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A29 258Appilc�_�ir�n Dat�: 9!iv-OS iax iU�ap �• Amout� t i�aid: � �, �V�✓���P� RECL'�1p�C ��:� �8PC2j �: ____,�--,� � I�I�1�� �� - - � � �-�-��- ��..a:�.-: a.zc-�aaa.�c�a..e�m.�.�.Il �aacs�7l�lLa f1PP�.ICAT10Ai FOR SERVIC�S '!) Pevrr±,d� rer�ta�ter� �y: (Ownerlagentlprospec�iive owner): � ��� � Hocr.e:r I�hone: ,��_� . Address: 3�0 /i Bu�i�le:�s Phan�: � o s 2} Na�i�� anci a�ddr�ss �� cument o�ivner ,�,�ZJY � r ��C.° ��'r�1 :I} Pre�F��e�ty Descri�SfiDn: Lat size: i�kre- Township: Qf ` e �) • �ubdivision: Af �s�.5�u1 /)� Lot �� 7 Dir�:.c;tions ta the property (including road names and numbers}; �IGU�,/ .�� �p c�,� ,q_ppro�, �- .�. : } � � . , . . Z J � ,. ' � ; .. .. ... . _ !3 -:, t T_ —7_ �Ej pr�:�as�r! 17�� an 5�rua�ure Description: answer�ach of the following c{uestions: a} ���rc�pased. ti Existing , Type af Sttvcture: ��,i �� �i �- ) Width: Depth: b) h�umber nf Bedrooms: � Nurrib�r of occupants or peopie ta be served: c) Ei2semsnt Yes,�; l�o Wili there be plumbing in the basement? d) C;rirbage Disposal: Yes � No . � ;i) W�i;a:�r S4ppib. i'yp�: Private �(new , or existing�, Public___, Community , Sp�ing � Ar� any weils on adjdining property? Yes� No �, if yes, pfease 9ndicate approximate lacation on the 'site pian. Ei) Da+:;c ;laur prc���rty �c�n�in previousty ir�en#9flec� jur�sdictional wetl�nds? Ves_„_ N� r/' F'LEA::'��w �J41'E THE �OCL01M1NG: ➢.��, Pl.AT OF T�-!E PROPERTI OR SfTE F'LAPI MUS3 8E SUBl1NITTElJ WITH T�-3IS �►PAL,iCA'TI�iV. ➢��=�iQP��tTI llWES i�PlD CORNEi�S �IUST BE CLEd4R#,Y MAR�CED. �, �""HE PROPOSEi� LOCATiOM. O� �►L�. BTRUCTURES MUST BE STAiCED OR FLAGG�D. A�:'�fE 5lTE.➢UfUBT 8E 32EAt}ILY ACCESS{BL� �OR APl EVAILUATIOId B`l i'�i� HEAL7iD DEPART01i�N? :al'AFF. l hereb�, ���ake a�plicatiort to the Person Cr�unty Mealth Department for e site evaluation for the on-site sewage disposal s.ysiem �`��r th� above-described property. I agree that the cnntents of this application are true and rzpresent the ma:cimum facifitie:� t� 6e placed rsn thie Qroperty: l understand if the site is altered or the intended use changes, the permit shall t�ecom�:. :�vaiid. � � ,�� U--� ;�'.�/�i�� nj. %� OS" .� - , `� �Gwn� ar �.�gal R� resentative Date PCND, rev. �61271�2 ��� Sf" ���.��� �� . , "�^ � � ���� I����.��m„-„ „�,, ���.��.11 I�-3I��.11�1� Applicant: : Location: T�x Map ` Parce�l � �. � Su��bd�ivis�ioia ,� ��,, r '.. � Phase Sect�ion Lo�t # Improvement Peranit Permit Valid for ✓ Fiv Years No Egpiration Type of Facility: �� New ✓ Addition _ Water Supply —���� # of Occupants # of Bedrooms �3 Projected Daily Flow �� g.p.d. Proposed Wastewater System: ���,� E� /jn�,_,� o Type: �„ Proposed Repair: � f� �4� �„�T Type: Permit Conditions: ,���v�� % (���yf��r� 1�DT '�5�7—/'L�� Owner or Legal Representative Authorized State Agent: � / O��(N d�% n ! � !,+ Date: � �� `� �� ' Date: '/(v The issuance of this permit 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 met. This Improvement 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 Sewa�e Treatment and Disnosal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. Authorization to Const�uct �Vastewater System (Required for Building �er�it) * See site plan and additional attachments (�). �-.ytj Proposed Wastewater System: �c��,0/g,p _ Type Wastewater Flow �g.p.d. New ✓ Repair Expans�i n_ Soil L1� • 3 g•P-d./ ft 2 T,ype of Facility: �� Basement _ Yes �No Wastewater System Requirements Tank Size: Septic Tank: � gal Pump Tank: JdqD gal Grease Trap: -- gal Drainfield: Total Area: �_ sq ft Total Length ?�o ft Mazimum Trench Depth in Trench Width _� ft Minimum Soil Cover: _� in Minimum Trench Separation: ft Distribution: Distribution Box Serial Distribution �, Pressure Manifold Specifications: 3 G!i✓f� � </�D ' Authorized State Agent: Date: Pemut Expiration Date: �/ The type of system permitted is Conventiona� X Accepted Alternative. I accept the specifications of the permit. � , � Owner/Legal Representative: / �' � i/.1�� • Date: ! / `4���� � PCHD rev. 11/10/OS � ���.�� ���.��� �-..� � � ���� ����,,.,,.,,.,�„ ��.�.a ���.a� �,, .. ., c ; � ; r �; :� .. � �. . ,�� ��► !� '�ax lb�g� #: �_,,. Parce� # .�5� Township �P� Subdivision: �'�� O� wa$�S 511a7D� �i`�t181�I�B8TL�' 5ection: �� �-7 ' itw� �/C.��r' /7/l�d' /�L-%/� 7/�•G� �CC�• � � � •1 � •� ff � 1 � � � Site Approv�ed bp �S Grouting roved bp � �`� y �4 �ell Log ' - ia- y Well T s Air Ves�t � - r$ - / b Hose B� � Concrete Slab /b ' � - d % ��:� - r �. - r id/z/ag - .r/k = �'�r ��s G/�j�i � fJBcvf� �iJys �✓of�arr���1 ��'� �See Attaciaed Sit�e S�*� Wells must be 10 f�et from propertp- liaes. �el]s must be 100 f�et fmm septic systems. Wells must be at least 25 fie�t from aap bu�ding foundation. Otizer conditions- pC��, rev. 09/07/Ol Z/� � �� � ``""� > • .� � ���;.� �� . �.`. „~ � �L1/ � � � Jl ' ����g-��.�.��v�.�.11 �IL��.Il�11�►. - M -'� - N�me —_ . �itl�/ ,�,�y�y � �. ,_,_ —�--. Tax.Map #� ParceZ # ��`� y�� Su�divisivn.: : �'/I � ,�i(G5�/ff� � Secrion/Lot#_ �7 y,�� � Auth ' � � . 9/� �a� , ����f' � biYze S te Agent � Date Syste��: co�tapol��nts t�epnefent app%xirnate conttsurs only. The contrui�`or �:ust, flag the system prior to beginning the instatlatio�i t�v insure t�idt ,�ifn,�iei•gm�e is �tcaf�atair�ed , • 3 t��n��►�l, �v �� . '3 1.�T� � OG -FT �- �w��r�tti .�oc, �til� • �`i '. z�°' .�.�,�' %-��,,��� ��n�- -y /S ao ` S,✓P�'� `in/� ���� �s�� � zs� " 3i, ��/ �19 ' Z?5� ��".�fq `3� " ?3.� ��' 39� � Cortl�'ol Cornbr • , Eass. i, �rton ,� �ti�ti o�0 ,. Coms� . I �`',�''F�^1 �5� Supp�Y %L � �yne Ease. -,; � � �r � ti �., .. ---, , • . .. .. __... ._ .. . . � •. �� . . ��`�"�•� . � � . � �.�Q ����/ /✓o�� : �vs�' i�t�f��t/y— ,�,✓l� �� d11f� �car'�id.✓ �� . ��jt.at� 4�✓- Go.t�y� �� , � ,�����f� ���-'� -3� ,.vf(�i^/�n/fin . ��" �,�*ltir�i 1' �yc' y- �o.� . � ��� y • � r Arnold . ;• . , ._.�. ,..� . .. .. ._... . ... . - -��r=�� �LOT 291L� 28n-� 271 �gg�,AENT C�RNER ( / �- � � �� �-- 27 EASEMENT ARE� S �flOO �� $3l �'•F 0� .� ti Note� - � d All supply lines must be installed at t.�ie same time within the supply line easement. � All supply lines must be pressure tested before lines are covered. v Prior to installation, supply line and drain field easements must,cleazly maxked....Contact Sur,veyor if in doubt. � o D'rain fie�d layout is approximate. A Pump requirement (TDH) is estimated. � Any questions contact Person County Health Dept. (597-1790). � � 4 �s�'R4°90 ; ; e��8o��, , , � , ' + , �'' , J � > ; �' �-- � � .�!�`i_. � PCf ID, t�v. 09%12/01 ���.sf I�I�I�.��� � : � � � ���� � l�,aa-�vna-�icasaa�a.a��.Il IHL�mIl�� Owner: D Tax Map: Parcel #: ��� Date: 6 �/� �� z� ���� ��� Line Tap Tap (Sch) Tap Flow Line Length Flow / foot # Diameter(in) ( m) ,- (ft) 1 � 1% .! oo , o� I 2 3 4 5 6 7 Zl • � S 9 10 ? � ft of line x,65 gal. per 100 ft= = 100 =� gal 75% x!�S gal =�� gal per dose gf • 3 gal per minute (gpm) = Flow Rate Friction Head Loss: .�ft per 100 ft of supply line x� ft of supply line ; 100 =��ft 1� ft x 1.2 =��o ft of friction head Manifold Size: � " Force Main Size: y " PVC Total Dynamic Head =�ft of Elevation head +_ 7� ft of Pressure head +_ i� ft of Friction Head = �TDH C�.s� Pump Requireme t: �l. :� GPM @ 3'`� � ft of Head Drawdown: ���gal per dose = 21 gal per inch =_Z inch drawdown per dose � i • : � �. � i � i � i : , � � � � _ � � �i� �����t� , , � - ' ' ' ' _ . . . . '� �[t�)1�00�0 ,. , 111 II �II II ::��ii:iiiiii:::iiiiii:iiiiiiii �����������������+��+���������� .� .. _. .. ... � � � � '� ' .� ,. - , a . ; : ; . y• 2" �in Schednle 40 8� 9 mc�x � f�ad9mde� Iwd/me�oQ ,- .:s:._:.:..:.w;�.;.,..'_�... - �—p -► Maz No. Taps off one nce hv 1/a for t80qin� b 1 4 3 �-►,�-�✓���.� `:= �s' � Ta +�12. ki�-��, q" 16 y � g* 40+ 21 �2 . � " �`iosv er Ta Size illaterial Flma� GP��i t/ " Sched 80 5.5 ;.'� Scned-�0 7•1 3/, " Sched 80 IQ.1 ;�, •• Sched 40 1 �.� Sloped To Shed Water NEMA 4X Simplex Contml Panel x �1 4" X 4" Pressure Treated Post j 12" Separation Electri�cal Conduit — I 6" Covez • ' � Acces� Cover. � • , • . ; ' 1 � , • � _ �. i .. ,. , i : -• ; •` � �` . : ��, Opesiin= Filled With Anti Siphon Hole Crrou Ihut Seal Both Ends Of The Con�ait � 24" Minin�aim ,. ., Threaded Gate Valve • Union / '� I'"I , , • :r .B�'rJ. , . '�,�Portland Concrete Gxvut _ . _: Mutic - - : . � Opening Filled With Supply ' ' portland Cement Graut Lixia • • ' 4utlet To Distnbution 2" SCH40PVC Pipe Concrete Riser 6" Separation Zip Coxd Tus 1 Inlet Fmm Septu Tank Portlan,d Cement t �� H�) � I 4" SCH 40 PVC Pipe � Check .�Nylo Valve �P< � High Water A1arm Level ' (6" Separation� � High Level - Pump On ' �VaporLock i �� "', Hole � � . . � �Draxdwrn �Up Hi11) � �, . , Low Level -Puxnp OfF ! �p �. ', Precast Concrete Tanlc 4" Cozuxete � ;.; (MatezialStzex�th>3500PS Block ' :,`_. ' ',' : , . ' • . _ ` • . . �,' • � ; , , '� ' �.oTZ7 �� �T ?�,�yf,,��/� Float Wires ' � '.� Fioats +.. E...Removable �•�. F1oat Tree , , �I " .i. �. � � L 1 _' . � . . leo0 GAI,L�N PUMP TAl�'K � ci.,. �.. C►1 a to `� .^ s'L� _ .. Fj% � Z�9,� ;1 w � � � 3 � ,�46 . 526P, _ 3 69 � \ 1$ C_17 ..1 8'1 O� m'� ' o� �E �b ti K• S2.68 ' � M 1.0� ' ��- �n . �, 'b S 15 � � � '►"r�6�2 �,�' � Mathis S27 _ �3�p1 r Q C i. O � � . r � � 1 � N � 5�� �.� �� 1 6 �� �, 0 5 y c- 3 2�` 3 ~ s 5go 0 0�'� p. C. 13-2 5 0 g29 - 1 4,' 1 C ;�, �'' � dc. w 530 _ � 9�4� 17 "�� �i� � .01 � � c- � c_2 1.20 '� � � Z Q� •ea�. a�.o,Z�•E � ` , 1.15 N ,4s•24"W • o N �-�0 �` . o dc• a 206.76 �y8a'� �c 45 . � / C-23 .� m „3 °� � L - - -: ' \A �v� y � �A 20 '�°� 1 °' y Nellie S• � c- n a � � .0� �, � �� .57 0 �, 0.& Tony . W 13 y446 �. $ g6'02'SO'E � j� ��ir dC• r' ' C �perian 385.05 21 cA� C-2�' �� ��� � ( �c p � . pJound � '� .00 � C �2' "p � `'' �' % ( • �� � C]C. 00 Z LO�. ta � i . W � � C�2 � S $C.q.��o, C-16� be retained � O ' � P o nd G° 3 2 0 0 � � T o n y V yesley b i n B d ;� � \ ��s �� c-3s 1.2a b y and RepO n n p� � • � � Q' ac. D� O � M . c-a� �_a3 s $s• z Cor�Mon � 6.77 ac. 22 c� 27 yo gsn�'2�W o9 �a4 9'�•�. p ea '. \ `-{omeowners M a N 34.7a � � L5�' �3 N 88 /V �'y F or ��ed with P°nd' ' 1 AO �v �• s s6 2z s2� .�.�'°b` �_� �'%id S,� �' �/ ers� ac. ;�m �s � s�S9 s °� �gs.�?'�3- 7o,x �o, � Co� a � H o M e o w n � � � N � r� o�� `o�+� O r. J � S O' � 8 l Y Si9 h{ ' T r 1/ � �orner 29 /� L1 ss� 28' y o �=� °D od Z 3 dC' $� �• p46// R �(iYP i' I �N s� ��s \ /' �Z 2�s o w, ci a��,� - v� �. oak /y • � 2 . 5 S u p P N �� w ^ v� o � `�' r L 4) 3 9� �� S B. � � i i D� 0�- 2 9- 4 0 , Ease. �o o-• �` � � 2 3 � 26.4? N. N 75•42'2 .�L 9, 43. O. � 25 � � 3 � � 3 � m � .00 = . J.67 � 38.7� �` 38 (✓ � O � 1�R^5729�544 �, 2 4 •� 1 p• P e d. E a se- io w OC... J 3 S 3� . � 528 �i 50'2�'4� W ARCS'� 3 . 2 8� 0 5'W QC. `n o 2�' m N C-2a 1 g t�1 . ' N 200.62 •8 CH= 149.44 � o` 1.00 0 '>> � S 29 ' y ard R. � i N s`��`� e �� � a c. z � '`? '� 9 . B°y� t o n � D�oo-42-00 � �S833 2 �_3p p,46,F' �' �-37 S�,>>�� •. �33 . 5 2 7 �ru r n p �7o�'J � � R_5729 5 8 w w c-s . c-Zs �5 .��w 31 s. 88 , s p.B. 342 � ����oAo ,,W '. 2 6 ? 9 � sl'1 . / C H�S 36 2215 . o I o � S�. �oo 0o c-3s S �.04 �'' ' � °o�. to' Ad�onaedicoticn- 70.00 �„� � o �.2� C_32 Z00 s� OC. q.p 00 � 8.00 �p � E' g.69 OW • a 26B Road R o �� aC' 9 p6 � �_35 33��a30� 6q.,5� L29.' �. Z 3� �.�'W C-33 C_34 3� ��s F r�g.8 ti.� l28 67-5�� � S � �, d` 525 � � �, � cr .� � supa�Y � REN�ES � �- � � � �' � Gr'�z' � Z� ° Eass. R�FE 27 ,'<v M 28 r' .�ar 29 �` S 15' SuPP y � v� - h o Un° �rton ,o �,94 ��o `c'm t�� �,57 �'�s F Une Eaa��� p` � ^ o`'" gtarlett L. p.g, 342-635 i� ac. �N �,'' 1.3� �' N a�• •: i ' 6' ' w dlbrook p,C. 12- N y ac. N : y Z'��' p.B 332-3�'3 P.�•� 3- 2 5p 240,00 _ _ 273�19 _ _ � R �� 45.00 - - - -rM �9 50 �o�trol _ 300,00 - - Corne� � N 83•02'09'W �,42,W wall � � I LSne EaseY N 89g� �� . � I penny � � �,Arn°302-508 � . � p.B• I�• r_.,rlc� Od Denny � � . d8%��/2009 16:07 336-388-5940 EVANS WELL DRILLING PAGE 02 + �: 1 ` �I:� � � �1 aii " � % `��.; _i� I!� :�;��. `�.:":.* `,....: �.`�+ ,'�. � �7�. ' �� � • �:�-.•' � � . � - .�.. ����� �`� �. � -�.:.� � �,�:.:�..+�•a���,�;::��.� �7�a,,.a�t1�.� t� �,�,,,� � D�viICT ��{ ,/}�l.�v'" �/f �� Subdivi�lvn: Distaaao Frqm r,ae►rr.a►t ]�roperty Line (Miniaaum� 10 fce�t} _ DiS111riCe frnm $CpSIC S��StCiA (�rit2lRum 6lj �¢GL) � � i4c�l rJCj}tb.: .1,G�; ^#: Y'iQ1d; NC ._ t3YM St��iq W�ttr �arix� �aaer �,`.�.�ih �_ � , U ft �__��,_, Cn�ag: � Depth: FYom �J w�G% ft. DKarnGk�x: 'ij�pc: Gaivanix�d Stecl .. � 'VN�aigh� � I�io�iea�e: �- S'$" . Hoiohs abo ihivo Shaa; it'ee No Any problomo cact xf "yes" �Ivo roiarnt; ,,,,,, _ ('*�Y1ql: . �Y Nait: � S�dlCem�nt ��pi1G An:xular S��aoc iNtdth /��.w inc�qs Matt�nd ot C3ra4t; Pu�po�i Y�reo��ru , Mat�rinla Used: • Np, ,�e�� 1�ortlAud c�meot W� If mixtr� (�urd, gtyl'v+e1, nutliag�) » Ratip ,_; � platcs; ,. � 7�e� No A x Lt�cr: � bepth; ,Date In�tallcd: Dr#llin� La� I harcby cer�ify that tht L:�w�c iafat�ttion is ooricat a�ud by ltae PorRan Caunty i�C:1�ih Daps�ant, � Sl�n»tur'� ot Cuqlrtacto� � !� C�.� %��� �'ump b�GtD�tian C.oatr�.: tor: Pump Dnpth: � PLuuP N��1c� & Model: �_ l lus.�chy ocrtify taat this p.�mp was inst�l2ed nnd the wal! on this data nnd that a cop:;� of ��e racard l�.s bcen tunvl� �'uxnp Installer 51tg1t�tuz�:. T 1'� "R�Y 1 A�If ���� � ��w-�r� •v��.� � �t Lo� . r,��p,�, p� �� �►��...�� ���_ � C.a�uutruetloa i�vel.: ,,,�..,,r..,, � � ir� � t3�raund: : ( zi! . in t,�ynd whila ettting awtiag? `Y"ns � QrarrcUCanart � Mnu1�r 3gaoa � �Ta ,rat �Depth _ ((� to �_ �t, ;ht af 19a� ,�,`� rou�de � �..^. �I�b,,.,,_�Xas .....,,,,,,, No f3�ta►tst: . „� insteikcl �►y: . .+ueJltlom A�'�►�+tn� r�'f /� RcS�i, //.Z. y� - N thia well was ea�u�uctad 'n tuccond�nee wishr�a�t,latior� set forti . , ! �. � IA � l�' � �} �bat � . IuatAllmeut --- 8tst8 �i,e�istrsU fn Numt�er: � � , � 1'utr� Si�o qcid tating; .,,�1.,,..}�p —�-_._..,..r._. ;� aampleted aceoiding to th ,1'nrsiotl Counry W�11 Rules tn �ffr,ct thc well aw'�Cr. . Dat�: . ,��� pGHA rev Q1/27I04 ��`J/6�I�0 ��'��1 ������ 'iK.�-�' .�-�+-- ��'�l � � 6 0/2/0l . ��y � � r �-� ���s � -{- s���-- . � a.�'3�.-F- (`� �`� �> -1 `-�y''�� ���---�- c�- Z - :a��Q 0 5 ��.� _ � :�(8 Paif��S�1 . a��o �ua6y a e�S Razuo n v - b v _ _ 0 :; �.� . . � '� �a�OF-4�.i1� }VQI1.a�iu � S�I�� 6�`� a I����c� .Lk�����02���tlE �E�l -�Q Sl��?.L9��J� �f��-' a�t�' `�'dSOvSIC� Qi�i`� .L��il��b'��! ��`�NE3� ��i� S��f�2� `c�li�.L`�'.E.S �����3;� '['%�S6�IC���a H.L�iC3f�J ��{ul��f i�c�'tf H! !�l ��fd w f���9�� ta8! C�i��'a.�f�� El.��B ��t�4 �ii��.�►1.� a�F{ t =i�n aiq�.L u':iM ��uppao��y u�) ad�l u�a�slS 00 �7�i� _ L2 v" �•0 �YJ° ti�=��%P"v�l.wa �?''/'' , aog� o o �� ���. � p��`� � �iQ�r� �P �ti � � � 7^ � _ � s' �� �i: e :UOt�E�O� :�ue�r�ddy -r�� �r-� � � -�-�� �� �� o:.s ��� � ; .������� � � ���--� .---� �T� ;.T�:.����!�;<<:�����; r � ����';� � �,�Pr� 3�����,7?O� �°���'�,� t � j ��� �8 a ���� Tan l�la� � rarc�! � SvstEm T�p� (T2bie Va) Ow�erlA}��IicG�f � Subdivision Addrzss/L�c�#ion S��fPh�s� �oi � � State�iD/da#� �TG ,37� Capacity �� /oo� gal. Tee and F�ItEr � Bafffe SEaial7t Riser (ifi a�r�iic�ble) T'ank Out(�t S��i P�rmane�f lVlarker �ump ���ak Wate r�or /SeuBani � Riser Wa��r i i hi ��rra� Ghec� ValvelGat� `�Give Anti-si on oie Flo�ts/Svviicf�es Alarm vi�able and autl��ie Electricad Co� onents � � Rate r�) s - A rov�r� Fump �l9odel Block Ur�de� Purrs� Pum Re�t-�c�vat �� e/Gt�asn . � �osis�ab��e�a�. �����s�c� �e�i�l Di�Yri��tion Pressure f1�ar�9 od Low Press�re �i e � A r. Pi�� �2�e�iai and G�ade Vaives s �agr�a�c����sa ����� Trer��#� 1�lidih � �. Trenct� D���h Z i�. 7.rEnct� Length ��o �. ?�e�ie� Grade � � Tr�:�ci� S�acinq ROC� D���i �f7C� C�Uc��E�Sf Darns/Sie�dow�� ��c. Przss�re La�er�l� � Ho(� Sn�c�nc� � Pipe. Sie�ve Turn-�rps/Pro�e�t�ors R�qr�a��d� �e�b�ac�� Fr�m 1(tle,i� F��m Pro�e�y a���s S�ructures/�asefr+e�ts axc Es / ratn�g� W.��s S�rfac� Waiers P��dic UV�#e� S�ap�aies �'er�ical Cuts (>2 �t.) 1l��ter Lines �le�icle�Traf�ec � �as�r�i�r�tslRigh� of �'J O�e� �asesnents Rec�rded es�i o� ��ra'�or an �ri-Pae��fe ��ase��nerat ��ms���� -i •� Ey �u� �,rn:� -,^u '=i1.^-./fl� � � on 1 � � �'•-15'S� ,. PROPO� PPIV ��NE EqS�MENr AREq — � � / � �`' z � � i �r�r's,c�oo � � �� � � � �-��-� _, i _ .�,� � ,. � ,�,. :�_ �' � '��5����' i � i � �_ C I � j � �t�CiC')� S�f �tC': T�� a � ` � .�-`� °u�� � r4��.i �, , � � ,,,�-�'°�.� I � , 7 � SJeP� , : � 15 ! , . , , , �._._._._._._._._._._._._._._._._._._. C -.-.-.-.-•- .� -.- .-.-. � _. --- - - -- __ I � i�','�- �o� a � I �i '�'j / !�� .� _ . .�......... , .�. .._. _ _ .. .. . . . ...i...--� a � � � � � �C /U -�-C� 1 //��5,' � � ����✓��,� .����= 5�;, � Gj� � r� ' � ER (�o�r Zgr�oT 2s�-aT 2�1 <--EASEM�N� COF�N /,., � . . �—. 1 ��' �Z��SL,'f- �L �., %�y �'�. <-- -LOT 27 EASEMENT ARE� O `� s . . � `` �` `\��iB I�81�j��� ���� � , . 3S o \ � 3`2�p3)•��S' __ ti � �3s`.�2S- O 4� Y3 �ZS� � � s�e s, ,_ , `?� 41q ���`, 39�Sp' � ♦ �=�i �SJe44O9p, ,�� ` . � � j �, "'' ,,� 80) � �, , .� � ��OT2 �.` ` , �P� � J +' j ,; ��T ����e.�. �-, �� , , 2 � 'cc , , �-- SJ c ����5'�c, _ = , �y' � -1 � 'C�I � ��� NOLE'> _—�______ /Vo,�- ',�v�� ;�y.�g��/r �y�/� d All sl�pply lines must be installed at the same time witliin the supply line �� G��� ���y��� �� easement. n All supply lines must be pressure tested before lines are covered. ��'�� "� �� �� � v Prior to installation, supply line and drain field easements must clearly ,,�''�'y�/,�r.� �r,��1f.«�-� �%�� marked. Contact Surveyor if in doubt. ���/�n/� ,��,yF�,�,c�--- � Drain fie�d layout is approximate. ����� ��y_ ��o� � Purrap requirement (TDH) is estimated. � f�ny questions contact Person County Health Dept. (597-1790). � ,� '►�� rc� �f ` ` ����� PCHD, rev. 09/12/01 Report To: P.O. Box 28047 North Carolina State Laboratorv of Public Health 306 N. Wilmington St. Environmental Sciences Raleigh, NC 27611-8047 ht�t ://slph.state.nc.us lnorganic Chemistry Phone: 919-733-7834 Fax: 919-733-8695 Certificate of Analysis PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET ROXBORO, NC 27573 Courier # 02-33-15 StarLiMS ID: ESO42210-0032001 Date Collected: 04/21/10 inorganic IG: Date Received: 04/22/10 Sample Type: Sampling Point: Well head Sample Source: New Well Temp. at Receipt: 4.5 Sample Description: Comment: Name of System: TONY WESLEY THE FARM @ ROSEVILLE, LOT 27 Time Collected: 10:00 AM Collected By: J Sriith Well Permit #: A29-258 GPS #: New Well (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Total Alkalinity 117 mg/L Arsenic < 0.005 0.010 mg/L Copper < 0.05 1.3 mg/L Lead < 0.005 0.015 mg/L Manganese < 0.03 0.05 mg/L Zinc < 0.05 5.00 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Chromium < 0.01 0.10 mg/L Silver < 0.05 0.10 mg/L Selenium < G.005 0.05 mg/L Iron < 0.10 0.30 mg/L Mercury < 0.0005 0.002 mg/L Fluoride < 0.20 2.00 mg/L Nitrate < 1.00 10.00 mg/L Nitrite < 0.10 1.00 mg/L Chloride < 5.00 250 mg/L Sulfate 7.40 250 mg/L pH 7.5 N/A Sodium 8.50 mg/L Calcium 32 mg/L Magnesium 7 mg/L Total Hardness 110 mg/L Report Date: 05/06/2010 Page 1 of 1 Reported By: �e�ic �oKeal North Carolina State Laboratory Public Health 06 N. W?m� gton St. Environmental Sciences Raleigh, NC 27611-8047 http://slph.state. nc.us M icrobiolo Phone: 919-733-7834 gy Fax: 919-733-8695 Certificate of Analysis Report To: Name of System: PERSON CO ENVIRONMENTAL HEALTH TONY WESLEY 325 S MORGAN STR�ET THE FARM ct ROSEVILLE, LOT 27 ROXBORO, NC 27573 StarLiMS Sample ID: ESO42210-0127001 � ������� ������ ��� ����� ����� ����� ����� ����� ���� ������ ����� ����� ����� ����� ����� ����� ���� ���� ES Microbiology ID: 16003 GPS Number: Sample Description: Comment: Collected: 04/21 /2010 10:00 Received: 04/22/2010 09:06 Sample Source: New Well Sampling Point: Well head J Smith Angela Heybroek Well Permit Number: A29-258 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert Absent Joy Hayes 04/23/2010 E. coli, Colilert Absent � Joy Hayes 04/23/2010 Report Date: 04/28/2010 � Reported By: Susan Beasley � �'�f� or�� �\ G.> � G i, ' \��'. <r� Explanations of Coliform Analysis: �� ' If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliford;b teria are Present, the water is considered unsafe for drinking purpose. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. PERSON COUNTY HEALTH DEPARTMENT SUBSURFACE WASTEWATER SYSTEM MONITORING REPORT �o"�' 1`� lo—� ��i � 2q 258 Date of Inspection System Installation Date Typ� Tax Map Parcel # Z�J� �',lec�r r (��r Property Address Instructions: Check yes or no for appropriate iter.is a�zd exp]ain in space provided for remarks and comments. If an item is not applieable, indicate by "NA". If an item is not or cannot be evaluated, indicate by "N" and explain. Note that this monitoring form is not totally inclusive for all systems. All maintenance and monitoring items specified in the permit are to be carried out. INSPECTION RESULTS COLLECTION SYSTEM: Evidence of leaks ? Tank risers accessible, free of infiltration and surface water diverted ? Septic tank needs pumping ? Inches of solids: Septic tank filter cleaned ? EFFLUENT DOSING SYSTEM: Required pumps p:esen: & functional ? High water alarm operating properly ? Floats, valves, etc. in good conditian ? Control panel & components in good condition ? Effluent free of excess solids ? Inches of solids(pump/dose tank): �1 � Elapsed time readings ? ri Counter readings ? Drawdown rate:�[_� YES / NO REMARKS ❑ � ❑ � � � BeIOW ['�e, � � � A�o�- CL�e55�b�� ❑ � ❑ DISPOSAL FIELD: Evidence of effluent surfacing ? ❑ � Evidence of effluent ponding in trenches ?❑ / Surface water effectively diverted ? � / Diversionslswales properly maintained ? ❑ ! Vegetative cover maintained ? � ! Protected from tr�c/unauthorized uses ? � / Distribution devices in goud condition "[� / Field free of settled or low areas ? �/ ■ ■. ■ �'. � f. ■ ■ �■ ■ PRESSURE DISTRIBUTION SYSTEYI: Tumups/cleanouts/valves�taps intact & accessible ? � � ❑ Pressure head properly adjusted ? � / ❑ COMPLIANCE: � Compliant Non-compliant ❑ Needs Maintenance ❑ EHS ...► � S►�,r��