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A29 246Appiicaa;ic�n �at�: -� G{C�5(O7A Amou _"�aid:� �- ��5) Recsi #;'�:-���Q� Tax iUEao �- Q�rc2i �: _ ���� �� ���� �l� � -�-- � ' ---. � � ��i� �" �xc�-Q+-n.ss-.cva�a.�--^-^� .eezsa�.ra.71 �Cm.as.i1.�I�a �iPP�iC�1710N �OR SERVIC�S _ . ' : :` ,:.Ser�ces`FZeq4�ested , .>'.:: `� ;.. ..: ,.,, . ,: . . . , . :.:, : -.. � ments Permit (Recarded l.ot) - 5200.00 0 Well Permit (New/RepiacemerstJ- $2 �ments PermR -�'150.00 Cl Constructlon AutharizatEon For Septic Mume FceplacemantlAddiitiaon) $t50.D0!$200.00 �ec�laes Existina Svstem Pemut S] Pemtit Revlsion Fee - 575.00 C.�NS't ��;i:jCT SHA�.i; BE�DME ENVALlD. �i} Penn:'rt r+aqu�st��d 1xy: {Ownerlagent/prosp�ciive owner): ��'� Horr:�: F'hone: -� - Address: 3�'0 � I/r� Busira�..s Phon�: -� � o S 2) Narra�3 anr� aaldress oi currero� auvner: .��-ir7� - �,j Pry����a�i�y C3escri�iio�: Lot size. cref 7awnship: ' e �,� Dir��c:tions to fhe p�opefij (Including road names and numbers):� �'r}rm Sev; I )�. Lbt # %s 4:) Prri�,�s�dl l3se an� �truc�ture Description: answer ach of ihe following questions: a) 1''rt�posed �'`, Exisiing , Type of Structure: ��� %��.� i �9- l Width: Depth: b) �lwnber. af Bedrooms: .. h Number of oc�upents or people to be served: c} E►�semen�. Yes,;,,_, �!o Will there be pfumbing in the basemerit? d) <��trbage Disgasal: Yes �. No. _ ;6) Mlati�ar Supply 1Cype: Private �(new � ar existing___), Public___, Community ,, Spring ` Ar� any welis an adjaining property? Yes� No r If yes, please indicate approximate iocation on the �site plan. Ei) IDor,�:; your y�ro�ert�! �flniain �raviausiy identi�ied jurisc�Ictional wetlands? Yes_, iVo ✓' !'l.Er4�i�i it�l�7� �'i�lE Fi3L1,b1N1NG: 9.A Pl.�►i t3F '�E PR�P��R'i'v OR St'�'E PLAN MUST BE SUBNIITTES3 WITH TH1S AP��lCA�6�OP�. 9'I�QPE}ZTY LtNES �tBVD CORNE3ZS MUST BIE CLEARLY MARKED. , �`�-lE AROPOSE9? L�I3CATiOId OF E1i_!, STRUCTLlRES NiIJST BE STA6(ED �R �FLAGGED. �'l'S�iE 517E 4UIUS7 BE 3t�r4DIL`�l ACCE5SiBLC F�R Ai11 EV�4LUATIOfN BY TWE HF�►LTH �EPARTNIENT a iAF�. I here�►�/ rnaKe applicatio�r ta ths Persan County Health Department for a site evaluafion for the on-site sewage dispcsal :ysterrr io}- the ataave-cf�scribed praperty. I agree that the cantents of this epplication are ttue and repre:�ent the m�imum �aciiitic�,i tu be piaced on the property: f understand if the site is aitered ar the intended use cnanges, the p�rmit shall �ecomc: ir�valid. /I �'' 11 +��frl :' l /.if..! �,.+. 9/ �� OS or �egak Date PCND, rev. 06l27102 � ��� ,' �� ���� �� . `� � i . ,, �� � � ���� ;� --7rb�'li���n+'r^'"� �3l:Il.�.tII.�1 ���.�LlL1�. APPlicant: � �pS Location: . � _ _ . T�x �V1ra:� ' � ��rc-el x ' � ' � � � Subd�ivi�s�i�a.�a ' P'h�:s�e Sect�i�a�m�'Lat r Improvement �'ermit � P�rmit Valid �or �Five 3� s No Eapiration Type of Facility: New 1C Addition Water Suppiy �� � # of Occupant�GC4 # o Bedrooms � ojected Daily Flow �� g.p.d. Proposed Wastewater System: (� � Type: � � Proposed Repair: � Type: Permit Conditions: �Q S� d� s�-2 �� Owner or Legal Represe Authorized State Agent: Date: Date: �� The issuance of this permit by the Health Department in does not guazantee the issuance of other permits. It is the responsibility of the applicandproperty owner to in sure that aIl Person Couaty Planning and Zomng and Bu�ding Inspections requirements are meL This �mprovement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement ]Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for 5ewa2e Treatment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Heaith Specialist warrants that the septic tank system wi71 continue to function satisfactonly in the futvre or'that the water supply will remain�potable. � Authorization to �onstruct Wastewater System (Required for Building Permit) * See site plan and additional anachments (_). �'Z ��U� �•��,,�,� Ur Proposed Wastewater System: I�Mtp� /J � C�a'�"1 � Ty'P� wastewater Flow 3� og.p.d. New � Repair Expansion p Soil LTAR: . 3 C� g.p.d./ ft 2 Type of Facility: � � i� � �'S' . Basement _ Yes �No Wastewater System l�equirements 'Tank Size: Septic Tank: (9c� 1�gai Pnmp Tank: �e�c�gal Grease Trap: gal �rainfield: Total Area: �D� sq ft Total I,ength �� ft 1Vla�mnm Trench Depth %�� in Trench Width � ft 11�'inimnm Soii Cover. �_ in Minimnm Trench Separaiion: � ft!�< <'� �15fT1bIIt10II: Specifications: Distribntion �oa Serial istribntion �Pressnre Manifold � bC�l1:M D "� MU,n : d�1 (L�J�' � Fc +�l ��`�'�.S Authorized State A.gQnt: Permit E�; The type of system permitted is permit. Ownet�/�.agal �tepresentative: Date: COIIVeIIf1�II� � ACCE�tCtl Date: 7/7 / � 0 Alternative. I accept the spe�ifications of the Date: PCHD rev. l l/10/OS A . �� Z-� ..� � ��� . �►�y�� ��� �� � � M .�i�Z � �.�'� N ,Q� -.__ �-��'a�''�� �%�. °� -�' ► � -- _- _ � ; � os � !F . � ��aM �a� C1 - M _ _ __ __ � , M a-„Y�S�d'�O � 1.� 1� � �"v' � pj�. � ��,�������b �� '� 's�'�b��� -5 �n��-.'(��"'� � U u,�5 �,S � � b�s � J-�.��, �1., � �' 1� � � , a �� �'v' �a�� �r�' �C'�� ' �` �.s u ` �,�,..p� , �'''`� u _ __ _ __ _ _��'ss Q • s� a � s� �;ps � �� � � S, ��j a � u �� � � � �� J� � � � � u� � �a'�(�1� t � � � � �. � � � � � _ __ 1+.� �� •.� � � � � . Q � � • Q � g--=� � � _ �. � ,. � :; .p�uz»su s;� a�rat�.teda�d �x aunsu: � uv,r,�vp»»�ssuz ay,� �u:uu�aq • a� .�oud ru�s�s' � �v�',�s� �O�uO' �t.L '�1�0 s.c�o�uas.a�muzxau��'v.,�uasac� s�ruauot�irio� uaa,�siCs �: � a�. . �a L .�-�. #��'I/IIO�S �xe d � �.�i � � � a b�d # ..� a� � ►: ��+ �ua�- a��S pazuo�n�- �� � W^ �, uOT . . qnS �,,� aur�N ��l ` ���� ����ds��� .�..JLl�L�.�� � � r .. «�. .�����(� -�� ��-, _ �� . � ���� �� �'1 . • ,.. � _ _.... �: �� ;. : � � ���� ,,. ,. _ �`�xn:��.ar�acn.�rn.�.a�?ru.�ai:� ����:7�,-�7E�:: WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map �t �� Parcel # 02 �i' � Townslup: Applicant: ck E�' � Subdivision: o��, � rY►-� Lot # % s Location: Type of Water Supply: �Individual 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 5ketch**** Community 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: a PCHD rev O1/27/04 ��� j �� � J�.lJ � �1/ V � V �-.�' �1.� � �L.J � � 11. I��..�-a�-��.,�,Y,. ���.�.11 IE3C�.m.Il�I6� NEMA 4X Simpkx Contml Puul . �F" X 4" Pre�saxe Treated Post Sloped To Shed Wataz 12' Sep�ration � E]actrical Conduit - n . . ,� .r . • ' `" • 6" Cov�r • ' � Accu� Cover• • ' : ; � '1 � � . _ � . i •�' � '' � r � � `�' ; . '�• . � . ; . �,, Openin= Filled With . Anti Sipluon Ho16' � Inlat From Septic Tank Portland Cement Gxa�ut �� g�� 4" SCH 40 PVC Pipa � C�� • Val . • T��x M����� '� F�ircf�l # - J Sul�cl'ivi�sion � ' � ' f'Ira�s�e Sc�ct;ioii Lot # Ihut Sad Hoth . End� Of Tha Co�duit � 24" Minina�m —; .. .� Threadad Gate Valve _ .. _ � Zip Co; Tia� Coxtcrete R'ver b" S.puation • • • � %�:.ssfii�+' . ' • .r ;�.-Po:tlaxudConcrat� Grrn�t • _ , s; Ma�tic • ' ; . Y� � � . � Opanine F"illad With Supply ' : ' portland Ceznattt Crmnt Lina • � ' Outlet To Distnbution 2" SCH40PVC Piy. , � --�� F1oat Wuss � � High Watar Alarm Ltvel ; ; (6" Separation� , , ' HiSk Laval - Pump On i• � � � +�Vapox Lock � F1oai� . �; '• � ` DrawdvFm Hola • i • .•: ` R.emovabk '.• • � � �Up H� �,. �. � F1oat Txee . LawLaval-Pump Ofi � . ' � . � • . Pump • . �„5 . . . ; ,, ' Preca�t Concxete Taxlc 4' Concrnta • ;.; Matexial Strength y3500 PSn B1ock � I " �''�.:'.' . : •' ' - •. . :i •'. : . � �� - • .-`',' � • �': , . ' . �_ GAZLC�N' FUMI' TANK . . �':. . . 'l � �� l a ni- !� �� l � ���„�,�� �1l.d���� '_'` � � � �T�'��Y o 'l. ��-- l � ��.-�.s�..,.-�.,,���.v. �C�,�..n•� Owner. J� � �� Tax Map: � aq Parcel #: �46 Date: 7 O I�ine Tap Tap (Sch) TaQ �'low Line Length Fio�v /�oot # �i eter(in) ( m) -', ft) 1 Z o '? � e v � c� 2 Z �-� �• I (� 3 Z o 7� l ov 4� 5 6 7 8 9 - 10 � �_ ft of line x 65 gal. per 100 ft= 1g �� : 100 = 1� �gal 75% x�ga1= 1�� gal per dose �per minute (gpm) = Flow Rate Friction Head 1 Loss: ft per 1Q0 ft of su ly line x!� ft of snpply.line =100 = 2 ft ��ft x 1.2 = Z• �ft of fricrion head �. Manifold Size: �' `F " Force Main Size: Z" PVC Total D y aamic Head =�ft of Elevation head + Z ft of Pressnre head +� Sft of � Fricrion Head = �_TDI-i � �`�U� Pump Requirement: 2� GPM @_� ft of Head � �,.,n��� ` Drawdown:. �gal per dose � 21 gal per inch =?� S inch drawdown per dose �� �C »-� a .r. ..�.a� ,�' i ��. i,,i � � , � _\+������0 , �. ,. i ...,.i � : ■ ■ ■ ■ � �i � i: ., � - �[i�a1��m0O � -�-o-o-�-�. o-�-�-- �-e-.�-.-,-�-�-�-�-�-�-.._�-<-�-.-.__�-:-,. __. �► (�1 f�) QI ��������������������.���a������� ... .. � 1 1 I �� : �,. r�N�*���!!l��.��!!l�������!l��:s � � � � c a � : : : •c Tadlbsh� L�i/aor�ot 9das@ I $ Y '. Siz� / � Tap� Na Taps o$'one 2 9 �+'iUSi 8i i3p suE ivlrnerial Ftmv G��t ,4•, Sc�ied 80 .i.S ;. ,• Sc}red 10 7.1 5, �• �ched 80 10,1 =� • Sciieri s0 L.= .f �