3C��,71�. �. . , o � � -��n Appiicar� ��y qi' S�v�.ron C(ar� ' Location: � � � C)�peratson: Permit System Type (In Accordance With Table Va): �3 • THIS SYSTEM HAS BEEN IN�TALLED � IN COMPLIANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUTES, RULES .FOI� .SEWAG��:TREATME�IT AND DISPOSAL, AND ALL CONDITIONS OF T1iE IMPROVEMENT � PERMIT . AND CONSTRUC'TION HORI7J�T10N. � � � . .. . .. .. . . . . � ' . . I� N�m� . � .. ... .: .: . � .3.-� ��4 �. � � .. . . Authorized State �Agent � � . . � __ � � � � : � Date � • � � Installed By: fr � �� . . Date: ��0�-79� . . . . . . ,. - . . .. �3 . ..��-� .. � ,. . 5 � Zlz 5' Z�' . s�v� q��' � ` 2�, t! `� d a'�° ,Ly . ti� --� . . . ... . - ... .. . . . ... ...... �... .. ._._. �� s � � ' aa` y . q. -�--- 2� 3l` E Z_ $a` 3� a8. � � 1` D �c �st'►'n, S�T ' ( Z �`S�E�►t p�T { t„nc1 Z,►sPc.� br 3 µ 3-z-o4 � PCHD, rev. 07/29/02 c S��Y�C T�iVK 9N��ECTiOIV C9��CL1S�' (Type li - Tax MaQ #�a1 Parce! #�� System Type (Table Va) ?�T� OwmertAppiicant� S�c�.ro� °� �� bby C(a.�K Subdivision (�,�c,�.�o� l�-i I ts Address/Location � SecfPhase Lot # q�-r� State ID/date Capacity. . ga� Tee and F1ter Baffle � Sealar�t Riser if ap licable Tank Outlet�.Seal Permanent Marker Pump Tank tate ate T - (�o Capacity I oo� al Watemroof /Sealant �� IRiser � � Pump- �heck Valve/Gate Vaive . - t�-si on o e . . � .� Floats/Switches � � � � � � Alarm visable and audibie � Electricai Componer�ts Rate m Ap roved Pum Model B(ocic Under Pump � Pum Removal Ro elChain � Distribution System Serial Distribution ' ressure an' o Low Pressure Pipe � Appr. Pipe Materiai and Grade N�� Tt�ench Width ft. �H-3 a-� Trenct�. Depth j in. �/ � z� 3 a-�4 Trench Len app fit. ✓ Ex��q� Trench Grade �/ Trench S acing � . Rodc De th and Qualiiy � Dams/Ste downs etc. � Pressure Laterals � Hole Spacing T�- 3 a-�t o e �ze �� . � �i' Pipe Sieeve . � - - � ✓ Tum-upsfProtectors � �i�equired Setbacics From Welis �. � From Pruperty lines � L . _ : .Structures/Basemerrts.:: � . � . � . � rt es rama � e ays � � . . . _ . . _ . SurFace` Waters � - � - � �, Pubiic Wa#er Supplies � Vertical Cuts (>2 ft. . Water Lines Vehicle Traffic =aseme�ts/Right of •, . _ ` . Other 7 � � pchd rev. 3113I01 0 PERSON COUNTY HEALTH DEPARTMENT SiJBSURFACE WASTEWATER SYSTEM MONITORING REPORT �9 �� 3-2- ��'� �ia Aa� � Date of Inspection System Installarion Date Type Tax Map Parcel # da� �w��,-� 0�,. �aat� , tSC ��1�7� Property Address Instructio�s: Check yes or no for appropriate items and explain in space gr�vided :or remazks and comments. If an item is not applicabte, 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: Septic tank filter cleaned 7 EFFLUENT DOSING SYSTEM: Require3 numps preser.t L fiu:ctional ? High water alarm operating properly ? Floats, valves, etc. in good condition ? Control panel & components in good condition ? Effluent free of excess solids 7 Inches of solids(pump/dose tank): L3 Elapsed time readings ? A. Counter readings ? Drawdown rate: � �1'� YES / NO ❑ � ❑ ■ ■ ■ ■ ■ ■ � � �: ■ �� ■ j � � ■ DISPOSAL FIELD: Evidence of effluent surfacing ? ❑ Evidence of effluent ponding in trenches ?❑ Surface water effectively diverted ? � Diversicas/sv�a:es properly maintained ? ❑ vegetstive cever r_l�intained ? j� Protected from tr�c/unauthorized uses ? � Di�tribution uevices ui good condition ?� Field free of settled or low azeas ? � / / / / / / / / j� '1 ■ ■ ■ ■ ■ PRESSURE DIST'2IBUTION SYSTEM: Tumups/cleanouts/valves/taps intact & accessible ? �j / ❑ Pressure head properly adjusted ? '[� / ❑ COMPLIANCE: Compliant Non-compliant Needs Maintenance ►'! ■ ■ REMARKS SCF11L —t��l� � Ac.C.'�cs S ►'a�, f�(5c►� Ga�a� C:+� �s� ha" � � �,,.�� `i3.5�. + 3,,5�,`�- 1,5 n•�\ = a� coPt� 011 c�d�- x � ��° "�' ' ,a r�►i'iliiTivl3:w CGi�iI�iF.i1TS: ��e'�I'+t�4 �'�Rv�� .'� ��r'�84 �F �� }��G T�S'C i��'4�► t�'at� W t3�i��. 'S't� I.RS'C � 1�FR'�.S ' OV �E'R�l�., , S't 5� A�4`�i� �IV �ti IN l'1a� ��11T�DN_ EHS `��,V.R-1C>` �• Sh�