Loading...
A29 224. � o� Aopliratlon Date: d'�`v `"� � � � • ,�� . Tax Mao �- Amourrt Paid- �j ��'� Rec�i t � . /1 . Parc�l �: d' ��� �\�_ � I�I�IE�.� �1� � � - - �c � �CT�i�-Y ��.�.�-�--.- ---- ���.�.�. �o�.a.�. Perm3 - $150.00 APPUCA710N FOR 3�iViC� $750.fl0lSZ00.00 � - �225.OD � �� IF THE INFORMAT7aN IN THE APPl.1CAT10N FOR AN IMPROVE�AEiVT P�RMR 1S INCORRE�T FALSiFiE� CNANGE�, OR THE S1'fE' IS ALTERE�. THEiV THE IMPROVEiNENT PEiiMIT AND AUTHORIZATiON TO COPISTRUCT SHALL BECOAAE INVAUD. - 1) Pernui requested b:(Ownerlag prospective own �.�1 �-tY i GS� � M eS• I�:a�� ���' V"� Hame Phone: ���-S'1 �1.� lno 611 �a-v� D�vis �2d. Business Pf�one: �q � G a-S'7 1 s� -1 t"i � �� �� y�/�, ►�.►` c.�c.. ICta.�-Y-� 2) Na�te aztd .address of current owner: � o r n�� n� 0.V �, � .- ~ �I, mr'D�d 2:`l 5 7 `l� � 3) Property Descriptlam Lot size: _� Trnrorufiip: Sut�division: Lot # Directions ta the property (Induding road names and numbers): 4) ptoposed Use and Structure DescriQtion: answer ct� af the foilowing questions: C�(� S`7 r 1 � a) Proposed�� Existing , Type of Struct�.u�e: �r i C.YL 1-��4� Width: Depth: - b) Number of �edrooms: � Number of �pants or people to be served: �_ �� c) Basemerrt Yes �/ . No _ Wll there be lumbing in the basement? d) �arbage Dispasal: Yes . No _ �Ct_,t� {y�. � ��5� . . 5) WaEer Su�ply Type: Private ✓(new � a� existing_), Public_, Communi�y . S�ring _. Are any wells on adjaining propeKy? Yes ✓No _ ff ye,s, piease indicafie approximate Iacatlori on the 'siie plan. 6) D�s your property cantain previcusiy identified jurisdlctionai w�lands? Yes_ IVo � � PLEASE NOTE THE FOLLOWING• ➢ A PLAT OF THE PROPEi�TY OR SiTE PLAN NIUST BE SUBMI7TE� WITH THIS APQLICATION. ➢ PROP�i�TY L1NES AND CORr1EitS MUST BE CLEARLY MARl�D. • � 9 THE PROPOSF� LOCATION OF ALL STRUCTURE� MUST BE STAi�� OR F�IGGED. ➢ THE S1TE MUST BE READILY ACt�SS16LE FaR AN EVAL11AT10N HY THE HE�11.JH DE3�ART61E�11' S'i'AF�. � 1 hereby maice applicatian to the Person Caur�ty� Heaith Departrnent fnr a siie evaivation fo� the on-siie sewage disposai system for the above-described proQerty. I agree that the cantents of this appiicatian are true and re�resent the maximum faaiiiies tc be pia�d o� the property. I unde�stand if the siie is aitered or the ir�tended us� cf�anges, tfie pelmii sha1� became it�v�i�d. _ � /�1 n � owner or Legai - �� 5 � D Ptl;D. tev. 061a102 `01���,�� �1: i"��iJ �� � ' � � `� ���� 7E��-�� �^�^ ���.3i IE--���.11.�It�. Applicani Location: c� ', —� C. A►'w.�u t a F 5cc,� c,F Pe�mit �alad fo Type of Facilifi�: ' l,� �on-: ��; � New �/ t�ddition �ater �npply � 7�,�c� # of Occupants R M�.x. # of oms /�'. Pmjected Daily Flow �_ g.p.d. � Proposed Wastewater S��t�m: Cu�v�tiv�.�i � . Type: �a Proposed Repair: Ci rw�r,�r�o4 � w�a.0 ha.u.2 ��'o ►a.r� c,n�,;� susLc,,�. � T:YPe: 1►_ a . � . . . w Ye11N �JT��rI � ' �!1"C'l-�� -, S'LllfJ f� I'V I�wi U ll F i�i ���5•c' S� c ti o t��%L.a t� �n►p���effie� �'ea�$ . r ✓ �'+ive Y�ars. rtq �`sgirat�n �. � r.l�ll • 1 • t � 1 ' � • • �7 �w I. � `+. � . ��• � �� , / i I I i/ / Owner or Legal Represe Atrthorized State Agent: m Date' ���� � � Date: a - /(o -0.S Tho issuance nf this peYmit by the Health Dep�rimc�nt� does not gua�rantea the issn�nca of other permita It 3s the respons��iiy of the $PP��P�P�Y owner #o in sure that all Person County 1'7a�ning and� Zoning and Buslding Inspectiona requirements are met '�his Lnprovement Pennit is subject #o revocation if the �ite Plau, plat ar the intendeal use changes. q'Le Tmprovesneaai �ertaiit is noi �ffected by a'ehange in ow�oerslup of the Property`. �his permit was issued in complianc� with tite provisions of t6�e 1Vasth Carolina `Laws and ��or Serua�e ?Yeahnteni and Disnosal Svstems' (15A NCAC.IBA .1900). Ne.rther Person �o�tp nor the Environmental lkdealth Specialist warrants t6at the septic tank �y'stsm wili contLtue to func3ion satiafactoritx nn the future or that the tiw�ter suPP�Y will semau► potable. - � . . ��l.ii�oB'IZat,lOII t� Cm1��[l�'������$e�'� S�SteLii ��eqnired for ]Btuldimmg �'esmit) . * See site ptan rmd additlonal a#achments (� � � r��sea w�va� sy�: (��,y�,►-. �. � Type ��_ Wastewater Flow �.p.d. New �l R.�pair Eapansion . Sa.7 LTAIt: _ a�5 g-P.d.l $ Z Type of Eacility:. �,� � �..�u �:_.,..�_ � �Basement �a �Yes No � i�as#�w�ter Sy�te� Reqnirements . . Size: Septic �a�: ►2sc� gal , Pu�mp �ant�: � gal' . Grease Trap: — gal fie1d: Total Area: ► � tis sq $ Tot� Length 5 8 5 fi 1Vlas.a�u�'I`�e.n� IDeptla i- a o a� eh W�th 3 i# ��ean Sonl Cover: �� i n_ in Minimum Trench �epazation: _Q____ ft (ba#iva: x Distnb�tion Boz Serial Distnbution .Pressure Manifold Aa�#�nor�ed State �gent: Permit F.x� The type af system permitted is the peimit. ��►e����� ���� �� Date: a�/C�-t� Date: Conventional Innovative Alternative. I accept th� specifications af D�: �� � `�' 0� PCHD7/3012002 J _ . .. ,_ .. .._.. ,... �...,T . . ,..�_ , � � :_�,'� � ' �� I �' � �LJ�.. V . - ��� � �„ s--,�.�-�- -r.�..� `_' _ ^_ . � �����' �F ���� � ��-���,.,,,�,,��¢.�.n ����. S�'�'.�. S��E.'T�: � � � � �� ��� Name �� d 1 Car�.. ��,;,, � Tag #� Parcel # � � 1. -�-, �- � Section/Lot# . / / - __ _ o�^ I ( n —t�s � , Aut�o � Sta t . Date . � // / System canrponents re�►r�se� a�rvxinrate�con�dours on y 3ise casstr��»r must, flag the systerss j�rior to � .� beginning the i���tallation to insure ihatpr�pergmde is mcrantained _..'w__,^°^o. � � � _ - ___ ___ _ ._ _.___ _ _ -...--- --_. __ _-_ ____----------- _ .-- _.__ _ .__. _._ _ --. � -- --- - - - - S89°56' g��E--_ _-- -- � - - - - - - - - - - - - -.- - - - - - - - 662.5 \ i � / �v - �� � STEPHEN L. DUNEVANT h ^ * D.B. 311, P. 199 � a � � � N �� � i e - � O ,' . =N�' ^ JP�� � � �� ��" � � 59 . 58' " ` `� 9s''`' , ./ NF S84°37'OS°E IF 507.81 TOTAL . 7. 3 7 A ��, si ' tu I F �5 ^� ��� �� � / 't ^ � / I�\ � ryNA /�--- � � z PROPOSED 50.� .�ry�"'`t'�' , - - = - - — _ _ R�W ACCESS EASEMENT �"" — __�___ s� NS N85'40' OS"W - - -- - - �� _ _ ,� -- __ __ 718.01 Ng � , . _ — — — � � — � .� � � v� � , . ---- --- __ �� --._� :` � _, � PATRICK LEE GODWIN, JR. � / KAREN HOBGOOD GODWIN `� D.6.512, P. 91 � NS � � � . ,--------------------------------------- � � � ' SANDRA BRADSHER DUNEVANT ' n R d4F p �nst � ,-......_ m- -, . .. _ _ t - 1� lacrt. we� 1-tfl \d.a,. ��-ern•�:•.�z b�,� ��.�. { -I� w�.�� �- ��- �� � r� ` �ts�, i-; � . ca�.Z �6 � %.+-�- � � h�usQ. � _ � _--------__....__ ._____ _- ----._ _ . _ _ _ . ._ - - ----__— . ______ - ICaep �01 a�- ls�} oZ5 ;F+ G-z�+-. os2� � s2,�,�1: c. Cr¢4s. � ; � � L} i 1' � � i �'_ +n � � � - � �'� i �4 � �- - - � ,1:,� � �:: . � � S- �? � i' 89' 57!F�9"W 247� '84 is IS ---------'–___�������.�ocacGfCYY����ECCi'�CCPrrnrvnu.,an�...�����-------------------- PATRICK LEE GODWIN, JR. KAREN HOBGOOD GOOWIN D.8.512, P. 91 i � a �a cwL ��s�-v�r� �- �...�D �- en��kr� ��n �t 52,+� �-+Z. c.o�^ t�p ,C� o. � GYPa. , v �:��:::.�� y.;..:;.. .:�•.:.;; .. . .. •. ; � . . �,. ....;;.:..� �:������•�...'` `��:::w. ... .. � . .��:;-..::� :.:�:,;:.. TT : :��.�J!.� ��.�'� .........:av::..•...::, .:.....:::.::....�.:.:,.,..., _ .:: : .. : . ... . .. . . , .�:. �.._;.,....:.�.:,..: :...:....:..:.: ...:.. :::. . . . . .... ... . �. ..... . �.�a:�-n�arvcn. sea�a:�:ai: ':: � ' ��,�.��7�ri:: : • ,.,,•''.�,Y„�- �11'•'�-`7L: WELL 1PERNIIT � � PI.,EA�SE SEE ATTACH�D PLAN FOR VYE]LY., SI'�'E ��ICDiJT Tax Map �c �� Parcel # � �' Township: Applicant: �c.�;��. a )��. C��u�„ Subdivision: Lot # � Location:_C.1� cS � Gi�s 1va�4. �ws TZc. � �or� c�o �� �.5'04 1 �r��.irn� `-� �u+be. is o., � : ,.r�- ►- loo, c �:� � �v Ilow c1,bc iv �o a� �.`l1 -� �s,su- (L� 'Y'ype of Water Supply: '� Individual _ Community Public �teqnirements: Site Approved By: _ (�_S �- c� -�S Grouting Approved By: � '7 -1�.cs3' Well Log: ✓ CS �(� - r� Js Pump Tag: ,� ` „ s�,.,.� -}� Well Tag: v CS i��.-DS Air Vent:,� CS 1 I- 1�-as � Hose Bib: .� � � � -� � �s � Casing Height: ,,/ � � � - t �=� s Concrete Slab: � Cs � �- i��x- Well Driller: �er�s.\ 's �J�� �:\�'� Well Approved by: � ****Se� Attached Site 5ketch**** Liner: �Installed by: Depth set: _ Grouted: Date: Water Sample: Date:, 1 �-f�-�S 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 buiiding foundation. � Other conditions: 9a I 1�x,� s�'�c ska�. � PCHD rev 01/27/04 08/02/20�5 09:33 8043740001 J�7a J't � ' � . �� L• • �: ' �. :. ., • ,:. • o1J �� T�'F M • ' �� � �' ���� ��--'rSY�.vaa�a¢3t'��caa�7�A.��o.� ��.aa��Q.�a HENSLEV WEL PAGE 01 Drililei Ib � � � Couta��Zit►y N:��i�t��� r . ,-_ . !l��i � , D-,-�t�e Dri�llcc� , , Groat Log Owner: I''i �- q.�' '�'ax Map� Parcel #� L�cstipri: �-' � r Subdivision: Lot # Weli ConstrtrMfon Dista.ncc From nearest Property Line (Minir.n�m 10 feet) 7D ' Distance from Septic System {Minimum 60 feet) // D' Total Dcpth: �� 0$ Yield: ��� GPM Static Water Level: �� ft Wattr $earing Zoz�es: ,Dcpth J��7 ft_ f�,t2_ ft ft� fi Casing: , Depth: From %t to �/ ft. Diametcr: �c► in � Type: Gaivanized Sfieel _... ✓ Weight: _ _ Thielrness: �r�,� Hcight above Gr��md: .,,,��, in Dtiv'e Shoe: _� Yes � No A�uy problems encountered while satti�p� casing? _Yes �No IP `�es" give reason• ' Grout� �.,Q�J-� 4�/1 Li�. �3 d b' l�eat: _� Sand/Cement Conczete GravcUCement �. Anbular Space Width v� inches Water in Annular Space ✓ Yes No Method of Graut: Purnped �� Pressure Poured Depth _� to �,_w F� Materials Used: No. Bags Partiand eement 'Weight o� 1 Bag �`� Pounds If mixttu�e (sand, gravei, cutti�ngs) - Ratio to ID plates: ,�Ycs _ No d x 4 slab Yes ,� No Liner: �/� ' ,Deptb.; Date instailed: Grout: Drflling Log �'rom I To I la�reby ctxtify that the above inforrnarion is by thc Pcrsoa County �Iealth De�,�tmen�_ Signature at Contractor a�d Installcd by: LocAt�o� Drawin� , -I " ` ��`, ��� ���+ I10� � ^ - - - - • - Q this well was conshucted ia accordance witta regulations set farth ID# � r Date 7� a�9�0.� Pump Installment Pump Jz�stallation Contzactor: M�2 ��^ �5 l,� ',�1 �� ir� State Re� stration Number: _��% 9 -- �.,p ���, '� d � t�c Watet Level: , j� Pump �vlaks & Modcl: r� �ip Sizc and Rstit�g: ���--- %p �L,,,� $Pm I hereby ctrtify That this pump was installcd and the well hasd cannpl�ted according to the Ptrsozr County Well Rulee in effoct on this date �nd that a cagy of this record hes been providcd to thc wcll owner. � ���1,� Date: Y� 5 PC�-ID rev 01/2�/04 Yum.p �nstaller SiQnature.� � 1 `���, �� ���� �� �-. v � �/ �� � V 1i 1i ��nv�a�-���.�rn��.��.�. ����n.�.��n T�x M�p � � P�rcel ## Su�bciivision Phas�e Sect+ioniLot # # of Bed�rooms , . Applicant: Location: � - perat��n Perm it System Type (In Accordance With Tabie Va): � THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH CAROLlNA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AND ALL COMDITIOiVS OF ' THE IMPROVEMENT PERMIT AND COfVSTRUCTION AUTI-lORIZAT10D1.. �� � � Installed By: ,'�`' � �` _ �-�- Lo' � � 0 � � � 0 - �� E) , 4'5 7'Z 0 8�3 C 2 s Z �'�'S 7�Z 8,a 83 ��.�2 �,s .�,Z $-0 83 l�� 7 dS Date Date: l�/ 7�oS L1 14D LZ-I�o �3-140 �4—�ND L5'►�D �, �7�0.. PCHD, rev. 07/29/04 � �E�TiG �'A�lK 9R9S€���'�1�.h� CV�E��(L1S�.4�IPe 01- IV� Tax Map # Zq Parce! # 2� Sys�em Type (Table Va) � Owner/Applicant �,-ir,� a �rt�n (�1K,%+��n Subdivision Address/Location Sec/Phase Lot # �_ State iD/date ��(�- /�5/Z-8�OS Canacitv PfS- /2sn aai. Tee and Filter Baffle Sealant Riser (if appiicable) Tank Outlet Seal Permanent Marker Pump Tank roof /Sealant Riser 0 Pump . Checic Vaive/Gate Vaive � Anti-si on o e Floats/Switches Alarrn visable and audible Electrical Comoonents Rate (gpm) Approved Pump Model Blocic Under Pump Pump Removal Rope/C n Serial Disiribution U-baX ressure an o Low Pressure Pipe Appr. Pipe Material and Grade �uate NI'tP'iTiC1t1017 LIII t� 7-a rencf� Width � � Trench De th - T,rench Len th Trenct� Grade � Tcench S acin � Rock De�th and Qua ft. in. ft. Dams/Stepdowns etc. Pressure Laterals Hole Spacing o e ize Pipe. Sleeve Tum-ups/Protectors Required� Setbacks From Wells � From Proaertv lines Surface Waters Public Water Suppl Vertical Cuts (>2 ft. Water Lines- Vehicle Traffic Easements/Right.of V� Other Easements Recorded e e pera or ai Tri-Partate AQreemen Commenis �- pcnd rev. 3/13101