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A30 100w , � Aatslicati�on D - Amount Paid• �200 � d0 �e�ipt �: �.2 7 (_ 7 f . ��r • i � �� I�LF�.� �� - - -� � � ��- �a��.a-��^^--- •��.�.71 �3Zaom11.��-� �PFl.lCA"nOIV �OR SEiZVIC�S T.ax 1RaA m-�.30 i�arasl �: �� 7} Permit requested by: {awner/agertt/q�ros�ective ow�erj: �'�� ' � Hame Phone:;�36 �'i� - /�3� . Address: �'l b �6rr; � �'��,r� r�✓ - . Business Phane: S�7ti �/�3� . . .�c�-�l� �,�s �•� • �75�1 Z) �lam� and address of.cur�ent �wner ��S'l - �l.�c c . !�w �, 3) Prap��lyDescripiion: Lotsize: -�% Tovrrnship: �� l� S. y�t Directlons to the property (!ncluding road names and numbets): Hw . c,`�Y ��; �r . A�/�.-, c1 r►,`�zs �r� � � Lot � 4) Proposed Usa anc3 Struciure Description: answer each of the following questions: r i a) Proposed ✓, Existing Type of Structure: � I� u�C l� �� Sn'�l ll �; 4-c 1, en VVidth: 7� ' Depth: ��$ b) Number of Bedrooms: � . Number of occupants or peo le�to be served: �7S merrl�j�5 c) Basemen� Yes . No I�Will there be plumbing fn the asement? d) Garbage Disposai: Yes . No f- • 5� �lat�r Supply Type: Private �ew 'V or existing�, Public . Communiiy , Spring - . � Are any wells on adjoining property? Yes Nn _ If yes, pleasa indicate approximate location on the • site p1an. � . .. 6j Does yQur properly cantain previ�usly identifiec3 jueisdictionai�weffands? V�es_ Aio � PLEASE PIOTETHE�att�lrVlPIG: A� PLAT �F �F1E PROPERTY OR S1TE P�AAf lNUST BE SUBMII'iTTED WR'�i TH1S �4F'Pl.iCAT1�N. . ➢� PROP�R'tlf L1NES AIMD CORNEdZS MUST BE CLEARLY M/�RKED. , ➢'YEiE PROP�SEfl LOCATION OF ALL ST'R.UCTl9RES MUST BE,ST�IKED OR FLAGGEI3, �'�i�iE S�TE MUST BE i2EADlLY ACCESSIBI.E Ft�F2 AN! E1/ALUATiON �Y THE 4-EEd11.TH DE��RTMEiVT STAEF. � � i herehy make applicatio� to the Person Count� Healih Department for a si�e evaivation for the on-site sewage dispcsal system for. the aboue-descri�ed property. 1 agres that the cantents'of this application are true and represerrt the maximum faciii�ies to be plac�t on ihe properfy. I understand i� the site is altered or th� intendecf use c3�anges, ttie permit st�ail be�ame invaiid. , , � � Owner or Legal Represen�tive �� -�j-� -� QatB PC;iD, rev. Q6l27102 ' NCGS "TUCK" �� N = 935,035.297 / _ E = 1,979,434.176 � L�-� �� ' . , o , , I' � = �� ` � � • �� s �� I F �� l �' ° - / —� � �� p = 02-1 7-5 � r,,� . / R = 681 �.5 � _ � � L = 273�j� � � � ' �� MP LC`� {�f�1 °35' 'E � `` � 0 2�o p�` �..T�' 2 73 . ' �� o0 � 0 'o / N c� � � �� o � �� I - Ns / - , ,/ � �' . � �� ' ; � � / � �` �t �` / � - � � �-�'? � �� i � / ,�� / y ►► _ , � , ,� ,%� � v��,� �� S t / " 2�` 1 1 1. 3' 1 S � N / � ° / �� w } � G -� P �� ,� , , �, � , 12 � 2 '�v � .� / 30 .�� . � � �,�� J p0 O ,i �,,�� 1 t t �'� � �{ -/Py� /l /�� , ,. i � � . , 0 . .�k.��f'-'�CJRt��[ � W I / � �� 0� � \ � O Q �f� � � " V � � i -I rn I � / � �� G��J ' 6' D j t � £''� r ��✓ / , � ;��. - a-,� �� ° � �.� �.,t � � �,� �� r � . .�� `` .� � n � ��, �, G � �� -�� _ � � .� �� - P � ,� � ; � I S � �' � �' r � .� �� Application Date: 3—�� / � Tax Map #: �/`� � � Amount Paid: Receipt #• ParcEi #• � 0,�_ '��`1�:�� 1L�1�� - - ^- � � �T� � � � . �a��a-��a-�--*� ��.71 I�7C.a�.]L�7L� APPLICATION FOR SERVICES � IF THE IIVFORMATIO(d IN THE APPLICATION FOR AN IIVIPROVEfliIENT PERMIT IS INCORRECT, FALSIFIED. CHANGED OR THE SITE IS ALTERED. THEN THE IMPROVEMENT__PERMIT AND AUTHORIZATIOM TO CONSTRUCT SHALL BECOME INVALID. • �ermit requested by: (Owner/agent/prospective owner): �� . �Z Q�� G/� � _ Home Phone�?3b - s �i �I -/�/3 �� Address: � eusiness Phone: �36 - ��i 7 - � � 2) Name and address of current owner: �U l 3 �fi� ��ti�� ti� � �urd(.e. n-►; 6[s. �c- c • 6�— � �. 3) Property Description: Lot size: �� Township: :�� Subdivision: ot # Directions to the propertyslncludin�q road names and n�� bers): y� S. 3 �r'r� lcs �.� / �� 4) P`roposed Use an tructure Description: answer ea h of the following questions: a) Proposed Existing , Type of Structure: S� /� � Width:� Depth: a'a b) Number of Bedrooms: ��.�� Number of occupant or people to be's� rved: O � c) Basement: Yes_, No �Will there be piumbing in the basement?�O d) 6arbage Disposal: Yes � �No 5) Water Supply Type: Private �' (new _ or existing�, Public_, Community_, Spring _ Are any welis on adjoining property? Yes_ No _ If yes, please indicate approximate location on the 'site plan. ' , 6) Does your property contain previously identified jurisdlctionai wetlands? Yes_ No� , PLEASE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPERTIf OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. . ➢ PROPERTY L1NES AND CORNERS MUST BE CLEARLY MARKED. �, ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STA�CED OR FLAGGED. ➢ THE SITE MUST BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMEAIT STAFF: � I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the property.� understand if the site is altered or the intended use changes, the permit shali become inI�v 'd. � _ % Owner or Legal Representative �� Date PCND, rev. 06I27102 ��* i 4�� 11lJ��i./ �� ' � � �� ab�]L7C0�*'n r-n'n �Sb��O.� ��..1L�� Applicant: 1 "l 1�� U�� Ta�x PJI�aE� % � Parcel +�- � � s��,h�i��s��o�, Fh,a�se�Sect,ioi�i Lot # Improvement Permit Permit Valid for '� Five Yearsr N Ezpiration Type of Facility: ,�'�UrCLI W 1 i�� New � Addition _ # of Occupants�' n?(�✓Lc� # of Bedrooms,�� Projected Daily Flow � � � Proposed Wastewater System: (�� v-�q,1 � ProposedRepair: ��v�-��`�- Permit conditions: � Owner or Legal Representative Authorized State Agent: � .z s�, �� < Water Supply �"I g.p.d. � '• . Type: �'� Type: �d f (�t1w� — Date: � �Y -o�-/ �Date• —•3� `-� �{ The issuance of this permit by the Health Department in does not guarantee the issuance of other permib. 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 ownerslup of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for Sewage Treatment and Disposal 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. Autho.rization to Construct Wastewater. System �Reqni=ed for Building Permit) * See site plan and additional attachments (_�. ' _ Propos R7astewater System: �9U��F'��'�c,�, � Type� Wastewater Flow `T� � g.p.d. New � Rep_air Expansion � Soil LTAR: f a�l� g.p.d./ ft 2 Type of Facility: ;�� c�'�, � o„r C ,� W�� 6�� Basement Yes No Wastewater System Requirements Tank Size: Septic Tank: �6�0 gal . Pnmp Tank: gal Grease Trap: ga1 ��f'�~ _�t Mazimum Trench De th �� Drainfield: Total Area: j yss sq ft Total Length ' p � Trench Width � ft Minimum Soil Cover: � in Minimum Trench Separation: �` ftt% � C• � Distn`bution Box Serial Distribution : ►�'LK Authorized State Agent; Permit Ex� Date: Pressure Manifold Date: �'- �� `�� The type of system permitted. is D'�--Conventional Innovative Alternative. I accept the specifications of the permit. �% /�- Owner/Legal Representative: �i��/��i�jy Date: � �Y "t' y � PCHD7/30/2002 ----- ___._ - __ _ '�� );.)'� . ��1l�� A. '� . v . . � � �V.T� 1C �L ]E�.�.a-m�•* �+�* ea.¢•�,]L IC 33C��.Il�]h� SITE. S�SE.TCI� Name �+/�� . W �1i��"� . Sub ion _ tluthorized Sta.te Agent Tag Ma.p #�.Pascel #�UU Section/Lot# ,�,��— � Date . � System components represent approximate �contours only. The contractor must, fTag the system prior to beginning the installation io insure that�iro�iergmde is maintasned ; 2: � . �� .>y��''�F�, o� � 8�, , S` e 8OS �\ I wn� . � { �� '—\ h�� ry � � . � ^ �o �h pi . . Ory � �. O h ` p �O ry .2�ry �. ._.... v ° " '' � � V� �'�� ; � ,� � t _ I � �i� � i � _ ��' i �� . y + �, V t�`�� p`�~� • � ��o� . I ' � 4e� o c�r�.as �.�" ' � ��, �`�'�� tal � � . . . �� ` � �,'��• �, �� Q N �,..�. ��,�.. c�,ra,; ►�� i w� � . � -�px. , �I _ � �� .�� W J - � t . �� 't1 � .. ` �,�.� � I( �( l2l � �r`�e�' �� .. ��s� � �' w � M � M 00 � ..�a' 11i�� • tD � �y�-Q�,. �i�.f' N �o �m �� o � � �,'h;� bQ�-�'�°` ��C., Z � �� ,..;; � �� ✓�n,+�t5��" . �1-�Lti �� - � ��-:� �. l� ��-- �` � � ri ►� � �, D �� ;�:,�-- ��-�� :, � �� a��p �`;�"" � ` . ��^� �,�Z�"�'" ' i r� �i� �.� �,G� � . Q�� C�� `r. . � (�.e cte;c,� -�v� 84 i -1 � �� Y1�6''WC,� . �:^, � ,�p/� 4 C� � � -" - � • � I �� ,�,,��` °� �' �' � . . PROPOSED DR1VE 6 PARKING W� =Z (nUf"'- OLL'�io d � J n �H U � a m. za� PROPOSED DRiYE 6 PARKINa �QY.� � C ( I (�U��/ �� '�'�`'�� ' -�-� � .. � ; ► Sos, .. ' ' I 23' � 8 � 48 „�. ,. . _ .. •8�� T �TqC . . �� Ue � � � �� r / � � � ��, ; , �� '�� ! � �irad-n.a-��.��na�.�.n.� ��.tn.��Jia Tax Nlap Parc-el # � Subci'ivision Phase'Section Lot # # of Bc�d�rooms i..� � i• � , Applicant: Y�.�1c.e.l�M;.}y- - '�. :��,.e,.��,:,� �t�3,. C��, -Location: �iqs -� aa. �.,f � a.�,su� �+�, �. Operation P�rrnit . System Type (In Aecordance With Table Va): � THIS SYSTEM HAS BEEIV INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH CAROLINA� GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AND ALL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION AU HORIZATION. � 11- 8-0�1 Authorized S te Age t Daie Installed By: CYi �iL¢. �� C�•�e.crzt. � �v�.� 1��1- I 1 -rs-v�+ . �� sw su s�f�/`t rv �8'/y N i a�ly S��V ' 13� 11 � 'ZS � _. o � � � � �� b �x.�,o LI � - PCHD, rev. 07/29/04 S�C �T�V�C 6��TiON �iE�l4.11S'� (T� 9I - �j Tax Map #� A 3� Parc�! # I Oa � System Type (Tab1e Va) .1.�. c3- . Owne�lAQQiicant 6�'ti.14 �.t4- SLlbd1Vt51Dn Addt�sslLocation � SeclPl�ase � � . Lnt # � . - . � • � . Se�t�c Taa�t cafion es r� . State ID/d�e Sz �-3Zy �-�zss�� ✓�S �r$ T�+enc�t 1Mdth ft �.-p.� P'� -�o�a . 9�. Trenci�. Depth �)8- 2c7 in. .� �• � Tee and F�r ..� Trenct� Len �-t 9S ft � Baflie � � Tnetic� Grade i � Sealant -` � Trencfi S adng � � � Riser �fi licable Rodc and Quai' Tanic Outiet:Seai � - Da�lSte owns stc. � � � Pemzanent Marker Ptessure� Lateials � . . - - - Pump Taask . Hoie S�adng - . � � , � tate � � .. . . . • . . . . Ca . Pipe S�eeve � . . . � . _ � . W roof /Sealarrt � Tum-u rotes�iors � . . . . � � . Ri�er - � .ftequiresl Sei� . . Water-Tigtrt � � � Frnm We�ls : � � . . � CS I � 8-0� . . . . PumQ- � � From Ptoper� iines � � . . � edc Vatve/Gate Vaive . : � :. . SSttvvctureslBasemerrts.:: � �� .,/ � � o e . � es e a . . . . . . �ioatslS�nritct�es. � : . � � • • . . � . S�rFacye` Waters . . . - - ;/ . . _ . � . . . . .._ . Alann visabte and audibie) Pubiic Water Sup Ges .,� . Eiect�ical Cam�nertts Vertical C�ts >2 f� . � Rate m Wabe�r Llnes . j AQ coved P Mode! Ve� Traffic �/ Btac�c Under Pum Adjac�rd� s ��, . - . P R�moval Ro elChain . Easern ' ht af �Nays ✓• �Distribution S�s�em - Olt�e� Seriai Distr�ution ��-+�X. GS ►�-4�y Easements Recor�ed . . ress�re _ r ntract Law Pt�essure Pi e �� Tri-Partafie Agree�rrt Appr. Pipe Materia! and� Grade • � � r .Sv��:t� �+� Ule3.e�k- o.a- �.irs:) • • ' �ICf'lCf i�°U. 3i'� �Qj �� . �, i � � 1 ��,` � � � �� I��.��a��a.�a.��a�.]l IE3C�.m.��3�n �uilding Additions/ 1l��obile �[ome iteplac��ents T� � #:� Approval Requested for. P��#: o a �obile Home Replacement ✓ Building Addition " J -" /� /� � Applicant Name• �'� t�J �c � 1�i�TS � l,�i u r 1 Address: � ' �o ��3 � url t�, � ha,., �r� � � Phone #'s: � �� - S 5"i— f5'3 � �7— �97 � Permit Located: ��es No Installation Date: 11— X — d �( Design �flow: . � � � (gpd) Current Contract with Certified erator on $le (if required): Water Supply: Well Public or Community Wastewater system shows no visual evidence of failui e on: J— 7� 4� (date) (Applicant's signaiure if site visit is not required) �� Comments- � � Addition/Replacem�nt Approved �� 'r�a� � Enviro ental Health Specialist � Date - � �g3"E N6��26 � �65'a� - � `, - -� _� � � rl pRr �FO �fs YqRO PqRK� G � O � e o � � � 1 -a-��_ R � �2� ��` � . 6 > S 8 ��' 2)3 •S68 ,�- \ N6 6', � \ � lo �� 273 5 S'3? „F v —�'—�� < � -�c � 7'Op �4 xB�N I °1 � 9� yl H �N �� OR f �f0 rro �fS �, pARK NG Y,�Rp Q � O 4 � �' E CHUR�HG _ /1 � 23,\ gUILDING / ), e �� . 548 � /____ . p yAR� 7 42 � 4��E _- - - - / o � N63°05'� � _ - - / ` __ _ -- _" 359 . 87 � � / REMOVED � _ � ! LINE T� BE � / A cR°'° S 's' . cFs EO l��so I ��I/y�Y k 2p� rARO I I--� 22 � YqRp ` \ 680 \ - � Wi 0 ^ry _ �' �-��-- ' 11� � 69 \O . ReeF��A Aly yF NN CqN � NjN 8S T p�S A �SF, qcR � ��g4 . RI ��'� r�RF � � �690 � . ORk r � tiEw FR. H�R� U@RE jNpFp AP CE Mj<<S�qY O�eNT 6 s I�qe qNT: . N c N2 S ApT jST CNU �6 C T 4� R�y THURo � M <<S �AYTO k MAp ' N• c N R�. CUR '� 30 p ?�54� r R E N T Zo ' A R C F� S TpTA NIN�. � po c AReq. R a ,o� E kjs�9 G B�j s �4 qc. •0 �T pRo/' 28 � BV j SQ. RT oN ARFA : TpTq� evlC SQ F�, UpON qReq : Up OUT 29, 288 SQ • T AREA : ED o oR CIcNTIb� ''� 0� ��T T XjSTIN� BUj� p AT e�jETq� �TAC I�y�: �plNc Hq� j� G PqR�I� � R£Q Q E ND F� ooRcAeEC ENOS TS 0 kI �� y pRo j E� � 4 S spCOING yF cy �s Rp SAN� So Sr oN s e SToRM 2 SPq �S 26 �°MS T�qRy Tp CID wASTE: JECT pR l'E� Hq2 TyIPo• A��pTE� RoC� �FF �RT Y ARO ARFAS S F ART Acc�s ORY IN� j R�M �S�S BV j�� j�c S jT£ p QUq p SN� fT SyoWN js pRoP �SFD Application Date• .� a7�/S� �1�� S� �� Tax Ma :� 3 O P AmountPaid: aDO,pO �� ,�:.•. Parcel#• l60 Receipt #: `�' 3�-LZI 3 �I�{ a,a.l C� �� y� � IE��a-omm � ��.Il 7HC��.Il� �pplication for Services , Services Reauested Improvement Permit (Site Evaluation) � $200.00/$300.00 (if> 600 gpd) �Mobile Home Replacemeut or Building $150.00 (if site visit required) Well Permit (New/Replacement/Repair) $300.00/$200.00/$75.00 Construction Authorization (Fee is dependent on the type of Permit Revisi�n Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information: Name: !h � /c¢, �-(� Address: � � . d� �-► ,G�s 2) Name and address of curre t owner ' diffe ent t n applicant): Name: a �,' ,� � .� Address: �3 ' �r�l� .yl� ` s Phone (home): _�"03 r�� (work/cell): v — /� Phone: S'�p 3 � ��l � 3) Property Description: Lot Size: ��s Subdivision: Lot #: Address and/or directions to Property: �j q So��— 7 m � l�.d �,�,L— ❑ yes ❑ no Does the site contain any jurisdictional wetlands? �es O no Does the site contain any existing wastewater systems? ❑ yes C�J no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes ❑ no Is the site subject to approval by any other public agency? ❑ yes � Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Use and Type of Structure: � g� � ❑Residential � �a—� ❑ New Single Family Residence Maximum number of bedrooms: L�'�pansion of Existing System If expansion: Current number of bedrooms: � Repair to Malfunctioning System Will there be a basement? ❑ yes ❑ no With plumbing fixtures? ❑ yes ❑ no ❑Noa-Residential I/ / Type of business: Gf1 U rPif�. ' Total Square footage of Building: Maximum number of emptoyees: Maximum number of seats: � Water Supply: ❑ New well [9'�ting Well ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes � no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): ❑ Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other p�y I certify that the information provided above is complete and correct. I also understand that if the information provided is inaccurate, or if the site i/s� ubsequently altered, or the intended use changes, all permits and approvals shall be invalid. �I� _ / � %. � Signature (Owner/ Legal Representative*) * Supporting documentation required. S =�-� �S� , Date Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat. A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (1(1/1 11 PPrcnn (�'rnint�� Fn��irnnmPntal T-TPalth �i75 C' �/inrrt�n Qt e.iifo (i T).._-L__._ *T� nnrn�. ..... � �.... __.. _. ��,sf ��.�� ` � � � �� 7Le �-yn u-� ��.Il I�-3� � �.11 �I� Applicant; _� Address/Location: �a,o�.�- G��c Improvement Permit Permit Valid for: Five Years � Non-expirina Type of Facility: �� .Q✓yr� C Gtn,•{',� New Addition'� Number of: Bedrooms / Oc upants�/ Employees / Seats: Proposed Wastewater System: '�a �6 � • . Proposed Repair: U �tntrP� � o� .,� � �Q. Permit 11,J1 N l� Taz Map: � 3 � Parcel: Subdivision Phase/Section/Lot # VVater Supply: �X� �/e � � �(Ot,J Projected Daily Flow:� gallons/day �, Q, Type: �G Type: � �� Authorized State Agent: ✓+� � +�t�✓ Date: -( (X) Owncr or Legal Rep entative: /� �,�,(� Date: •- — The issuan�e of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibility of the applicandproperty owner to insure that all Person Gounty 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 Improvemeni is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina °Luws mid Rrcles for Se►vaF� Treatment and Drsnosal Svstems'(15A I�1CAG l8A .19U0). N�ither Person County nor the Environmental Health Specialist w�rrants that �he septic system vvill c�ntinue to f�nciion satisfa�torily ia the future, or ihat t�e water sapply wi�l remair pota5fe. Authorization to Construct Wastc�water �ystem See site plan afzd additiofsal attachmefits �_). -�(t'G�1 I+�� (o w Proposed Wastewater System: U V• 4�J �� Q) (*1Type � Design Flow ��3 _ gal./day Nev� Repair_ Expansion� Soi(L'ff�R: , a75 gal./day/ft2 Type of Facifir,�: �� y��r- C/Zt�.t+�C � IN i��'C� Bsse�ent: � Yes _ No (*) Sys[em 7"ypes III6, Illbg, IY, and v, require periodic system inspections by tfie Ferson County Nealth Department. Wastewater System Requirements Tank �ize: Septic Tar.k o�-fl 7�i gal. Urainfield: Totai Area �� sq. ft. Trench Width �X ft. Pump Tank � d C7 gal 'fotal Length �� _ ft. iVliti.Soil Cuver � X in. Grease Trap C��10 gal. Max. Trench Depth �C _ in. Min:Trench Separation � X ft. Distribuiion: Distribution Box� / Serial Distribution__ / Pressure Manifoid CnPrifiratinnc� I.n C.4-0� 1� IA��ui �. �. '� !T� �� ✓/�YI'1 � I✓l T� � J�f S 1��. S 1 �luthoriz:,d State Agent: �� • Q • - �=T'I�e system permitted is: Conventional /Acczpted and specifications of this permit. {X) Ovc�ner or Legal Representative• / Alternative IssueDate: S-Z4��5 Permit Expiration Date: S ZQ- Z� / Innovative . I accept the co�iditions Date: - � �l— Person Counry Environmental Health, 32.i S. Morgan St, Suite C, Roxboro, NC'27573/ph: 336-597-1790 (rev 5/12) PVC�aOe Vaiw �m�a�. `��,;, � I�I�1�.��1�T - � � ��°� . � �; �.-1� ' � �� ¢� �� Owner. Tax Map: 3o Parcel #: /�� Date: S�Z�—/S Lime B'ap Tap (�cfla) Tap �loFv Line engtta �odv / f�ot # fl�iameier(in) ( m) �; (ft) �i�� s�,� 1 � � - S Z�' � c� y � �. � � 3 ' .o 4 i3o' •n yz 5 6 7 2- �t � 8 9 l.0 � h 4 ft of line x 65 gal. per 100 ft=� �: 100 ��1 gal 7 5% x a 1= a l e r d o s e -ZS a l er minu�m = I'low k$ate � g � g P g P ( g P ) Friction �ead � Loss: � Z ft per 100 ft of supply line x`�� ft of supply.line =100 = 2' s ft 2� 5 ft x 1.2 =� ft of friction head �. Manifold 3ize: �- Y " Force Main Size: � " PVC Total Dynamic hieasi = y2- ft of Elevation head + Z ft of Pressure head + 3 ft of Fricrion Head = �TDH Pump Iaequi�eanent: 2-5 GPM @ 2�. ft of Head i)rawdown: 2l v gal per dose ;�-gal per inch = S•z-5 inch dra.wdown per dose N�(O G�tea�allHqigmt �fonmation i��: . ,.t 7 �� cs . , ,. i► i► �i► i► 1 1 1 I � � :.� ., _ , , ' 1 _... `•_. ., 4ma�x � _ � � - •. i ; � '', '�' �[t�a1�0�00 i� ii* ii � iiiiii9 iiii � iii iii � ii �� +��**�r��:i�N��.�:��+�� a v- � ' ' - • - �1ozv er Tap Size iLtru¢rial FTa:v GPJ�! f.� " Sc1:ed 30 �•� �,'� Sc3ted 10 %-� '1," .icl:ed80 1Q! �• �• SCited 40 ?= ? .i 3 ��.�. ��.�.�� r� �� '�0df a�Qrn^ 8,�,,,5 0✓� � l 1 h rS, 5,� n-r �� S��o-�--�- `� ./� /�.9 �x �lox 1� ` " - i .._ n,�.�.ed �,� a K pe�� i � � �d��Q�' �f juM,�u�r hi.��.�c�Q cTc�ss olo� r �'��a6Ze� du�lef se� l �19�, wa�r- �(ar�n _� �� .�(�� ; r�►er ov��,d�e eKab�� _"�iu4r ��a�� `p � �C�� pu^�� o�� red��o�`a�� `�a�,p o�'� �� '�s �t� � ��°� �tp��°��' '1� � � � 1 a � �.e� ,rv�� e �s -�°Q i ,� S�Q �-�' b'-aek�� - .��o � l R$ ��C � s'e'r C'�C �a'� �� a�` �� phone 336.597.1790 � � � (` / ` � fax 336.597J808 i� s'�,� �`�- �1 ✓l � aCun'li ✓1,�'1 �1�t7 r• 20-B Court Street, Roxboro, NC 2757� ,. � � � ��.Sf 1C�'I�I�.��" .. � . . � :�:�o�.�� 7Eaavau..��,ll ]]�3[�a.n�4,. ,'�,;�;;�E � . `.'SITE� ��TCFI , ^ . Y1�� . _. _ ,�. . ... .• Tax Map #.�3°�� # l o� � :� h' � � .. Section/Lot# • _Zq^�S — 1luthoxized State Ageat � Date Systen� cdhnp'onenls �p�eaeet apprvxinrate�eonrowis only.' Ths conf�clor mws1, Jlag the rystem prrar to begrtuung tlre dukrJlah'on io ieAsHrre thdtpwpergnade is nwintairted __ _ _ ___ ��Sii:::i•ffli,!_jc�;Re.!. �.:C:td�E°v��n.� 'l.,^.i'f'i<G l itv;'. ��` �\ � } ��' U, jTI', � '/ . �::,....., 9 .% d� -' � � � -' �%. �'_ � `� i �P` /�,C�'�� / � i � / � : i : � �. % i'' - �� i i�� 1 � i . / � ^_•" • ��2-��.'-•:i' j / �'� .Q _ b'�;;.: � / j' / � / ; '�7.i.r4'J � j � � �.` �:5� �S, �L � /,' /` � • ,a, / : / � � � I'�� ' � � � �. 'i ��_« 1 i b , r � � � / � �J / j� / � /�• �216 w5.-'/ � — � � � ��/ . \/ `� nkD � � / / � � ^`.� � 100' PUBIIC ROY/ � r'� � i'"� �` \ .� �� \ �' � ` \ �,�,v��'V � � . . �� ,< �\ , '�.\ �\ �\ �, / �`. � � �� :•'.AINf"If:IC e e \�\ Ak£k � � �'D�� , '. ,. Y ` '� � .. . , o�� \ ' `� AYp �; , .�aa�nr�c `(I�� \ / _ • '� �\� �-�% � � EXISTING OR1UN FlQD y�pr� su�e � 70 BE RETAINED t �� (l�(Ot!1t . .: 4^. CHU�pi Si.^.N /i'. I C i'�.CE 4'x6' � /� ' ,' � TOF Gf S7iN� ,��.\ �� 9' IiI.H �.�� : � - ,�a <_� ! nR��i�s i � 1 .�j� �� ' � ?ARvINi; ./ �� . -�;� � � t ^ �, /y '. i �'' i ��\ '� %� 20' TYP �l � � _' � r;�tc '� - � L r PROPOSED PARKINfr'�� . ti• _r �, / .. `i i �f'� r c'� '•r TYP ''� t5' TYP PFRSON QAlE:_ $9' I `-PROPERTY UNE �R�� I I� 1 � ► �� so� srora�wn� corrrt�o� ��—sr�ucn�r� e� accas 1 1 � � i �� . �saHn�r. rrP \ .; STD. 6' •4 'R.SO� � / / ��, k� . n.'S -- � iYP .�, 4j, � iwo—w�r �ui � / � �cc�ss o� �,I / .. /v I� / ! _�� RELOCATED SHED. / POS(ilONm 15' r-.--.. .�-..--.� -� _- -- -- _ - - _ - 1 ' L�� =1 S � tdE�Y LIF� !tt�EP�t:DE�I"i rfAF'ri: i CHURi;ti j ' A HU!?�La VAt• ;.S r:)s'v�:S`"= < , j,� T,�;( }!AP AJG-i0� ; � S.J� ACR�� j , TAx F'aRC�L 6:cCCRC� P:t;ML'cR: 2�2?3 S iG":�t:.^.•. ��Sii:CNT!r",L oFF P�AZn wv�.w�. QSYNA. l�C. T J.S. 038, P. 77.6 ZU\:�G: R�Sl�1cN':l:a �Aai� USE: 5!'�'GLE fAti11l.Y P.! r i .... BEYOND CRADMC / � � . �� /� ._ i �ac,� e�ct�� oQ—� � � � =� ► � ��' �'� � � � b�� / � .`20, / � ' WI �SSu✓�e �uc��f � �0�• ��R'� � � l � I ( I� ,� EA MNNTEWstCE EASEMENT / / � I r � �S� � ( �Da►,►-, -e►� a,�� _ _ � � � 1 . �� a�c � J�' �' � � � /� ��- ' ' 1 �a'�'� � �� Ir .n � r,�WW ' REFERfTS OF BI�IP�R ' I � _�'_� ��,2v-� f�u'Z'(' � � ` � . pav`� C�!v�4 s-� i�t s�x�� 30 � p�.�. I be. �a� ��re.►�. Pf.�,'r'�� ( �?'`,� S� ( �' .��t' S' /�. � /� I ��C � 1<<_�0� ��. sf ��..� �� l � � �� IE��n�n.a-�a�.�an�aa�a�.Il ZE-3L��n.I1�IIEa Applicant: 6'I�W L� � � �S�" P.Srfz'�' /�' Location: i/ „ . . .�� ,�-� Tax Map � Parcel # �D 0 Subdivision Phase/Section/Lot # # of Bedrooms � �'' Q �rLi�Prr-, C'�t4r� �► �"'( �'� �i�rQ,.� v y Operation Pern�it System Type (From Table Va): �D� �Q Product (III : ►�q�. � �X� �"' "'`��'"'� � g) Type V& VI Expiration Date: Type V& VI Renewal Date: � ; � This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. (Authorized Agent) l�e�.v�'� ' (Licensed Contractor) Scale PCFiD, rev. 12/14/12 � �' c�� sr (Date) (Date) � �jT I ✓l,f ,�l ' `-" 1 �n��`�'�7 iFPr �hSt�ti�d Jr -� l(-z2-�-� � �jAsN�K�f— �vc�i�rcrKo-2 Tax Map: Parcel #: Septic Tank System Checklist (Type II-I� System Type: Se tp ic Tank InitiaUDate State ID & Date: - —( 5 ? Capacity: �( Tee and filter Baffle Vent Riser Outlet boot Perm. Marker Distribution D-box (levels set) Serial Pressure Manifold � LPP Notes• � Nitrification Lines InitiaUDate Trench Width: ft. Trench De th: in. Total Length: ft. Minimum s acing: ft. Rock de th/ ualiiy Dams/ste downs Crrade (< .25" in 10') Cover (6" minimum) Setbacks From wells Property lines Foundations!basements SurfaceWater Other: � Pump System Checklist Pum Tank InitiaVDate State ID & Date: �pr -_� 5 _ 22_ o ' S-2o Ca acity: �- �ppp R.iser (6" min.) NEMA 4X Box Model: Piggy back plug Hard wired Alarm functioning Mounted on ost Above grade (12") Conduit sealed Pressure Mani%Id Number of taps: Size and sch: Contracted Certified Operator (Type IV Systems): Notes: Tank Com onents InitiaUDate Pump model: Block (4") Nylon retrieval ro e Float tree and attachments On/Off float swing: in. Alarm float 6" se aration) Anti-si hon hole Check valve Threaded union Gate valve Conduit sealed Outlet sealed A proved and secured riser Su 1 Line Size ancl material: in. sch. Length: ft. �� l �� ... , _. y/ �, :i �''(1' ��\\�� . �' � �� :'.� '�l./ Z:'V �� . .. .: . . ..:. . T. . � �].C]L.W'11:7[''QaC'A.?rTMn. �71.71-'�-�II:�L � ,��' �L'II-��.�; . . WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map I" Applicant: _ Subdivision: Location: Parce,� # �� Township: Type of Water Supply: t� Individual _ Community Requirements: 5ite Approved By: � id � o Grouting Approved By: Well Log: � ✓ Pump Tag: L' ' Well Tag. � CS '1—�'� Air Vent: f/ Hose Bib: </ C Casing Height: C.S Concrete Slab: rJ CS Well Driller: Well Approv� ****See Att: � (�,,� Public �°�-�r Liner: Installed by: Depth set: _ Grouted: _ Date: Water Sample: r�,,�l2� �e�Q,� CS ��-y-�u Date: 11 ^ c� -O�/ ,�r� 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: PCHD rev O1/27/04 r � .P'�� C �T �� W �� '�--��^ ),,)� . •'�� 7 a +C..�,�, - � �! � � �l� �� I��-��-�� Q�.�G�o.b' 7��mIl�.4�. ��° Q�� ' 5�� Cror�t �og , p��• � �.i �'j, � Tax Map,�� Parcel # UG Lncation• Subdivision• Lot # We oastruction Distance �'zom nearest �'roperry Liste (Minimum 10 fcct) �J Uistancc from Septic System (Minimum 60 feet) _�'� r Total D�pth: ��c� ft Yield: �_ GPM St,�tic Water Levei: c� S^' ft Water �caring Zones: Depth ,�„�/ '_�'_ ft ft ft ft Casing: � �; r, , , � . Depth: Frora� to ;��_ ft. I7iameter: in Typc: Galva�ized Stee1 �/ Wcigh� '�'hi,olmess: � Height above Ground: I� in Drive 3hoe: ��Yes No Au�r problems encountsred whila setting casing? Yes �G'o Tf "ycs" give reason• Gront: ' Neat: Sand/Cement Concrete GravcUCement�� . Annular Space Width ___ itiches Water in Annular Space Yes No Method of Groirt: Pumped Presswe Poiu�ed .� Depth �_ to �Cl Ft Matcrials Y7sed: - No. Bass Portland cement Weight of 1 Bag Pounds if mixturc (sand, gravel, cuttings) — R.atio to ID plates: / Yes _ No 4 x 4 slab � Yes _ No T,i,ncr: . Depth: Aate Installed: Drilling Log Graut: Installcd by: I1oca#ion DrawinR Fr4m To Forxo.atiion C� C. • ,.�..v+ s .� � � �'.� � .y�" �= r — .� �� I hereby certify that the above information is correct by the Person Cotim�o:tii�epartnzerit�,� / Pcunp Installation on Pump ]�epth: � Pur�np Make & Modei: this well was constructcd in accordance w�ith regulations set forth ID #,=� Aate ��-•�'�' �/ Pump Ya�'tallmcnt $trte Registration Numbcr: / � `o � � ft Pump Size and Rating. �hP � gPm Y h�reby certify that this pumg was inst�lled at1d the well hcad c leted according ta the Person Co�ty i�V'ell RuiCs in effeet on this date and thai a copy of � cort�- on provid the well owner. ,• �,m� r►„��npr si�9 re �-. �. ti�� Date: �� '�' PC;T� rev 01/27104 Z00 ' d t/8� = 60 �018010 T SGZ6 86S 9EE �� I 6u ! i i!-aQ i t aM a� �au,ae8