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A29 245ApPiicarf,r,m Dat�e: - -OS Tax iUEao �: �moun _�aid:� �¢.. �tX�S�G���b� � ce �iQk ��: _ �are�i �: ; �����`�� ������ - ---_� c� �D ZCT1�' � �" -�'-"r.a:x��a--a�.a�a�sxr��-�-*��+.e�ra�.eaa.� 1�E �aa.m.71�I�� Improvements ments Permc� - 5'15o.Do Home Fceplacem�nt/Additlon) RopairlReplar.a �iPpl.ICA'jt�P! FOR SEi2VICES - fi20U.00 Permit $150.00!$200,00 Permit Revisioa Fee - for - $a2s.ao �i) Parrr�'rt requ�st��l te�: (flwnerlageritlprosp+�ctive ownerj: �¢'� Ham;�� F'hone: -� - Address: 3�o Il� Busiru:.s Phone: -L� � �� S 2} Narri�� anr� address of c+urreest owner: ,��?-�nY'f --- �,} Pra����r�iYiy Descre�tior�: Lot size: cre� Tawnship: ' e �� Dirrc:ti�ns to !he p�opet`�y {tnciuding road names and numbers): �` .�„)��' .�., ���r di.Si�ln_ f?��� � �rirm 5Z'ui II� Lot#� 4�) prciF;�ased 13�e a� Struciura �escription: answer ach of the following questions: a) I�rc�posed �%", �xisting _,, Type of Structure:���, %�%.'.�r�i �9- ) Width: Depth: b) NJ'wnber af Bedroorns: ._=� Number of occupants or peaple to be served: c} £�asem�n� Y�s , Na _,,,.;_; Will there be plumbing in the basemerrt? d) C�cu�age Disposal: Yes _,, No ` a} �!4l�uF:r 5uppi� iype: Private �(r�ew � or existing�, Public___, Community� Spring � Ar� any welis ar� adjoining property? Yes� No � If yss, please indicate approximate Ic�cation on the �site plan_ Ei) Do�;t<; your �rop�rty �na�iain praviously identii�ed jurisdlctional wetlands? Yes� iVo ✓' I'l.E�►�iE:: f�� �T� �'i�lE F't7Li.0YU1NG: 9.� Pt..B►T aF'i�-lE �RQP�R'1'Y OR SI'iE PLAN MUST BE SUBMIYTEi? WITEi THIS AP�LfCAT9�l�. 9'af�OPER'TY LlNES �tN� CORNERS MUST B!E CLEARd.Y MARKED. , �`�i�E PR�POSE� LOCATiOM OF �Ll. STRUCTIlRES MUSY BE STA6CED OR �LAGG�D. �'Tl�E SITE lWUST BE �DILY �1CCESS{Bl.� POR Ai1t EV�ILUATIOM BY i�lE HE�►LTl-9 �3Ed'�RTiVi�iVT -a iAF�. 1 heres���� rnake appiicai3orr ta the i'ersan County Health Department for a site evaluation for the on-siie sewage dispcsal :system io}• the aiaave-de�cribed property. l agree that the cantents of this eppfication are true and repre:sent the maximum �aciliticwa tu be piace�l on the property: l understand if the site is aitered or tfie intended use ci�angea, the permit shal! �ecomi; ir�vafid. � ' �-, ,.�-,.. ; . /„ ,� � . j� O5 9 ar l.egal Date pc��, ��. osrz7ioz ' �1�� ,��i �.1311 �� �� �� � a + ,, _� �J � � � � � ������� ���.�.Il. IE 33C��.11�I� Applicant: ( N W�S Location: _ _ ___ T�x M�a.� � � � � �rce�l tt • � Subdi�ris�iora �_! ' � h�s�e-�Section' ot � Improvement �ermit � �ermit Valid for � Five � _ No �apiration Type of Facility: New � Addition �Vater Supply ���� # of Occupants �''�Q # of e ooms � Proje ted Daily Flow ��D g.p.d. Proposed Wastewater System: � Type: c�� Proposed Repair: '.► Type: �j Permit Conditions: �� 7`'/� s,c.��'� Owner or Legal Representative ' ture: l.�ate: Autharized State Agent: �`� D�� � The issuance of this permit by the Health Department in does not guarantes the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that a11 Person County Planning and Zoning and Building Inspections requirements are met This Improvemeat Permit is subject to revocation if the site plan, plat or the intenderl use changes. The Improvement Permit is not affected by a c�ange in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for 5ewape Treutment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County aor the 'Environmental Health Specialist warrants that the septic tank system will continue to function satisfactonly in the future or'that � the water supply will remain�potable. � Authorization to Constract Wastewater System (Required for Building Permit) * See site plan and additional attachments (�. Proposed Wastewater System: � P C�G�i� d�ts✓' �� Type� Wastewater Flow �v o.p.d. New '�. Repair Expansion Soil LTAR: , 2? � g.p.dJ ft 2 Type of Facility: �� � Basement _ Yes � No �astewatea� System Recyuirea�ents T�nk Size: Septic Tank: 000 gai Pnmp Tank: �� gal Grease Trap: gal �rainfield: �otal Area: �j 2o sq ft Total Length �� ft 1Vla�mnm Tr�nch Depth 2� in Trench Width � ft 1Vlinimnm Soi1 Cover. t�_ in Minimnm Trench Separation: ( ft� •C Distribation: Distribntion �og x Pressnre Manifold , • � . � � � si�':ii�:l1l� ,. � . . �1L:�I.c;*7L'i/�►Z���r Authorized State Ag�ent: Permit Exn� The type of system permitteri is � Conventional permit. Owne�/I,�g�l �Zepresentative: Accepted Date: � Alternative. I accept the specifications of the Date: ' PCID� rev. 11/10/OS A �y'.. .���'7�?� 1!. 1Ld���� V � • � ����� ]E���o� � ���.Il lE3C��1�. .,�.�'E. ��.''��. . nuutonzea �raTe .ngenz TazlYtap #. Aa� �Paxcel # � `�.:5' Section/Lot# 1 0 • a . °� sy�rn ��o� �r�s�t �p����cont»urs anly. The contr�tctor must,�ag the syss�m�rior to . Iregiraning the isrstallatian to insure that propergrade rs main�ained °: � V 1 � � � ..� �� � �� � � � � ' '� � � rj _ _ __ r• �• �� � � �- ► � �� � ��""� � � � � �' � � � . � � i � _o, a� �� � � �, i� . � � � � ���'�'4'� � ��-4 � �� � �� . �� � : ���� �� � �� , . ,.. � ,. �.� ,. . ::.. ... . : � � ���� , I�+�;�a.�:��rn.�ru.�,.����a.Il. I�ZCo�:7L�]�n; : WELL PERMIT - PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Ta�c Map � a� cel #�'¢ � Township: Applicant: u CJ � Subdivision: o ` r Lot # Location: Type of Water Supply: � Individual _ Community Public Requirements: Site Approved By: Grouting Approved By: Wel.l' 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: Da�e: PCHD rev O1/27/04 l�--������ J.� ��� �� ` ' '"�-- � � �1.�! 11 1L, � ara�w-aa�-oirn.,.m-.. �aa�.cn.Il. ��a�am.���. NEMA 4X Simyl�x Contml Panel . +4" X 4" Presscuv Treated Post�,j � • . Sloped To Sked Watar 12' Sap�ration �. � Elsctxic�l ConBuit — 6" Covex • ' � Accae Cover• � ,• ' . ;~ ' .1_. � • � � r � . l •�' � ' � r'-'•, � `�' ; . 't• . '' . ; �,, Openitt= Filled With .�n{� Siphon Hola' � In]at Fmm Sepiie Tanlc. Portland Cement Gxaut �� g�� 4" SCH 40 PVC Pipe � ' � Check • . � Valva $igh Water Alaxm Lavel (6" Separation� ' Hi�t Levrl- Fuinp On �,� � � " ! u rv��: Lo�k •• ' � xo�. . . .; Drativdatm �Up H�1) Law Laval -Pump Of£ ---""� " � � '� . �. 1 . . T�nx fVla�,�o P;irc:ul #� � � . S�ahci'ivision �' i! Fh•���=,c Sc�ct;ion Lat # Ihut Saal Bo�h Concrota Rvex Ende Of Tha Cox�rit �- 24" Minixsaim " ' � ' � ' ' � ' b" $apuation Thre�Led Gate Valve ; Union , . Zip Cazd Tia� 1 ' P:ecatt Coz�crete Tuilt 4" Concrete ' � ; •; Matexial Stren;th }3500 PS Block �,.. .., , .. ,. , .• , • "`,� • • , . . : • . i • �� �� P]oat Wue� . < � r i �tt� .�: �.x�����. '•�: Float Tra� , , �'� `'� t J , -;: . � . �� � • � •. • , �� GAZLC�lY PULVII' TANK e ::. . ,r..tfiN" . — 3latvd Coxticreta G:out C Matic � . . • � OpaninB Fillad With , Poxtland C�xnant Crroat Outlet To Distnbution �� 2" SCIi40PVC Pipa u P � J � � � �� � `�,s ��t� �.��.�� IPI�I�.��� .---= �-�- � � ���� ��..���...,... ��.�►. ��.�,�. Tax Map: Parcel #: � ��t ��� �ri� �' �l Owner. Date: rl b l� �ine Tap Tap (Sc4�) '�ap �'lo� ]Line i��ngth �ow I ��ot # �iameter(in) ( m) � ;• ft) i 2 v .s �o .os' 2 �� 3 4 5 6 7 8 9 � 10 � `� �'� ft of line x 65 gal. per 100 ft z�� —�' ; 100 =� gal 75% x Z� 6 ga1= �� gal per dose � gal per minute (gpm) = k'low giate �+'riction Head Loss: � 7 ft per 100 ft of supply line x~ 1� ft of snpply.line =100 = z ft 2 ft x 1.2 = 2_� ft of friction head �. Manifold Size: �- Y" I'orce Main Size: 2 " PVC � �otal Dynamic �[ead =�ft of Elevation head +_�ft of Pressure head + Z' S ft of Friction Head = 3� S� TDH Pump Requirementc 2 S GPM @ l3� �ft of Head � Drawdown: 2l per dose � 21 gal per inch =� inch dra.wdown per dose ::., � ..,,..,� ,r � ,�. ��� � , � ��� � — ::+;a�����rs . , ,. ; . ,,, , _ I I I I � �[(�)����00 -�-o-a-�-�. o � a---�-o-�-�-�-�-�_.._�-�-�-.._�.,-�-._�-e-�-� .-. :.. _ ..._ II) III �I) II/ i�iii*iiiiiai%%iiiiiiiiiiiiiiii � � � � ,. :� :.:� : :: �: r.av�.� �a� gmm� � � S: � � ;l�tanifold Si�! � Ta u�old Maz �ia Taps aff oae side �� ace b�i4 ior ta `�oth si� 34" 3/a" t3 1" {� 2" 4 Z 3� y 5 3 � Flow er Tap Siza il�cnerial Flaw GP:�L ,: ,• Sc}ied 80 .i.5 ;, „ Sched 10 �-� ;, �• �c7aed 80 1(J,1 °, , �ciieri 10 1= = :3