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A29 225Ano�tcation Date: 3 �� �� Amount ;°aid: �d0 . o O Re�at �: .Z;�� 3 3 �-�-G .3 �� n� � �� � � r �� .��� . %� d o� � � � - ,d �- 3 � � g, �`—����_.�� ��.11�� `�' � �! - --' � � gTZ��T'ZC' �- Ea�rao---,• �.•.•• �aso.�31. �'-3L�.m.]i�.-� AP�tICAT]ON F-0R S�VICFB . Ta� �lan �- �I't�� r. �aP(STRUCT SHALi. BE�a11AE IWVALlD. . � . . o 1) Permc� rec�uested by: (Owmer�a�g_e�ntlpr+os��tiv� ownerj: _ T�6 d. �U� I C� ��X � Lr YV . Home Phone• • 5���-57 tS�.n Address: � Business Pt�one• � 2) Alame and address af cvrrent ovvn�r. d rr C� �� � C J�s N� c���SL�I 3) �rapesty Descriptimn: Lnt si�:. Township: Subdivisian: Lat #�. Directions to the property (Induding roa names� and numhers): d) pro�ased 1lse�d Structure Descri�ation: answer eac,�i of the follnwing questions: � � �.. _ a) Propos� _, Existing , Type of Struc�ure: �Idth: � Depth: b) Number of Hedrooms: 3�-4 Number of ocz�Qarrts flr peopie to be served:� cj Basemer� Yes , No " Wiil �iere be plumbing in the basement? � d) 6arbage Disposal: Yes No _ . � 5) llUat�r Su�Qhl Z1Pe �� �_ (n� _ o� existin9�.��, Pu i�_, Cammuniiy_, Spring _ Are any. s-erf adjoming praper#y?: Yes;��lo��lf yes, P�eas� indicate aQproximat� location on the . 'siie plan. � . . . ;�,. 6) �ees your_ �roge€iy canfain pa�vioiasiy id�ntm�:d jue�sdic.�ional we�ands? Yes_ �!o � Pti�ASE �O'TE i'i lE FflLLOW1iVG: �:� PtAT 0� THE P4ZOP�TY OR SBTE �iAA! i4flUST HE SL]Bi1flITTEi3 W9i�i T3-31S �►l'Q�iCAiIOI�. ➢�ROP�TY LlNE� A1dD Ca6tAl�S MUST HE CLE:�►RLY 11�R4��. • y i"}�iE PfZflPOS� LDC.�TIO{d �7F �,Li. �TRUCTURES �ftUST BE ST�� OR r�AG�Ei3. � i'NE SIT� �IIUST BE R�DlLY �C���SiBi� �aR �Td E1/.4�lJAi7C3B! H�l T}�1E HE�LTI� i�E�A�TNi �T STAF�. • I here�y malce applicafion ta the Person Courrty Healtf� .Department far a siie evaluation fnr tiie on-siie sevvage dis{�osai system fer the above-des�ribed proQerty. i agres thai tiie cantents of this appii�tibn are true and repr�zni the m�imum �c;liiies to be placsd on the property. I underst;�nd R ihe si�e is altere� or the intende-� us� ci-ianges, the permit s#�ail be�am� i�tvali�. �.� , � _ � • /� cwnef o� � -:�:� -� 5" D�e ?C:�D, ,2u. O61Ti; �2 .:;:;. `�-���� �� ����J ��� �1 ��,t � �J �� 1�1 � ���-�,�^,,.,r,� ���.1% I���,�.�.��. �� Location: �� a aN Per� Yalid for ✓ �'i�e '4tes�s. ,, . Type of Fac�7ifi�: r � # of Occupants �.ax # ufB Proposed Wastewa#er S�st�m: � �Praposed Repair: c Pe�ii Conditiuns• -1 c�2 - Qwner or Legal Rsprese Autharized State Agent: � / � T��x �J1:��� � -:�rc :,I :' . � S��r.f�.clli v i �i:aia `• I'I�r�:�_��:�5e�c�i��i��:�L.af � � S �C -� S��d u� i�tU. an �tp����t Pe� ; . �� I�jew �Additiun '��� 5n � �ilX�k PP 3' Pwje�d Da�y Flow � g-P.d. .� � .� . u.,,,.. i� ( n. r�rFi. � n.�.. i.,�.r _�• � .• � �• � i ���� �� %�I Type: _,_�[[-ct 7�pe: � i �.,a.a� Date: 8'� 7 -�J Date: S� a5' TI�o iasuanca nf tf�is pe�it Uy tho Health De}r�tment in �bes nni �a ti�e issaanca of other peimits. It is the respons��ity of ihe aPP�PmP�7' owuet to in sare that ail Person Cotmiy P9�ng and' Zaning and Bw�ding insPections requirements are meL �bis Improve�ent Per�it is sub jeet #o revocation i� the �ite Plan, Plat or. the in#ended use ci►anges. T�e Improvcanent Permit is not affecte�i bY a'cltauge m o�sner�hip oi th� propertg. �S� permit was i�sued m compliance wifih the provisio� of tl�e North C�oli�.a �Lrrws and ,�� j'or Sewaee TrerrA�emi and �isnasal S`e�stems' (i�A NC.siC.18A 1900). Neiii�er P�rson Co�nty nor the Enrriaro�pm�ntal Healtla Spe�ial'sat w�xants that tLe sept�e t� eyst�m w�l con�iune to f�ctioa satiafacturily in the futmca or that the wa#er suppty w�71 remau► petsbie. � " ' . . '�.n���#ion to ����ac� �a�tev�atea�� Systerii (�d �o� �ui�� �er�it) . * See site plan and additfonal attachrnents (�. � � Proposed ast.�Water System: � .t�o�t��� `�Pe� �Iastewater Flaw �g.�.d. New � 1�.epeir Ez�answn � 3a7 I1TAIt: �, z�.s g.p.d:l $ 2 Type of Eacility:.S �� �- � c�, � o� • � "Basemeat �Yes �_No � �ast+ewater Syste�t Iteqairementg Size: SepticT�:I25C� g�l ,. F�ap `Tamlc "� gal' . GreaseTi�p: '- ga1 fie1d: 'Tota1 Area: �'X.0 S sq $ Tot� Leadgtl� �_ ft li%as.i�tuan grenc�a Iiep#�a / g fin ch'9S��.th 3 f� 14�.ix�a� S�a� C�ver: �'� � l�nimmn Treuc3i �epazation: � $ �a�aoa�a� 3t�te Age�: Permit Ex� The type of sy9tem per�ittesi the pe�nit ' ��e�r�.��� ���e��e� Boz Seri�l Distabutian �Pressure Manifold . . ,. . _ � , • . - �, �ate: Date: �-2�/-c� - Iimo�tative Alternative. I ac�ept #h� speci{cations of .'��i�� .. D�. � �,� � � � �c����o�2002 � . .. : .����� �� I���.� �� ~ �'-' �r `L'J �i,J 1,"J 1L � r ]E �.�a-�,� ,� ���.Il 1E33C,�.�fl�]� �f- J�y �ow�° S rate A�nt ���. S�''���. �,�� �,�. ��� W i i� C�+�/ gLt2S �+ L9'�� 3� _ �� /79v T� �ra.� # � �-a� P���. # � s �ection/Lot# �� S-o'�-c)� Date '.$'ystes�r comaa�ione�ai's �present it�5�t�vaeisraute �coniburs only. TTi� corata��tctror� mrist�g the sy.sterrt prr��- ta lregiaasaisag tdie arastdadlia�rs to zr�srsre �dasat proii�rgsrxde as sr�cssaa�aiaaed ; . W `� v _. I/ �� � � � � :� 'u .L� � '�i c � n �-��i� `SZ�rv2c�� 4�-/P�2.� � vo' _ n � „ �,Y.���� �-t � �.j-ij�nf' � �� � � `� ' �N�� . (`, �l �. , ��' � �� sou.uz�� �� � � _�. _.__� o / / i i m� /' / Q � W �� op h r " Scal�: � = o� _ ��� /� � / ;.\ ,,-�" /" �.. \ � � ,. 'ro r. .\\ `srs� � . �'/�, .\ � \ \ I I \. �-' / , , �� /'U �\ � J I \ _.� , , r-. __ ��_� �� :� _ _ _ �' �� we!/ � �� � �� 0 � � I� � ��`�� � � ;� ; _ u� � � � �t � � ' � � i ' i �. �' �i C�n o¢r��+ \.�ne z, I � W� i ' �g" �t-�r�• '���'` < i W; , i � i W� � �Z i Q� � � �g;, i i o'.� gV � o ° � � �m 1 �N < d' � N � I I�iJ m„ � p � - � � � � �g0 �_ I�Q9-�Y`-4c�..•. 50 o �i i �� i ; WI as N � a� I � . o� , � � n a� � J �r1� \l�+ c..l- ' ' ' '1 � � � �� `�, � � � �� ��3% AC �_� ; ��� � ' ��.���� _ , � � ��� ''rr,bgL� � � , I �, =zN = 'r _� 6� -� _i � � . N �J�� ,,, G�� Oc�Q/ �I'�' ►-� �P� ` �4C�V ` � PGI�3, �eR. 09/12/U1 .. {•:.. . .. . ..j'.ti.: •::•.��.•:�" ���� ��• .:..••�� � . ��� . . ., . .. ..• t •.� v.; �: v'Y : :. � � . �� : . . . ��'':i: ...y:�:: � .�.����•� ,^.. •Y .`,+�,...7.�"�,�;......i::. .:.' . ... J,.. .. , .... . . .. rh. r;n\....:e�•. .. � �jj""� . .,_... . : : ,•:.....;. •.. :. • ....: .. . ..,. i'��•.:�-.-�•.� -�L:� � �'��� . ... ....,...>,.. .;•h,..;..,,,...v- ; :•:..,.,..•: � :•:: ::... , . , :. . .. . . . . . . , . • ,-,. . •>. • ,: . :: .. ,: :• , . ,.. ... ..... .......... •.� .. . .:.: � . ..��� : •.. ..;.. . ''_ , . �<,.-„��„-,.-„�'aea�n:��;�: ;��-3C:o;�.��36i�: ��ny:.�:�:.,.:.,,.,.-- �—�.r-r..,.....:.........:y.... �....::.: ,.. ..:..... : �� p '�� � • P�ASE S�� A�A�D Pb.AN FOR WE]LY., �SI�.'E L,AXOIJ'� Tax Map � Parcel # o�oi� .. '%vvnslup: Applicant: I c�ron C'�oc��an 5ubdivision: �`�. .1 �n _ _Lot #, .-+� N i s cw�r V u� �• o,• Type of ��Vater 5upply: �Individual _ Community Public �gtes�nirements: � � Site Approved By: SS Zl D I,iner: �Grouting APProved By: ' Tnstalledby: . well Log �.2 Depth set: Pimap Tag: � . _ Gmuted: Well Tag ' Date: � Air Vent: � - �d„ - Aose Bib: ,/ � � Water Sample: � Casing Height/ � . Cancrete Slab:�' . Well Driller. e�t - Well Approved by: � .� Date•. Z- t�t -o�c ***�Se� Attached Site Sketch**** Wells must be 10 fest from propert}r lines� �c>� ��., lls t b 100 f t from s tic systems � -- S��c� We mus e ee ep • Wells must be at least 25 feet from any building foundation. �� , V �ther conditions: . PCffi� rev 01I27/04 ,�--�� ��- IP�I�� �� ��� Qo � _._. �._ �� � , '''.—r.,'„_'� � � �J�T'� �Y (c�� �r�e�s � s ( __ �cl � �nawi�ccnua.:n¢a�-,m.Q,�� i�raoin.l�iLIln lJattl�J'JIfJlJil9ill / S � Owner: � L,ocaaon: _, Subdivision: r,,•o��c z.�g _ Tax �Iap � Parcel # ���� Lot � __� Well Construdion Distzr:ce From nearest Property Line (Mi:�im�:m 10 fe�t) ��D ` �„ Distanc� :rom Septic Sys:em (Mirumurn 64 feet) / C�Q ! Totai Depth: � ft Yield: �, (iP�1rS Static Water T_evel: �. ft `�l'atET Bea.-ing Zoncs: Depth I 30 ft(�� ft.o21.�. iZ r't Casiag: Dep2h: From �.� to '� S ft. Diameter: _�^ in Type: Cialvani�.ed Steel ►%�� Weight: r Thiclrness: � Height above Ground: � ;n Dm•e Shoe: _�_ Yes ___ No An�oblems encountered K�hile setting casing? _Yes ✓tio if "��es' gi�•e reason: Groat: �( . Neat; � Sanw`Cernent Concr�te Grava�Cem�nt. , �(JVII�� Annular Space ti'1� idth �r inches Wate: in Annul.ar Space _�Yes ___ No Mcthod of Crrout: P�nnped �/ Ptes�ure Po�:zed �_ Drpth �,!_ to ,�O Ft. Naterials lised: 'i No. Bags Portland cement _,�___^ Weight of 1 Aag �`T _ Paunds If mixture (sand, gravel, cuttings} -• Ratio to N',,� ID p;ates: �Ycs �_ No 4 x 4 slab `.'es � Na Llner: N�� Depth: _ Date Installec: Grout: install�c bv: Fr�nn � To 1 hereby cer*.i:y that ihe above by the Ferson Cotulty Healt�� Signature oi Coatr;tetor Drilling Log Formation s LocAtiou Drawing �! �� �etl O that this we!] was canstructcd in accordance with rcgu;a�ons sec f�rch D�t�_ -a� os- � P�p Installmemt Pump Installa*�on Contractor. -2nS �� S_ l�J����_ tate Registration Number- _� � __ _ Purnp Depth: � � ft S b�c"�Vater �,eveL � � ��� Psmp ?�iaice & Model: -e � Tc`C�C2� = Pump Sizti and Rating: � hp �� �r..: 1 nereby certify that this pump was installed and the well :�ead completed according to tl:e Pcrson County Weil R�es i� effect on t:.is date and !hat a copy �f this record has been proti�ded to thc well owr�r. ..,.,.. Z.� 849�:6.9CC 4�'-�e�H I�:uaauc�inu3 c� utt:ad VJd B2 S� 600Z ;i� f.�; �C � �i � �����^� y'y � ��t�tt �I�p da 29 P��� � ' Z 2S `�� (y 1 � j� �.G3�f 1� �.ca.J �i1. V cbJ°WL°Jl'llllVtl�ll�° l�l ' ��. v� �� � � � � � � • D . • Y 41111Y3 J�YVI�VW� �� W _.- I��.��-�� -���.��.1I I�3L��.1i��. � . � t� °� ' � ° �° ° y . Applica Locatio �br+cl�. h�x��.� , . . ._ . ..� , . . . - � � : � r��i � e r �.t � � � � ; System Type (In Accordance With Table Va)� � �< � � . ?HIS SYST�IVi H�►S BEEN 1f�STALLE� IN CO{�IPLI.4NC� WIiH APPLICABL.F NORTH CAROLINA GENERAL STA�UTES, RUL�S FOR S�VAG� TR��►TNtE�IT AAID DISPOSAL, AND /�LL COMDIT101VS OF ' TI-3E tMPR�VEl1�ENT � PE�2MIT Ai�D C�NSTRUCTION �4UTH09�i�AT1�N. . . . �S � � : �—ry,t�c� - .. Autho ' ed St e Agent Date Inet�Ilee� Rv \ �v�.�nw. _ � o. . ie �- Sow1 �l�+o� �7 �/tI-t�l. ' � b'"��0 FCHD, rev. 07/29/Q4 � ����'�� T�,�� �R�S����'��.�! ��iE�3�L,��� �f'�� �� � � Tax Map # A29 Parce! # zzs 5ys�e�n Type (iable Va) L ct: Owr�er/Applicant d'�,�Qz r'�„�,, Subdivision Add�ess/Location �"Glcw G��- 7� SecfPhase Lot � , . � Se��a� T��ak � � � �nit�a ��e - � �it�� aca��on 9ne� � Ini�� a�� � , State �ID/date S - yS _ -o�, Trenctt �dth 3 , ft. �� ' . � � � Ca aci 18Sb ai. ,/ � � Trench De th $- a� in. Tes and Filter ,i T,renctt Len th ft. Baffle Trench Grade � � Sealant Tcencl� S acin � Riser ifi a licabie � � Roc;c De th and Qual' Tank Outiet Seal Dams/Ste downs eic. � Permanent iUlar�er - Pressure Lat�ral� � � � Pum� 'tarak Hole Soacina � � /Sealant Riser Water Ti ht � � P�mp . Checl� Valve/Gate Valve � Anti-si on o e Fioats/Switches �Alarm visabie and audible Electrical Co�ri onents � � Rate m � A roved Pum �ode! � ` Blocic Under Pum Puma RemoVal Rope/Chain ' � Serial Distn�ution � Pressur� �lan o Low Pressure Pi e : � � A r. Pi e Pulateriai and Grade � Vai�r�s a- Pipe. Sieeve Tum-ups/Protectors Requi�d� �etb�c�s From� Wells � � � � � From Propertv iines � Surface Waters Public 1lUater Sia lies . Vertical Cuts (>2 ft.} ... . , Water Lines . Vek�icle�Traffic � O#taer Easements Recarded .. ,;, , , Coev�a�a�en� . . ,, � ✓. � • - �' � pcf�d rev. 3/'i 3/01