A29 2381�q�iiG;itya�� Dat�: -"� � �f{`�20 i ax 1ll�0 �: --
��mourft :?�iid:� 33�dr�X-�1�`��
I�er.ai �t.r�_ � Parcai �•
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uementS Permit- S15D.00
e Hcme Repiscamer�Addition)
dPPLiCAT101d FOR SEitVICES
s�so.oa�oa.no
Pertnit Rev'ssian Fee -
for
�9} Pei��it: rec�uesf+�d �Sy; (l'�wn�rlagen�/pr++aspec�ive owner): ��'� �
Horr;�: ?hane: -5 Address: 3�� I!
Bu,,�c�ess Phone: �o S
:Z) Pda�ri� and a�dress of current owner: .��rt �
3) Prr��sEirty i3escsiptian: i�at size: cre. Tavunship: ' e �1
DiE•eciions to th� property (Inc{uding raad names,and numbers)� ;
�"r�rm
s�a; I e� Lot #�
4) P�brp+�sed Us� an Structure Descripti�n: answer ach of the fo(iawing questions:
a} F>rn�osed �E�cisting ,� Type of St�cfure: ��s i���i��4- I Width: Depth:
b) Tli.�mber of Hedrooms: � Numt�er of occupants or people to be served:
c} B�asement: Yes : No „_ Wiil there be plumbing in the basement?
d) �arbage Disp�osai: Yes �, No ___,
a� lAP�u4or 5uppl� Type; Private.� (new �pr existing____}, Pubfic� Community , Spring �
A�e any welis on adjoining property? Yes� No _ If yes, please indicate approximaie location on the
'site pia�i.
B) D�ae� ycur �rro�ert�/ contatn previous9y ldent�fied $urisdictionai wettands? Yes� No t/�
Pl.�►� E NOi� THE ��LLOWiNG:
� 9�► PL�T �1� T�lE �R�3PERT`f OR SI'1'E PILAPI MUST BIE SUB�flI'fTE�1 W1TH THIS :4Pf'L9CATlOi�.
���ROPEii'�'Y'.LINE� .AAtD CORNE£�S MUST B!E CLEARLY MARiCE�. ,
� 1'�iE PRt��C3S�D LOCAT1t'�N OF �1LL STRUCTURES MUST 8E STAf�D Oi� FLAGG�E�.
�. 7iiE SITE �flUS'i 8E R�DILY ACCES9IB�.E FaR Aid EVALUATIOM BY THE �IEALTH 9�E�ARTilNE�I7
:►TAFF.
f her�es�•� make appiica�iorr to the Person County Health. Departmen# for a siie evaluation for the an-site sewage disposal
systei'-► far ttte above�cl�scribed properiy. t agree that the contents of this applicatian are true and represent the maximum
facititi�:= to be piaced �an the property. l understand if the site is aitered or the intended use ci�anges, the permit shafi
becarn{: =nvaiid: ,�°'
i��,. y,��� , �� ����..-�_ q, �� os
or L:agak
Date
PCND. rev. �6127102
f ,
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; Su��bd��'iv�i�s�i�o�n i�L�'
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Improvement Permit -
��rmit Valid %r � Five 3�eaa�s No �zpiration
Type of Facility: �i g� New %� Addition i�ater Suppdy "��
# of Occupants �'�L� # of Bedrooms , ojected Daily Flow 3 c� g.p.d. ��
Proposed Wastewater System: c�F � Type:
Proposed Repair: QC Type:
Permit Conditions: � � U� S�-e `��
Owner or Legal Represe
Authorized State Agent:
�ate:
Date: 2 � 0
The issuance of this peimi.t by the Health Departmeirt in does not guarantee the issuance of other permits. It is the responsibility of the
applicantfproperty owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met This
�lmprovement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement ]Permit is not
affec#ed by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina
`Laws and Itules for Sewaee Treatment and �isnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the
Environmeutal �Sealth Specialist warrants that the septic tank system w�71 continue to function satisfactorily in the future or'that
the water supply will remain potable. � �
Authorization to Construct Wastewater System (Reqnired for Building Permit)
* See site plan and additional attachments (�. �Z �G�,J
a� OY
Proposed Wastewater System: lu�t C�An� �C� Type� Wastewater Flow �d�.p.d.
New � Repair Expansio Soil LTAR: ��� g.p.d./ ft 2
Type of Facility: �����2 r� Basement _ Yes �No
Wastewater System Requirements
'Tank Size: Septic Tank: ��� gai Pnmp Tank: � �� gal Grease Trap: gal
�rainfield• Total Area: �D� sq ft Total Length ��v ft Ma�mnm'�rench Depth �� in
Trench Width � ft Minimnm Soil Cover. � in Minimum Trench Separation: � ft�• C-
Distribntion: Distribntion Bog
Specifications:
Authorizerl State Ag$nt:
Permit Exn:
The type of system pennitted is
P��
Owne�/�,�gal �tepresentative:
�ri D' tribn ' n iC Pressnre Manifold
; �l� o�s���, s��
�?p
Conventional � Accepted
Date: (o/ZL
a�-r
Alternative. I accept the spe�ifications of the
Date:
PCHD rev. 11/10/OS
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�• Syste�tt com�ionen�s r�p�esent c�noa�imat�e�con�vurs onty. Tha conir�tctiur �rxst, fTag tha sJ'siem prior io
beginnrng the installativn to iasu�e th�prvpergrade i* mai�tameak:
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.�'' �;���roarn�.�.a��u.��n:71 IF-7���.]L-�7l� :
WELL PERMIT
PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT
Tax Map /4a� Par # a 3� Township:
Applicant• � '
Subdivision: 0 �t Lot #
Location:
,�' p N �' •F Q S rS
Type of Water Supply: � Individual _ Community Public
Requirements:
Site Approved By:
Grouting Approved By:
We1T Log:
Pump Tag:
Well Tag:
Air Vent:
Hose Bib:
Casing Height:
Concrete Slab:
Well Driller:
Well Approved by:
****See Attached Site Sketch****
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:
PCHD rev O1/27/04
0
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��rnw-a�c-am�rn�� ms�.�.tn.� ��aa�.��1%.
Ixilat Fmm Septic T
4" SCH 40 PVC Pipe
NEMA 4R Simplex Contxol Panel
� �1
4" X 4" Pressiu�e Treated Post �
Sloped To Shed Water 12" Seppxation
\ Electrical Con�uit —
�1
IS" Covax • ' � Acce�s Cover• .• , ' : ;. � •1 �
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�,, Openin= Filled With . Anti Siphon Hok' w
� Portland Cement Gxout �� g��
� • .
Check
, Valva
Higkt Water Alarm Level
' (6" Sepaxation�
. ' Hish Level - Pump On
�� +�VaporLock
," � I Hola
. . � .�Dravvdo�m �Up Hi71)
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Low Laval -Puxnp Ofi
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T�x M�,�� ' Farc�l # � •
Siihcl�ivision �� ' �' �
Ph��s•� S�+ct;ion: Lot #
Duct SealBoth Coxurete R'vex '
Endt Of Tha Conduit ' �
-� 24" Mininnun
,. ., . - , � .. , 6"Saparation
Tlueaded Gate Valv+e ;
Union . , • ' :�'. J�' -
.
'�,�Portland Concrete Grout
_ . _: Matic • - : .
Zip Cvrd � . � Opnning Fillad �th
T�� Supply ''' portiand Camant Graut
Lina • • �
Outkt To D'utn'butiox
.tWvt„„ 2" SCH40PVC Pipe
, ROp° Ploat Wizef .' �
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F7aab ' '
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� �R.emovabla '•�.
Float Tree , ,
. � � . �p :
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Precast Co:ucrete Tank 4" Concsete - '
� � � � ;.; Matexial Strex�th }3500 PS Block ` i � "
�'.�:',• , : . • • . • . ,,•. ; . , �� ' , . \ �: �' '.'. �,
� . � � ��� � GAZL�N PULVD.' TANK
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Tax Map: Pazcel #: � 3� Date: ZL d
�'ap
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Tap (Sch)
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7�
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Y�ine Lengih
I'iow / �oot
7
��� ft of line x 65 gal. per 100 ft=f qS� —� ; 100 =1 Q�gal
75 °lo x�Q� ga1= .� gal per dose ��per minute (gpm) = JFlow Rate
Friction � d
L,oss: ? a ft per 100 20 �pply line x M��� ft of snpply. line =100 = 2 ft
ft x 12 ft of fnction head .
Manifold Size: � " Force Main Size: 2 " PVC ,_
Total Dynamic �ead = ft of Elevation head + 2 ft of Pressure head +2` 5 ft of
Friction Head = 2� TDH �i,e,,,
Pamp Requirement: �� GPM @� a� ft of Head � p�DY..
Drawclown: ., fTgal per dose ; 21 gal per inch ='"� inch drawdown per dose �il
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e.� ^ Sclted 30 �.S
t." Sched �0 7_:
, :• 3claed 80 10,1
=4 " �'ched sp 1_.�