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A29 141z z � Person County Health Department � Sewage System Improvements Permit Date: > >s Permit Void After 5 �Y��!��,;�- , � n!�% Owncr�-,�� ^ ��" �—�''+;��`=�-��/� SR# Subdivision Name: Lot # � Lot Size: �,T3 L� ��^� Type of Dwelling: . ` Wa[er Supply: Privatc: �— Public: Community: , gediooms: ,�s— Garbage Disposal � Basement Basement Fixtures INFORMA C R/T�FIED BY _� $ailltclilall: �� f r� �' J— owncr o�� tative :a • . � REPAIR. REEVALUATION: ------------------------- Size of Septic Tank: -.�� gallons Size of Pump Tank: ,.. / NiUification Lme: �� Depth of Stone: 12 inches Max Depth of Trenches: Altemative System: Conv. Pump LPP Pump Remarks: - D ell Approved:��C�Well should be 1Q0 ft� from any sewer system g C� Sanitarian Da ge y m proved: - ' BY Sanitarian � CERTIFI ATE OF COMPLETION Contractor. ,. �� a � , � ` . ,, : — — ,...3 -------------,—s ,--------- �, Sewage System location, installation, and , protection must meet state and local ''� regulations. Septic tank should be pumped out every 3 to 5 yeazs and shall be maintained � by owner in such manner as not to create a public health hazard. Septic tanlc and'd niuification line must be inspected and approved by a member of the Person Coun.ty � Health Depaztment before any portion of the installation is covered and put into use. If the site plans or intended use change this permit is subject to revocation. (G.S.130 A-335F) _ L.ocation of sewage disposal sewage system sketched on back. (OVER) Person County �ieaith Department � Well Permit o� l�f�- � Date: '� q � This Permit Voi G F '� Owner: SR# �_ Location/Directions: , Subdivision Name: Lot # Drilling Contractor: ��j�� WELL CONSTRUCi'ION b Distance from Nearest Property Line �/J/, �.,, _c Distance from Source of �' Pollution /�� , � Total Depth: ,�$�t Yield: ;-��=�PM Static Water L.evel FG � Water Bearing Zones: Depth � FG/dCi FG FG Ft. Casing: Depth From � to �� Ft Diameter. � Inches TYPE: Steel ' Galvanized Steel `-�� If Steel, does owner approve: Yes No WeighG �.� Thiclrnes�: %,��-Ieight Above Ground: J.1-- Inches Drive Shce: Yes � No Weze Problems Encoimtered in Setting the Casing? Yes No If "yes" give reason: � GrouG Type: Neat S ement Concrete Annnlar Space Width � Inches Water in Atmular Space: Yes No�---- Method: Pumped Pressure Poured �� Depth: From �_ to Fc Materi Used: No. Bags Portland Cement _� Weight of 1 bag 9 lbs. If mixture (sand, gravel, cuttings) - Ratio: 2_ to �_ ID Plates: Yes v No �p 4 z 4 slab Yes —��No � I HEREBY CER'TIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH REGULATIONS SET FORTH BY THE PERSON COUNTY HEALTN DEPARTMENT. b �.`� C i atute C Date 3/ �ZlSa Sanitarians Signature Date Issued Sanitarians Signature Date Completed Sketch well location on reverse side. � . ► / NOTE: Make sketch of instailation showing lot size and shape, location of house, septic tanks, privies, water supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located at later date. Note location of water supplies on adjacent lots. . � (1) ' i �� -- (2) � � � IG-�- � � � `� PEi�SON �OUNTY E3�IVIRONIV�E�ITAL t�EALTH P�.�.4SE SE� ATT�CHE� PI..AN FOR SOIL ARE�4 AND Si(STEM LAYOUT rax lIAaP �1: —��C'Tn` l Pa�cel il L� � . � • . Zoning - � � � _ , TownaMp APP�� Locatlon: Subdvlslon: S�Won: Lo� C?%,zrl !� . � Improvement Pe�mit A huildin4 aermit cannot be issued with oniy an imaroveme�t Pennit New . Repair Addition ✓ Type of Strudure S� Wateir Suppy r�t/�l�e �'�� # of Occu ts = �•of Bedrooms 3 Other Basemeni? �Basement Foduces?T`_ . Projeded Daily► Fiow: ; Proposed Wastewate� Pump Required?' ti Proposed Repair • Pecmit Conditions:_ _ g.p.d. Permit Valid ar: Five Years ❑ No Expiratton m Tjrpe: � n. o il � ,,_;,,No Owner o� Legai RepreseMative Author¢ed State Agent s/O Z Date: � ��, ^9 0 / The issuance of this permit by the Health Departrnent in no way guarantees the issuance of other p+,ermits. The pemnit hoider is respansible for chec�cing with appropriate goveming bodies in mee�ng their requirements. Thls site is subJect to revocatio� if the siie pian, plat, or the irrtended use changes. The Improvement Pern�it sE►ail not be affected by a change ia ownerst�ip of the sibe. Thts permit is subject to campliance with the p�ovisions of the Laws and Ruies for Sewage Treatrnent and Oisposal Systems of the North Carolina Administrative Code. Authorization To Construct Wastewater Svstem (Reauired for Building Pertnitl Type of Wastewater System µ C p � Wastewater Flow: �� .p.d. Fac�iiy Type: 3�i� fP3/'��.-�__ New 0 Repair �Expar�sion � Basement? 0 Yes — f8�to Basement Fhchu�es? 0 Yes �IVo Wastewatsr Svstem Reauiremenb Septic_Tank Size DD� � � g�o� . � Pump Tank Size: 6fl O gaqons Total.Trench Length: �- - feet Maximum Trend�t Depth: _� inches Aggregate Deptfi:� in. �dmam Soil Ccver. � inches Trench Separation: � Feet on Center c1ate: �- - � �a��o�,'oz... o� /oD '� �,�s�� %;,� ��' �`i 5j`�' -/dn�c' "��c��l � �h k �i� � The type af systiem peRnitted el3oes ❑ does not differ from the type specified on the application. I acr.2pt the specifications of thls penntt awner/Legal Represe�ve Signature: C/�J''� p�. 2� p"�.. . - �� PC}iD, rev. i 1/18r98 ... ._. __ _...-- -__.__... . .... _......_._......... _..._. __._. ... . --. . Person County Health_ Departrnent EnvironmenffiI Health Section SITE S14ETCH .. . _.... _. .r � e — A nt's Name >-S. . Authorized State Agent Tax Map #: �a �' � Parcel #: / � -� Subdivision/Section/Lot# � —l� �� oate Sy�tent con�porte�tts represerri appr�e cnntours only. The contractor must flag the system prior to be�irtnt 1nA t/re instaUatton fo t�sure thbt proper �rade fs nialntained SR �1�� X;J�;y c��i W✓A�✓ I ih¢Y �(�p' - V �Ay��/,S'�pp�OWn / , N �So' � 2"sE��l�/ � ` , �vc lu��r7 �:,�. „ (�l� (�a�c - l�t�i'err n � . /--��'�"%��' ' � inc� .' � c � .� 60' _ , � > - / , �� a,— �" Ad� po � _ — � D� e� IiM1�Q� �� h/�, ��"�p � s,� \ � SCa�e: � �� _.� O � � dS�S'�iDoJr� a� Q� i8"d�O��{ / �S �,�D �� 1�^ � �� \� � �� h� i � �,.� s' ��-'��.1 c.�N � /l¢cJ �iiL r �l't�uY' �e{,�'��enq 1"ePl�t�'T �o+�'��nn-S �) �ns -��.11 aol�'�, e.rd l loo' fff I,n -e._ -�-a ex�'s�nq sys7Pcrt aS S�4c�Ji7. � � SL,�II ,� ,�� S�-, !Yl vb,'�� t em e- .e_ �;or �v �-�aai�_ �`QYitO✓e�'�D�i s'(� /'/rt��" d� l��.ero�.�, 8nS `e , � � �tr �;,�L s1,� // � re�� ve � �� 3� �f� s'��i4� n 2�J iLo�� e s,'�-� � �� ' �'e-ro�� , �,�,: �- ti� � : jss r,.a�-f- � o�°Q.-�� o.,s /� �� !✓a�e✓ l�ne s/�// � � �h;.t��u�r� o� -% o-� GtL�S �� cJ��.�'�i"'S�,�Piai a�(�/�o►- -�rom 4n��d r �Q�oa�ra/' c� . 9'� r,�s�<rl� f'!ew l nes or� C'd,��our, �«Jc oc�� ,irtPS cJ; �� !� Trah.si�7��/'�1Jr �� vr,5�``�//i� • S�See a�/��lw�� 3.�,- you��sJs�PH� gpeC i Xp' / flYIS �i Gt c. 1 Cra��I'�!, � � (�' .incl�'7�,O�LS" . � ry $� i�CC�1Ed �tEflC FO[ �,eCLi1C31 $DECZf2C3t�LlLS .� � 1 �" �� = I1� = Iti = 11) 111= �ti=nt= � r�� = i �i = � it � . .� � • .. . .�. . � • . Undergcc�a,d Cable In Caaduit Siith Suitable Sealer In Both Fr.ria Of Ca�d�it �i �.�ri � • _ •�■ _ .• • - . - ..� .. -... a�� r�� • r - • • • •�ea . - -�. .. .� . � .- _..., . . !•� q,p,{�ro ,^�' c 4� . uv� �,�� j ,N aas �/`"o�e,�� : �� T — � _� Sub�rsible :�sn� Effluent Yuap �•�� 8" Cencrete BLock : : . . . �� ...�� •.�..� : � �Sir�gle � / � ♦ y ► • �ri�� r��c� .i • - -1 � �� n� h_i = ir«� �t� .i • '��r_• c� � ■ � r �i • •�r �=t = lIl].Stt CiC� . � � �y 1� i ,� ' �i� = �� = r<< - �� = al� _ �� = �� .- ��l = � t� = 1�( i� 1= t i� ,_ t u,= t t �= i�-.=. �"-` = , � � • • . . � :..-� _ • . � �p'� > J 6 d p Gaiioa T�lc •j� I _ - . �' � � . �Supplq I.ine To .� `� � d. Diaae[er Schedu�Te 40 PVC ..a '• pi� � � g� t�l-r;aval 1� •' � Gate Vaive w ' T�1CP.3�E'd U[t10R • Qiecic Valve 3/16" SyQhor Breake� ��ole � � ?�ddix� Str.�s Aiusxl A,tl Q�r35 � Alazm Float (elevation) "Yu� On" Ftoac (eievation) � ' "PuaQ OfF' Float (��on) , � , � PUMP EWTING P�emp Hust Se Rated To Deliver � _., 3p Gallons Per Hinute � Against � Feet Of Tota a ' Dynami� Head (TDH)• I � � �. , . . , a a � � • ' .d ' ' � " �ja ' ', • . � • a , � . � s , . , . . 'Ilus Ta�k �nll Y� c� a stabe P� �P '� � I�ic�r1 �rl gal.l be Iak'I�sl�3 CYr�i.t� . PUMP SYSTEM DETAIL SHEET See Following Sheet For Additivnal Specifications, Noces, And Explanations. t . �`✓`�fiG�� -� simplex Control �.,,L3 � Panel Wit;� `� � � �� Built In Alarm #%4 p:essa.e :rez�e� "..•.• �es� •�: ?qc:va:ee. l i�Bi� �% . «� �nclasure � i�ater tiq�t , + corrasian stall ? circuit resistant � scunaect svitc� � panel does not � � ve a dead front :' ::�._::;, � f �5 zanaal 4isconnec�. �.. '•- _ / ote: � 5reaker dues ,,._ , � constitate a y�� ` scannect) , „• to �I .� fiaish qrade� ;nap .;npply �i:cni�' ` �lars Ci:cnit �aCer 'ight :zal ' ?ydrauli,: ce;eet. � _ _ -� Setiedule ?9 ?VC aupoly �— — — �-- �iq back p1llQ and Receptacle r. 9z9 pressare t;eated �� past or eqnivalent �Q� �� 3a�;Ofi11C? �1at C �i9at . } � cottasiun tesist�t . 2' ainiiaa Gas 'iqht Canduit >li' to finisti grade . paip sapply circaiL alan cuntral . . � � 3ater fiq�t Seal Hydraalic Ceneat Harness &:cess Cards — � Sc�ednle 40 ?YC • SaPP17 Hote: ltiis is nat a Yiring diagraY! Cansalt an 8lectrician! " Dnct Seal � '.ackiaq S��:�s 3araess Szc�sS �:�:�� _ Receptac�e anst be aotor =ated �a�-valtaqe �iara � COQR2CL10II Oact Seal '•he a:ara �cs� 5e iOQQ�:� I.'. :`12 ii1:.i3?� liviuq ,;ea a� �tie „� � ve-:_sg ,ao� in-��e CIdYl ipdC? QdI3QE 4: nnde= a :o6i2z �one; Phe raee� �nst be a�d•..iz and �is:51e Lo spste� :sers r - - - �. _� . � � Lockiaq straps • ' � -� i Aoaltcafton Data: '�6 -9 -6 0 Amount Paid: I � Re�xipt �k . � �1 �� t� � ,O a" � .� � � Person Countv Heaith Deaarttnent - Emrironmentai Heaith Seclion Ta7c MHD #: � � � Par+csi #: � � � � APPUCATION FOR SEiiVICES � 1) Asrmit r+eque�ea by: (ownerf,zger�prosps�ve owme�j: f�� 1�' ��-T �= C�iC ..T '� Home Phane: 5�'7 -�-1 8� S q�; Z Cu�c,+�J �N �+� 8t18�PhOI1B: 54"� 9'?(0� �7Ci'�6�L"7 NC� ��73 2) Nams and � of c�rrent owme�: .S A Mt . � �� x �u 3j Property �escriptlon: �.oc a�e: I At T� • Qu�f ��!- c Dire�ions to the property pnduding road names ar�d numbers� . �z o N ��st�e's �� C�1 � �. o ,vt e e.'� a ti1 S i �� - 4q S T� (zo��-c�� cet G�L.c�. r�n F�Q�T �� \ U�re�ln ' •- -- fl-u� �2oP o►.i �c= Pj J�;V��On 4) Proposed Use and Sttucturs Descriptlon: answer each of the following questtons: �'�.� � a) P,rcposed L�Exi�ng �. b} Stldc Bu�t q Moduiar�Singie UVide Q Oouble Wide�] ' . c) Number of Bedcnams:� 4• � cn Number of occaiparrts or people to be served: a- e) Basemertt Yes Q(�o yes, # of basement �xturex � Garba9e �isposal: Yes 4 Nd6 b'� x' 2 j� � Dtmensions of Propoaed Strudurs: UVldth: �F� Depih: a�S . . �� s�PPhl TYPa: Private..� (new � ar e�dstlng �PubHc q Communiiy �, Spdng � • � Are arry we�s on a�oinu�9 W'oPertYt Yes ❑ No 171f yea. la�tion B) Pleass lndicaie Dealred Sysbem Typs: (sy�iema can be ranked in order of your preferencs) �Car�ventlonat lMo�#ied Conventianal _ �1lternathre Innovative .Dtl�er (spedij�): CLEARLY STAKE ALL CORNERS AND LWES OF THE PROPERTY, 3TAKE THE CORNERS OF ALL PROPOSED STRUCTlJRES. PLE�SE ATi'ACH SURVEY PLAT OR SRE PLAN TO THIS APPt1CATION I hereby make appiicatlon� to the Person Cou�riy Heaith Departrnerrt for a site evaluatlon for the on-sifi�e sewage d(sposal system �Cr the above-descxibed prop�ty. i agree that the contertts oi this appllcation are true and represerrt the maxirrwm faciGties to be plac�d oa the properiy. 1 understand if the site is aitered or the iniended use changes. the pennit sha� become irnrafid. l un�and that as app8carrt, i am responsibie for idendi�ring and maricin9 proPeriY Gnes, comers and maldng the �fie accessbie ia� the perso Pe�s� Courrty Heaith Deperfinerd to condud their evaluadons. i understand that i am respor�le far noi�ying the Nealth D ent if my property corrtains any wetlands as designated by the Atmy Corps of Engineers. . I �" L � . - o � . �wner or ReprEse�ti,►e . . . PCHQ, tev.1011?J99 (+ • PERSON COUNTY °"`°"" December 28, 2000 Robert Eggert 323 Weldon Wrenn Road RoYboro, NC 27573 PERSON COUNTY HEALTH DEPARTMENT ENVIItONMENTAL HEALT�I PROGRAM 20-B Court Street Roxboro, North Carolina 27573 . (336)597-1790 Re: Application for improvement permit for Wastewater system for property at #323 Weldon Wrenn Road - Person County Health Department File: Tax Map #A29, Parcel #141 Dear Mr. Eggert: The Person County Healdi Departuient, Environmental Health Division on December 27, 2000 evaluated the above- referenced property at the site designated on die plat/site plan that accompanied your improvement pernut applicaflon. According to your application the site is to serve a three or four bedroom residence with a design �vaste�vater flo�v of 360 to 480 gallons per day. The evaluation �vas done in accordance �vith the laws and rules governing �vastewater systems in North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A, of North Carolina Admiiustrative Code, Rule .1900 and related nzles. Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 tl�rough .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorpUon sewage system. T'herefore, your request for an improvement permit is DENIED. The site is unsuitable based on Uie follo�ving: 1. Soil depdts to saprolite unsuitable (Rule .19�3). 2. Unsuitable soil characteristics (Morphology) (Rule.19�11) 3. Soil ��etness conditions indicated by cluoma colorization (Rule .1942) 4. Available Space (Rule.1945) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated se�vage on the ground surface, in surface waters, directly into gound water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. Ho�vever, flie Health Department has determined that none of the above options will overcome the severe conditions on tlus site. A possible option might be a system designed to dispose of se�vage to another area of suitable soil or off-site to additional property. For the reasons set out above, the properiy is currently classified UNSUITABLE, and an improvement pernut shall not be issued for this site in accordance �vith Rule .1948�. Ho�i�ever, the site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if �vritten documentation is provided that meets the requirements of Rule .1948(d). A copy of tlus rule is enclosed. You may lure a consultant to assisst you if you �vish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal revie�v of tlus decision. You may request an informal review by the soil scientist or enviromnental healfli supervisor at the local health department. You may also request an informal review by the ♦� N.C. Department of Environment and Natural Resources regional soil specialist. A request for an informal revie�v must be made in ��riting to the local healdi department. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition from a contested case hearing wifli the Office of Administrafive Hearings, 6714 Mail Center, Raleigh, N.C. 27699-6714. To get a copy of a petition fonn, you may write the Office of Administrative Hearings or call the office at (919). 733- 0926. The pedGon for a contested case hearing must be filed in accordance �vith the provision of Norih Carolina General Statutes 140A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statue 130A-335 (g) provides that your hearing �vould be held in the county �vhere your property is located. Please note: If you �vish to pursue a formal appeal, you must file flie petition forni �vith the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. Meeting the 30 day deadline is critical to your right to a fortnal appeal. Beginning a fonnal appeal �vitlun 30 days �vill not interfere �vith any inform�l revie�v that you might request. Do not wait for the outcome of any informal review if you �vish to iile a formal appeal. If you file a petition for a contested case heazing �vith the Office of Administrative Hearings, you are required by law (N.C. General Statute 150B-23) to send a copy of your pefition to the Nortli Carolina Department of Environment and Natural Resources. Send flie copy to: Office of General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigl�, N.C. 27699-1601. Do NOT send the copy of the petition to your local healdi department. Sending a copy of your petition to the local health department will NOT satisfy the legal requirement in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel, NCDENR. � You may call or write the Person County Environmental Health Department if you need any additional information or assistance. Sincerely, �� '�JI Suzanne Knott Envirorunental Health Specialist Environmental Health Division Person County Health Department • . `�� J•Yr .l.i.li��i/ �ia� \ ` •• .�, .Y)1{ � y�q • ' • t `4.i':��T� . . �1C3T33�O�re �exe �C313�7.� ��Q�1L� . _ _. -_: '�iv, :"..;;: #: � � l . . . Par'cei #• � `G � Zoning: Township: ' � Subd(vis�on: � ��::�: �:_ � �`� _Sectlon: � Applirant � � p�� Location: \ � ��1,✓�- , Lot: � �� S e'� `� U . S'� s� �� ,�d�: �;��- � i � a ,�5��" �peration Permit . , System Type (In Accordance VV'�th Tabte Va): � THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH CAR�LINA GENERAL STAi'UTES, RULES FOR SEWAGE TREATMEiVT AND DISPOSAL, AND �LL CONDITIONS OF THE IMPROVEMENT PERMIT AtVD CONSTRUC7'ION . . � ii`;!: • S:: ;. -. ._�i.: . *,i. '� t. �l.��j nlErnft�Fne.,�.apdj l�� State Agent ��- � Date . �� J�� a�. � � �-� � - �2r`�^°. �- ._ 1.7" � v - � �� « �� ..�, ��o � l I� �� g�.� � � � � �� \ � ` . � �� f( �7 « . . �. ��,�� . � � 6a� . �va�,� � �j� �� c�+M� ry p� ( o I' '�� 11-t��( l�� ` I �S �QUv . � 5t6 �a�F PERSON COUNTY HEALTH DEPARTMENT SUBSURFACE WASTEWATER SYSTEM MONITORING REPORT �?, - � - I Z S- � - 02 �. � ��-- Date of Inspection System Installation Date Type Tax Map Parcel # 323 La )�(�� (�t:�e,1n � � 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:�_ Septic tank filter cleaned ? YES / N ❑ � ❑ � ❑ ❑ � o ❑ � ❑ EFFLUENT DOSING SYSTEM: Required pumps present & functional7 High water alarm operating properly ? Floats, valves, etc. in good condition ? Control panel & components in good condition ? Effluent free of excess solids ? Inches of solids(pump/dose tank :� Elapsed time readings ? �'�J Counter readings 7 Drawdown rate: Q' i DISPOSAL FIELD: Evidence of effluent surfacing ? ❑ Evidence of effluent ponding in trenches ?� Surface water effectively diverted ? Diversions/swales properly maintained ? ❑ Vegetative cover maintained ? [� Protected from tr�c/unauthorized uses ? � Distribution devices in good condition ? � Field free of settled or low areas ? / / i / / / / / REMARKS s�o�i� +a� K ho� acc,es s, .b [e. ❑ ❑ ❑ �"See ��- 0 � p N fi� ❑ ❑ ❑ PRESSURE DISTRIBUTION SYSTEM: Tumups/cleanouts/valves/taps intact & accessible 7 �� ❑ ��` Pressure head properly adjusted ? ❑ ��►W YV�zMrf7! COMPLIANCE: Compliant ❑ Non-compliant ❑ Neer�s Maintenance ❑ EHS �i � M ,