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A29 114�-��, ; ,, �� ���� �� ' �—.� C� c� jCT�T��Y �aa�na-�aa,*-„-„ �aa��.� ����.Il.�� Applicant: 'Location: T��x Ma�� ,i � � P�rcel � S��i,hcllivis�ioii � � � � t ► ,, � - Ph�-��s•e Sect.i�ia Lot # Improvement Permit Permit Valid fo� �'ive Yea�s No �piration Type of Facility: New Addition 'BVater 3upply # of Occupants # of Bedrooms � Projected Daily Flow g.p.d. � � Eroposed Wastewater System: � � . Type: Proposed Repair: Type: Permit Conditions: Owner or Legal Representative Signature: Authorized State Agent: � Date: I-.2�-Q3 The issuance of this permit by the Health Department in does not gua�antee the issuance of other permits. It is the responsibility of the agplicant/praperty owner to in sure thai 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 complianee with the provisions of the North Carolina `Zaws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC 1�A .1900). Neither Person County nor the Environmental Heatth Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the w�ater supply will remain potable. •Autho�ization to Construct Waste�vater 5ystem �Req�ired for Building Permit) * See site plan and additivnal attachments (_). Proposed Wastewater System: l„��;��,�'�pa.1 Type �_ Wastewater Flow ��'�� g.p.d. New `i� Repair Expansion � Soil LT�iR: � -� g.p.d./ ft 2 Type of Facility: �� Basement _ Yes No . Wastewater System Requirements Tank Size: Septic Tank: �� gal Puffip Tank: gal Grease Trap: gal Drainfield: Tota1 Area: �p� sq ft 'Total Length "�l�%d ft 1Vlazimum T�ench I)epih �_ in Trench �idth � ft 1Vyinimnm Soil Cover: K� in Minimum Trench Separation: � ft Distribut�on: Distdbution Box � Serial Disinbution Pressure Manifold . � Specifications• ��.'� �� ~-� S�'e �� Authorized State Agent: _�,�l,�v Peimit Expiration Date: � Date: r ��d � The type of system permitted is � C ventional vative Alternative. I accept the specifications of the permit. . Owner/Legal Repre�entative: Date: j '.,Z �—(J � PCHD7/30/2002 ^..' � . . �. -Y,�'� ,._:.__..,,,,1... � ,.` f �,� . � '.: � . • . � \ ._..' . '"`'" �~�°';'T.;•Y�i`-'^"�: 'k�"`X.�; ,�. � + i � `✓� � � � � � /� ' . � �`�y � H �` � ) 1 • � . -� * t . �. /1 . . � /O . . • :,'J Y +��lt �� � . ( � ♦��.JY �� . . • . 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' ' ' ' �� .. i i�,. i � nn � - . . . b�.. . . i � ` �' r..` , ` .� _ �r� _ � � � � a w � a � B 2817 PERSON COUNTY HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERNIIT Not for waste water system construction. No permit(s) for Construction Location or Relocation Activity shall be issued untii Authorization for waste water system construction has been issued. Tax Map # � 2� Parcel #_ Zoning _ Township Owner/Contractor C•_� Subdivision N Date �-�1 7-- S.R.# l I b 2 � Lot# � SEWAGE SYSTEM SPECIFICATIONS Repair Lot Area . Size of Tank (�(`� � SFD Mobile Home Size of Pump Tank Business # of Bedrooms 3 Nitrification Line �(,� �k� � Max Depth Trenches �� << Permits may be voided if Well and Sentic Lavout bv U� This report is based in part on information provided the homeowner or his/tier 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 E-' 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 �.i. ,., ��1 t i i�C�-, i . . �,- ��iQ%t�(�� Y � ,f4. ���'-�n` R"i "�;'.�i�'�'�'��°��<<� 4�� .•�• , �a ' �� .a°:�l E . .'�� �.'�� i� ��a`�� �^r��t'"�:��1` .�,,�,= �u�. , ► i 1 I. �i I � e� ��. � A ��r'� `5'I � �U . ,� aia �`--'. G' .P,� ° U ,,,�a� N lS,��^ � _ . N � ° 3 5' 2 �J"!�/ �5�6 Ga�---- �� f.�'�� ��. �Fii � .., ���i�Ci� ����JLie�.1�P�l�f �����d���'� ���,e� ,� CiJi.lT�t�l. C��h��� j� �, r1 �� � �,� ,. � � �.��h -----_._____.._._ 3E3 � U 7 �'"'-.�...-.� _ . ......_..�...���„„���„� � f 't�� �� �. � l�� - i , l�"�,.�. �`�"' `��,�' � i•, ' "�-,-„� 7Q`� � ` ' {., � "'".-�,,.t,M�.. t, ; b J � Fx,,, ..:.1 ' . '-� � J. (� � 4 c� �`� T �. . ��. �y .7+�� �1�. `� :. i '• .l - �� � — - � � 3 � l � °�J�� 3a0 IQ `� � � . *�.. (II �. 7�� �,�_ / / ���� �� ���� �� �' . �r ������ ����r�sammm 1*^n"n ��Il.�.�.�L 1L 1LaL�S1.�11�� Applican Location T�x M�p � P�,rc�el n S�ubdlivis�ioia �, - - � h�s�e:'Sec�tior;�`Lot � Oper�tion Permit System Type (In Accordance With Table Va): .•�� THIS SYSTEM HAS BEEN INSTi4LLED IN COMPLIAWCE WITH APPLICABLE NCIRTH CAROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AiVD . ALL CONDITIONS OF T�IE IMPROVEMEPIT PERMIT AND CONSTRUCTION AUTHORIZATION. � �,-- 9 -03 Authorized Stat A�ent . � Date Installed By: 3, %e c� „S . Date: �� g—� 3 � I � � I�tDJ'�'1�-2: l`�� , 6 �3 g� �'� ,�, � - � �o ul I PCHD, rev. 07/29/02 S���lG �� K INSP��Ti�N C�iE�KI.lST (i'yPe il - �!!j Ta : Ma� #��,�—L_ Parce! # 1� System Type {Table Va) a- — Owner/Applicant Subdivision e . � � Address/Location r� rP SeclPhase � Lot # St�te I D/date ��� _ � g-�,� Capaciiy. 1 ao� Tee and Fiiter •� Baffle ✓ Sealant ,i Riser (if applicable) � Tank Outlet.Seal ✓ Permanent Marker /v, Purnp Yank roof lSealant Riser Check Vatve/Gate Valve Floats/Switches �� � � Atarm (visab(e and audible Electrical Components Rate (aam) 0 Approved Pump Model Biocfc Under Pump Pump Removaf Rope/Chain Distribution System Serial Distribution ✓� ressure ani o d Low Pressure Pipe � Appr. Pipe Materia! and Grade i ���, Tr�ench Width � ft. Trench. Depth a � in. Trench Length �-� � ft. Trench Grade ✓ Trench Spacing Rock Depth and Quaiity ,/ Dams/Stepdowns etc. -✓ Pressure Laterals Hole Soacina Pipe Sleeve .. - - . Tum-ups/Protectors Required Setbacacs From Welis,�` From Property lines Structures/Basements Surface Waters - Public Water Suppl Vertical Cuts (>2 ft Water Lines Vehicte Traffic EasementslRight of W� Other Easements Recorded . Comments reement pcl�d rev. 3/13/�1 � ���.�� � I���� �� -, �- � � ��°��- �7�'6�Il.���e-n �*'n-n �]1jZ��II.� ��.a�.�'f�1t� W SJ�.+i_+ ��$dlo/18� . ���E SEE A�'�"I'�C�I� P�1V FiJR WE�. SY� ��OIJ'� 'Y'�x I�Yap #: �_ �'arce! # ��. '�ownship. .,.'..... �i1 II� I j ► �0 r , .; � ;c � : ► Li � �..«. . ,r • '��e of Wa�r �a���l�r: i�es��anen�• ,,� IndiPidual Site Approved by � ���D� � ��� Grouting Approve by :� �s � �� -� -�3 We1t Log ��� ���3 Well T t � 03 1111 Y ei�t � � Hose Bib � Concrete Slab _ �'� 1(q��3 Wel� I)�er: Cvr,.s �,���� �r� �'I.-`' '..;� ,: �.. -.r Community Public _ �„ a..k � s ��� � P ; r . � �F � JU'.1t �/ '�'OS�C 1�1�C�3E'S� Slt� 5��1� Wells must be 10 feet from property liQes. Wells must be 100 feet from septic systesns. Wells must be at least 25 feet from anp building foundaiion. Other conditions• Z�� PC�ID, sev. 09/07/01 ��� ��� ��� � ��� � ��� ��� `_' ,.�-�- C� f.0 ZC.1=�(`�C` �r ��.h���.m ��-�.,L.�,�.;�. �.c�r.�.,:.n.�l,��,:n. � �' Owner: � � � Location: ' Subdivision: __ UGUUI}(�{7 ,�l�J i�� D � � 'r' �' n�(;�1WjJ ��(tU�i Ca ��l �l r� _c '.�.�� 1��Qr r l �, n S D��o ��o� �` - 4 -� 3 i�'e� �,og '1'.U1 iYlap �� P:u�ccl rr �f� Lot !� �i tii�cll Cox�scx'uctiozi Distancc From cxcarest 1'ropc:rty Liuc: (Nlinii�zum 1Q �feet) _"�______-__....... Dista.ncc from Scp�ic System (Ivlic�imun�. GO icct) '� Total Depth: _1,� �— f� Yield: ,/ S GI'M Scatic Wacer L�vel: .�____ C� Water Bcarinb Zoncs: Dcpth _�� ii ��J �tt ��_ i�t _ Ct Casiug: . Dep[fl: .From �_ to tt. lliamctcr: , ul T e: Galvanized Stc;e;l '� �� � yp Wei�ht: _L�'.('hickness: �y � !-Ie:iUl�t abovc Gx-ound: __,��! ici Drive Shoc: ./ Y�s No �1.iiy problcros cncounlcrccl `whilc: sc:llinb c,l�iti�'? __ Ycs �No if `�es" give reason: ___ Grout: Neat: San.d/Cement �� Concrcic Grave;l/Ccment ,�lnnular Space WidCll �_ inclies Waler in A.ni�ular S_ace Yes `— No Meti�od of Grout: Pumpcd I'ressure: ' I'oured Dcptl� `� to _ iYJ[accrxals vsca: No..,Ba�s Portland ccmcnt Wc:i�;ht o�l� l 13a� ��-__ ['ounds ' It mixtl.u•e (sand, gravcl� Cl1tC3I1�;J� - R:1C1U _� l'0 � ID plaic�: �cs No �4 x 4 slab �-�.'cs __ No Urzlliub �,ob l,oc:icion llrawiu�; . r • "-i } 1 , ;': � a ; , �,, . ��� �. - '+ . ,, rt. [ hereby eertif,y that tlic abovc in�unila�ion is conect �d that tl�is wcll tivas c;onstructcd in accordance with regulations sct forth by th� Pcrson County I-lcalth Dc:parmZent. Si aturc of Coutractor �C �1) t� �0� �:�tc �.�%,– b�— �` PCI�D rcv O1116102