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A29 232A��siication Date: `"��l �`d� 2 p �33 �}e ��J � �mount �aid: � �QQ�,jL-� 5� Rec�ipt �: � , ����.�� I�'I�I�..� �� - - -1 � � -���� � aa�s.a-�.��-�-„ �aa�.eo.I1 ���.w.IL�ILa l�PP�1CATlOfd FOR SEiZVICES 3ax iUlao �: Parcal �• IF THE INFOiaMATIOM IN i�iE APPLIC�4TIOi�! F�9� �Rl IflAP4��!lEi�IENT P�ERIlflli' IS INCDi�RE�T. FALSIFaEL1, CHA�GE� OR TFIE SIT� !S ALTERED. i3�EA! T➢-aE I�PR�b'E3�iENT P�RiViIT AND �,UiH�RiZ�iTlOft! Tt� COi11STi�UCT SHALL BE�OAAE IiVVALID. - �) Permit rec�u�ted by: (Owrnerlagent/prospeciive owrner): /�� Home Phone: � Address: 3�0 /la Business Phone: - D o s , 2) Name antl address of ctarrent owrner: ��i'I � 3) Praperty Desc�aptoon: Lot size: cr� Township: 'Ye ��l Directions to the property (Including road names and numbers): � � n,i)�S �e�h�i di.Sl�n nin � �'�}Y�1 �u; /)e� Lot #� 4) �ro�osed Use an S�e�.�cture Description: answer�act� of the following questions: a) Proposed _, Exisfing ; Type of Structure: �S %e�P�i�i�i4-) Width: Depth: b) Number of Bedrooms: � Number of occupants or people to be served: c) Basement Yes , No Will there be piumbing in the basement? d) �arbage Disposal: Yes No _ ' 5) lf�/ater Supply Type: Private �(new _ or existing�, Public� Community� , Spring _ Are any wells on adjoining property? Yes_ No _ If yes, piease indicate approximate location on the �site pian. 6) Does your pro�eety ��ntain prev6ously identified jur�sdic'tional wet6ancls? Yes_ i�o i/� PL�SE �OTE THE FOLLOVIlING: 9� PLo'�T OF 'i�lE �ROPE3iTY OR SIiE PLA�1 i1�USi �E SUBMI'q'i'E�D Wlii i'HIS �►PPLIC�►T10N. ➢ PROPERTY LINES AND CORPJERS MUST BE CL�RLY MARKED. �, � 9 T9-!E PROPOS�D LOCATIO(d OF AL�. STRUC'�'URES flflUST 8E ST�►FC�D OR FLAGG�E�. 9 TiiE SITE MUST �IE 3ZEADILY ACCESSIBL� �OR j4i� EVALUATI�N �� ZFiE HE�►LTFB B�EPARTV�iE�IT SiAFF. I hereby make applicatio�t to the Person County Health Department for a siie evaluation for the on-siie sewage disposal system for the above-described property. I agres that the contents of this appiication are true and represent the ma;cimum facilities to be piaced on the property. I understand ifi the site is aitered or the intended use changes, the permii shall become invalid. % e' or L2gal g, i� os Date PCND, rev. 061271�2 � ���� �� ���� �� v� � s . ,, � ������ ���-n.�<�„',, ,�-„--, ���.m.11 IE3L ��.Il� Applicant: / T�x Mra�� � �rc�e:l � . ► � , Subdiivi�s�ian . ,� ha:s�e Sect�ion'Lat � Improvement Permit � �ermit Valid fo� � ve '� s_ No �zpiration Type of Faciliiy: � � • New �Addition �Vater Supp�y _ (�� # of Occupants� e�,� # Bedrooms � Projected Daily Flow `� �v g.p.d. -}�,, Proposed Wastewater System: � Type: �tL � Proposed Repair: ,/iiAM�P G �W Type: � Permit Conditions: Owner or Legal Represe Authorized State Agent: Date: -- � The issuance of this peanit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are meL This Improvement Permit i� subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected by a ciiange in ownership of the property. This permit was issued in compliance with the provisions of ttie North Carolina `Zaws and Rules for Sewa�e Treutment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmeutal Health Specialist warrants that the septic tank system will continue to function satisfartor�7y in the future or�that the water supply will remain�potabie. � Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments (_�. Proposed Wastewater System: �. Type �b� Wastewater Flow ��.p.d. New � Repair Expansio Soil LTAR: ��i.� g.p.dJ ft 2 Type of Facility: T ��� Basement _ Yes '� No . �Vastewatea� System Iiequireu�ents '�ank Size: Septic'Tank: � gai Pnmp Tank: l('�� gal Grease �rap: �rainfield:'i'otal Area: %3� sq ft Total I,ength ��� ft 1VIa�ffium Trench I3epth g� t g in Trench �idth 3 ft t�inimnm Soi� Cover. � in Minimnm Trencli Separal3on: � ft �• C• �istribation: �istribntion �oa Serial Distribniion k Pressnre Manifold Specifications: �� � St 0�2 S ��C.' � Authorized State Agent: '�/'�' Date: "' 2�'�'' Permit Expiration Date: � -a0 -� The type of system permitted is � Conventional Accepted Alterna.tive. I accept the spe�ifications of the permit. Owne�/�,agal �8epresentative: Date: ' pCHD rev. 11/10/OS `1�.?. �� �1��� �� . - - -" �:�`_���(��T� � � � ' ��933��T'^ �^'^� C21�AJ1. ��0.�..JL� � /�s� SIZ'� i�LA3�7 Name u/ � a S ' n � II,, Tag �fag # �Panei #�� Seaioa/I.or# / — —o Authouzed Srate Ageat D� • 5ysrem compaaeass reprrsearapp�arr canmurs valp. The roarracarmusr�agr6e system pacrr tn beg�mg ffie msrnII�aa m %••Q,•,,• sharprapa�rrdeira�a�taiaed. � " �;crvt �il� � � Q ,� rr`��e. s-e��Qe�� , - /�,��� � � � .���/�'CC�z✓� Y��. �� ^ d;-� r/1,�� S�,S'�M r%� �I � ~ ���� � � � S C����� . � f� __ _ �o L(o�- � K � �4C� 5�4�/Li � � � � �� � G�(,(n� G�� ��� �Z� � - �Qy,�4�e � /� �� � �,�<c �1 u� � r�`'c�t � dv � � � P -----___ �A , � �<<� �- ��.��. R-����r SC��e ; ` `� �d � � � . �� � s'h ''s. � � � �9� � ��' C�, � e �� � . � � � � �� � � � � r� � _�_� Vi � �� � � � � `,y �. �'o D�� o � � � G ,� Y ! � J s �� ����� V � ' � ) l ���� �� � ,.�.. � �,;,;. ; . � � ���� ; ; " I�� � �,7L�7�; . ����.����.����.3L WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map � Applicant: _ 5ubdivision: Lacation: Type of Water Supply: '�Individual _ Community Requirements: Site Approved By: Grouting Approved By: Well Log: Pump Tag: Well Tag: Air Vent: Hose Bib: Casing Height: Concrete Slab: Well Driller: Well Approved by: ****See Attached Site Sketch**** 1..ot �# t Public Liner: Installed by: Depth set: _ Grouted: Date: Water Sample: 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: Date: r PCHD rev O1/27/04 �-�---����;�� Jl ��� �� `�•.1 � � ���� �aa�v-a�c-as��a.�mm �a.a�m� g�a�.m.���►. NEMA 4X Simplex Control Panel . 4" X 4" Pressara Treated . Sloped To Shed Wafer 12" Sep�ration \ Electxical Coxuluit - i ' ' '. .f ' � °O • . • , .•; • . 1 b" Covax • ' Acces� Cover. � • • . ; 1 , � . ; � ' � r ' . . . ., • � , " ;. . . � � r _;, ��• , ,'`. , , �' , �,, Openin= Filled With . Anti Siphon Hole � InlatFmmSapticTattk PortlandCe:nentGxaut ��g� � +1" SCH 40 PVC Pipa � ' ' / T��x M�t{� P,tr�:-c�l # /, , , Sul�ct:ivision Flra�s�c Sc�ct+ioi� Lot # Duct SaalBoth End� Of 11u Cox�rit �- 24" Minix�aiat - Thre�dad Gate 9alve I; Llnion / � r"1 Zip Cord T'u� 1 Check .�.N; ' . , . Valve � High Water Alarm Lav�l (6" Sepuation� „ , ' Hish Laval - Pump On ' � � i� fiVapoxLock �� !• � �� Drawdawst Hola • � 1 . � (Up H� � � . Low L�val -Puxnp Ofi . '..,5 �F ' P:eca�t Coixrete Taak ' 4" Conezrta xre ' • � ;.; Matezial Stxength }3500 PS H1ock � ^�.... r , . •. . .� ' '. . : ..'• Concmta R'vez b" Sapuation • • •• • . :�.,�:'N" • — '�„_..�Po�tLxudConcrete Cnoi�t _ �, Ma�tu • - : . • .YI• � . . � Opani� Fillad With upply Yortlu�d Camant Grout ,ine • • ' Outlat To Di�tnbuiion 2" SCH40P`TC Pipa �� P1oat Wire� .' � .• •r F7oat� �.�: �,R.emovabk �•�. F7uat Tre� , , . r �' .. . •. ', � :' �'_ '. ' '. ,�(N� GALLUN' FU1VII' TAi� . �::. . �.��. � IPI�I�.� �� .^ ������ ��p �� ��-������..0 �[�.�,u,� Owner. ���t�"` Y!1't Tax Map: � Parcel #: .23� Date: ?�-� (� L,ine Tap Tap (Scl�} Tap �'lopv Line i�ngth �"1ow i foot # Diameter(ua) ( m) - :. ft) 1 � z � �v S• S' �'sa � n ��- 2 ► ' �o �� 5-� �- �o , v� � 3 `Z �'� . S� Qv ,o6f 4 �o � �.s- Qv .dG 5 ' L �Ec� �� l .n'� 6 7 8 9 - 10 � ��n ft of line x 65 gal. per 100 ft=Z ��� '�� ; 100 ��� gal 75 °Io x=� ga1= 2/ S gal per dose � gal per minute (gpm) = k'low IPate Friction Head Loss: Z• � ft per 100 ft of s�ply line x~�� ft of snpply. line =100 =�- s ft • S ft x 1.2 =�(� ft of fricrion head �. Manifold Size: �_ '` _" �orce Main Size: 2" PVC T o t a l D y n a m i c � e a d = 1� ft o f E l e v a t i o n h e a d + y f t o f P r e s s u r e h e a d +�� ft o f Friction Head = Z � TDH Pump Requirement: 3? GPM @� 3• ft of Head � � Drawdown: 2�>al�ose � 21 gal per inch =•� inch drawdown per dose :�� a .� ��.�.� , r� � .��.:i,,i � � � .' � :rf������0 � . � : . . � ,. 1 ...� � � �[(�)��Om00 -�-�-o-�-�. o-�-�---�-o-o-�-�-�-�_.,-�-�-�-..-r-<-�-.-�-e-�-..-:-. I' " t1 I, ���*lS��!!�l��E��l�.4,l��a�.!!!��! :............ !+li��*!!!!�!Nl��!l��:I:i�i�i�i� � � � � �.. _ � , . a a � � : : : � v: +Z» nfiri Scbe�aie d0 � Tadhe� . - l�i/vo�ea 9mma I � y � . . . - . ' �%�V 8i �A Size iLlcuerial Flaw G?�! l.�.'• Sched 80 �.S . L,,• Scned40 i_1 3, :• �ched 80 10,1 °� �• Sclieci 4Q 1-.� -1