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A29 201\�, ; ,�f ���� �l V �-..� � � ���� 1��.�n�-��.�ti�.�.m.Il u 33L�.m.Il�1� Applicant: � Location: 4 G � Ta�x M�� � � Farcel � � r S��hci'ivis�ioi� � 1)� . [ ' Ph��se Sect�ion Lot � Improvement Permit Permit Valid for _ Five Years No Ezpiration � Type of Facility: v�R 5�� New �ddition _ Water Supply C'�24.�e.. # of Occupants j�(� # of Bedrooms � Projected Daily Flow �� v g.p.d. Proposed Wastewater System: o Type: �'� Proposed Repair: ��,�,m (1� �,.(-; �_Q Type: � Permit Conditions: Owner or Legal Represe Authorized State Agent: Signature: � � Date: 7 � 3(-0 � Date: �l—�D..D� The issuarice of this permit by the Health Deparhnent in does not guarantee the issuance of other permits. It is the responsibility of the applicandproperty owner to in sure that all Person County Planning and Zoning and Building Inapections requirements are met. This Irnprovement PermIt is subject to revocatlon 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 ln compllance with the provIsions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). ` Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments (�). ������G�� J Proposed Wastewater System: ��n��(�(��y�-� � e Wastewater Flow ��g.p.d. New � Repair Expansion _ Soil LT - 3 g.p.d./ ft 2 Type of Facility: ��, 5� S� Basement _ Yes �A10 Size: Septic Tank: ��gal Drainfield: Total Area: �� sq ft Wastewater System Requirements Pump Tank: � gal Grease Trap: ��I- gal Total Length �_ ft Maximum Trench Depth �_ in Trench Width � ft Minimum Soil Cover: � in Distribution: Distribution Box ��erial Distribution � Specifications: Authorized 5tate Agi Permit Minimum Trench Sepazation: � ft Pressure Manifold The type of system permitted is Conventional 1/�nnovative the permit. %1���,�-,,Q �! OwnerlL��*�l Re^resentative: Y l,! 11�;' Ul.l. ����`lMi'� � �i Date: 7 �O � 2 Alternative. I accept the specifications of Date• `�`� ���oL � .. � , .. ...._ . . .jS Z1 �n ..�... ::,� ..... ,,,, .. ���� ,, r° 5r� N85' S2' 46"E ......;' , � ;- .1 � �' �... � � �► � ; r L� l J 1 y ' ~ v0 4 �% � 6� 7:jj �� ,.�, • �1 �, ��� . NS � _ i } / �, �,� � � .� -� � / � a / L.EG. 32., �.. e� �,`.. o � i � , . , 3 � �:`�. ��� � � . ; N � .. � �_ ., ' { � ' 1 • ? A CRES .� - .�;�� .. . - •� / 1 s... �I � �¢ ����� --- 19 NF . :� � � � _�' • 3 + 30"E I S `' �',. ; ...I,S. 'I S, 36:. ; IF p ` I�S ,�pl'd � � 81 0� � TpTAL .. `, , , TS�. . . . 424 •1 , ' , � W � CONTROI � �' �� .. . �.��� .:35 -� �CORNER NS �. � � `fl ,. .;,�. ..:..a,�� . � 32.;9� � • ��2 \� �. . w ..::-o,A 2�' � a� 0 ` ���'�" _._____--- i S N� � 1 8 2� . � ` l � 4 A C R S . �r � ... ' . . � � � �� a � � � , ' . E -����� � � \s �� � � ! v', .r,, , � r S.. i.�! I.EN � �` ° ` (� � O9►�E , � �. • , N� � � �� ► t Oj �`�""�--`�, � ` �o 5,S � NF I S 37 $' 8� . . � � , � �S ��� � Z ., � � . . ! LEG 17 y 31.34' � / v'� � \ � ` ; . . ,: . . , , . . � � ; . . , . . . �,��.�.�- ��I�.��� `�'= � � � �1�T�� �.° na�n�-�n.aaa�n�na��.� ��a�.m���a. WELL PERMIT PI.EASE SEE ATTACHED PI.AN FOR WELL SITE LAYOUT Tax Map #: _.�+ ��. Parcel #��_ Township � I �� � i( I Applicant: ` � �1 � � � � S � Subdivision: ' �.�e � �— Section: Lot: % Location• "1 � ���- , � � Twe of Water Su��ly: �Indiv�idual Requirements• Site Approved by �3 N e'8'o a Grouting Approved bp �3 N 8"8'�a We]1 Log ✓7 N g"8-oa Well Tag; � �� 8�a� n�. Air Vent ��N 8 16 -�� Hose Bib ✓ �r�. �3 ac "b� Concrete Slab ✓�� `°u' ✓o� Communitp Public Well Driller. Well Approved By: Date: � � � ��' '�°5ee Attached Site Sketch'�` 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: PC�ID, rev. 09/07/Ol � ���,Sf ���.� �� °�' ao � Q �a�v _ `_'' cC � t�TTl�T'IC� � � ,����-� �.��!/�« IE�a�a-o�a�aa����.Il IL33L�.�.Il�II� 0�-0 � '� .c3-7-�� Owner: � Location: � . Subdivision: � Well Log Tax Map ��� ParceT # .�Q/ Lot # /� Well Construction Distance From nearest Property Line (Minimum 10 feet) Distance from Septic System (Mini.mum 60 feet) Total Depth: � ft Yield: ZO GPM Static Water Level: �� ft Water Bearing Zones: Depth C� � ft��7`-T` ft�l �- � ft/ � ft Casing: Depth: From � to �G' ft. Diameter: �_ in Type: Galvanized Steel� Weight: cl�ess• �_ Height above Ground: � in Drive Shoe: Yes No Any problems encountered while setting casing? Yes � If "yes" give reason: Grout: Neat: Sand/Cement Concrete GraveUCement Annular Space Width inches Water in Ann Space Yes No Method of Grout: Pumped Pressure Poured � Depth to Materials Used: No. Bags Portland cement ����.?.SS'� � Weight of 1 Bag �_ Pounds If mixture (sand, gravel, cuttings) — aho to ID plates: �Yes No 4 x 4 slab � No Drilling Log � Location Drawing Ft� From To Formation % rJr/clS%: �t.� � • ��k . ,( i3 �C? r �o� ��'� ci 1 �n�' ��� I � G�� , f1oX-►�'� C�'fd�= � t� ✓ �p�� � IC I hereby certify that the above infoimarion is corr ct and that this well was constructed in accordance with regulations set forth by the Person County Health Departm . Signature of Contractor �� ID#_�6� �{ Date cg - 7 dZ PCHD rev O1/16/02 , ' . ' ���� � � Ji.. �a �. i ' 4J �.� �j � � ' . • .�� .,�L a.r� ,y—� . . `�ai� �r �7�,.J 1. 'g•��,r . . �]C3T34�O31�w�n'* .w�*' '�.LL ��¢7L3 . • t . . �`� � . _ _ .....• T� "�'.:,:=�: . � , Paree�l � � Zoniag: Townahlg: ' � � � . 91��n: �+�,� � � 1.�, �'Z/:� • • 9ecllon: 1:� 1 � .. Al�� _ ! � . .' �i���� l.a�tlon: '���'- - . c • •; . � � erafiion. �P'errnit � �s- �G � � . � . . System Type (In Accordance 1A� Tabte Va): � . . . , . . THIS SYSTEM HAS BE�1 tN3TALLEE� IN � COAIPLIANCE 1MTH APPLICAB3LE NORTH ,��. CAROUNA GEAIERAL STATUTES, RULES FOR SE�I►AGE 4itEA1'�ENT R�ND DISPOSAl, �� AND ALL CONDI770NS OF THE IMi'ROVEi�ENf PE�'1' �ID �ONISTI�!lCT�ON . :;:;. �; . I�UT�10 N. � � _ - � . � � �dv�e.�� � � . l �� . , :rt . . Aartl,orized state Agent � �aie .._.._:,,_�... _ . . . _ _ . . � . . -"'-r��',� . • ' •''•,,• . � �� _����. �'�,�`�z . . ,-�.� 2� � (^ � 1 '` � � 5�� l °�� � � � � . � -� . , � , /� u y���. z� . �ldlz� _ . . � 1���,��L. �ss'l2 �� '��' � bs`� � .11a l�� � _� � ��-�a�- ��� �� � ��,�e �f��� _ s S � - � � � ��� � . . . � �� � ��s � �� �