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A32 105Application Date:,,�-���-Ol.o Tax Ma #: J? Z� • Amount Paid: �, o0 Receipt #: Parcel #: �� � ���.?:�� ������ �r�iC.X.J� \ v (��-- -t � � �71�T'� � � �� ���a-��-T-�- ���.�.n ��,.�.a¢� APPLICATION FOR SERVICES �r �-,� ��.�. S� � � %� �, h r1�,,r-►'s IF THE INFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS INCORRECT. FALSIFIED. CHANGED OR THE SITE IS ALTERED. THEN THE IMPROVE�%IEN7 PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. � � 1) Permit requested by: (Owner/agent/prospective owner): _✓/�/ ,� ! Home Phone: ,(p�F � � iS� Address;i ' s Business Phone: Sq7-O,SD � 2) Name and address of current owner. ,�v ;, _ -�o� .s �,/.,�? ,,. 3) Property Description: Lot size: -�r.7� l�G7ownship: /"����d/r��%ubdivision: Directions to the prope►ty (Including road names and numbers): Gd „/n,,, � � Lot # 4) �roposed Use and Structure Description: answer each of the foliowing uestions: `a) Proposed � Existing , Type of Structure: S��N l �� �- .� � Width:�_ Depth: /�� b) Number of Bedrooms: �-�o �i Number of occupan s or peopl o be served: 2 c) Basement: Yes_, No �Will the,re be plumbing in the basement? d) Garbage Disposal: Yes . No ✓ 5) Water Supply Type: Private ✓(new _ or existing�, PublicJ CommunityJ Spring _ Are any wells on adjoining property? Yes�No _ If yes, please indicate approximate location on the 'site plan. 6 Does our ro ert contain previously identified jurisdictional wetlands? Yes_ No ✓ ) Y p P Y PLEASE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLlCATION. ➢ PROPERTY LINES AND CORNERS MUST BE CLEARLY MARKED. , ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAF(ED OR FLAGGED. ➢ THE SITE MUSfi BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT 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 place n the property. I understand if the site is altered or the intended use changes, the permit shall become inv�}iH� , Owner or Legal Representative � /D D� Date PCHD, rev. 06/27IO2 � N•67•IB-19• 7.C�' ►. � •.� Q � .s�o4 ,� � 1' 1 \ � \ � cFcerro -�— c0iner lOvnd -.r- bon pin sel -o- molAemolicol �irtl (no ircn sell � NOTE- This surveyor cerlifres only M Lines A-B ond B-C. A/! olher lines were odcplEd from a l975 Philllp ✓. flall p(al of survey Enl!lled P�opc+/y o! Don L. Whilfield, J� C9, y Hoi`�i't �/op Property of WADDELL W. BREEZ� DORIS W BREEZE \ \ J.gJ. 3,a •..F y,/ � \ ;' � � v`0Q. �,z � �� � 5. %8 OC/@S ' �. n = � PCo�vS y �kQ � q E `� N� � � •`$ � �� � ti • s \ . •q � O °� .� OQi � �1. a Bushy Fork 7Wp. , Person Co., N. C. December 1983, Hall-Hamlelt Q Asscc. ScQ�e � �� - ��� � ,CO• p /P0� 2M� Nea/ C. Hamlel! RL5 2465 ,o��� r,AAOliy'� ��,�y'�GIJIEijFO•. / ' 3iE;\1. � i ;. LZ•S:i n4 ,, Q�;;,su�;!E.�•'C� �o�`,�� r, ��DH�L.�•', B 1 'bo p �^ � .Q,�, . � S Q'2b y� a\. .� .� �� o�� e �anr�R ��I' � ro / 5� / a � / �;��`5 � ��e /• ,Q� a=o,� ss; ai• R r 69l. 28 L�]6.�9' LC,5.12-JS�OI�M 76. /B � ,�u�-+�sr�i c�uio�.i�in, ��riso�i r,ou�i:rl �,1��L�;�C.G, certi'r/; tiiat under my supervision and direction this ma� v�as drawn trt�if an ac;tual fiQW >.urvP �nd tl�at iti�.� error of closure i�_��j�'�.--.; '�Jitn�;ss my hand and seal 'sblt j�"�la� ��f �f"a,GI����`'�T �7i3 j. _�1.� ��L-c.7�i{�j�I •��'-`�'•`I�, 7� ReY,istered Land Surve/��� 1w�ro-i r,;��ic��ir�a, H�rssori �;o��►►:rr i,_ !+��------� �lota�y ubli�: do hEfet ��,�P.r�u}i ti,a L LS ._eaLC? �Mle.l�—.�--� Surveyar, perso�:�lly ap�2are�J hefore m.s thi5 cr.ry sr�d ac�cnowledgad tii2 du2 exe:uti;a c` uiQ fcr2goin�; instrurne��i. Nliti�ess my hand an, notarial s�al this��� _daY o� �e�tt���'C—. 19 � \ l°J�F hi� a mmi}si n ex�es ��:.— c� ,_.__.. Notary i u� ic ' D ��� ��, ����� � -1 � � � � , � � _.� � ���� � ���.��� � ��..�:�.� I����:1I�Il�. i�x Ev�r;p � ' arc�el r � Sur � dlivirs�ion P� ��s�e. S ect+i a n: Lo�t r Inaprove�ment �armit �'�z�mat sTalad for 've �ears 1�1'o���iration :. / Type of Fac�ity: �va�e f�esi'�P New �dditian _. # of Ocsupauts �2- # of B rirooms Frojected Daily Flow Pmposed Wastewater System: � Proposed Repair: Permit Ownez or Legal l Authorized State WVate3� �u�Pl�' �� Type: 'I�jpe: Date: The issuance of this pemut by the Health Deparbment � does not gua�antee the issuance of other permits. It is the re.sgonszb�ity of the applica�/proPerty owner to in stue that all Person Coimty Planning and Zoning and Bu�d'mg Inspections zequaemeats, are met. This �mprovement Psrmit is subject to revacation if the site. pl�n, plat or the mtended use changes. The 7mprovement Pesmit is.�not :�;-<:.. a�ected liy a ci�nge in own�er.ship.�oitlt�property. This� permit �avas� issued in_eflmpliamce with the prao}sioas of the.No�. �G�ar.alina • ?::,'�;_:';.=fLmus==aad �uE�s fa�' Sesvr�,�.: .?'rei�ni�rstx:r�md':Disnosal Svstenls' 15A �T+C��:=18�-::1900 Neither Parsan:�,�'auri�nao�:tthe:, ;,;�, - �:. .:: . ._ )• - ��-�n�meutal I3ealtfi::S� � - � :�ta��he.septic tank.sys�m will; �ction'satisfacf�rT�� " °� . . _ �cater suPI�Y ' . ..,,. . _...-tk�. will.rematn.potah%e. �,� ....__. :..,.��.:.- . . . , . _ _ �,:�:�� �- .� _..._ . . ':i.:.�:-- ...�.:�..�.�.�r..l' ' � � . _ . _ �.�. :.::�t'::.:u.i��:.� .. •, : _ ',-r�. ^.rck I� . _ - ' _"y ' -.. . ., . -..� .._ ..�_ . ,.. , . ..... ._ .. .. �3� .��,:..,._< .,�._:r�' �A;uthorization �o �o�i'struci Wastewater Sysie�n (dteqn�eci�fu���ding Perntit)�" � �_. F - * See site plan and additional attachments (_,. _ . . " . Praposed �tewater System: � Typ � •� astewater Flour�,�g.p.d f.i DUM/) CVl'1ctJd l�ttwt�0 . New � Rep �n � Soil Y�T ` Z,� g.p.dJ $ 2 . Type ofFacility: � .. KPSi�Q,�:e Ba"sement_Yes ..�1Qo . �astewater Syst��a Reqnire�e�ts Tank Size: Se�tic Tank:� D00 g� �nmp Tank: DAD gai � Grease Trap: gai I3rminfield- Total Area: � S y sq ft Total Y.,ength ,�_ it � 11�a�mnm Trench �ep4h � in ' p.C. Trench �idth � ft t�'ini�nnm Soil Cover: �lL in Diinimnm �`rencii Separation: �_ ft Distributaon: �istribution �uz Serial �istn'b�ion ✓ Pressare Mani%ld . Antiaori�esi State A.� Permit The type of system permitted is P�� �vv�e�/�..�� ���s'�$�tatiee: Conventiona.i Ac��ifed ' Altema.tive. I accspt the spe�cations oi tne Daie: pCED rev. l l/10/�5 _' r a '� n�'-ha I Sys�-�em —� 3fQ0 r9.e .� � 3 be.dro�m — ��b /� c� � u � , � ��� -- j Z' �{Ye ncl. bo-�m,S ` ac�c����°Yla' � S�Sf�m � Place g' vver � _ —� �► . 275 L�R I . ;� � `o SD� � C��re� ; � P Q• I w � �M �! � ; ; I /� r , UJ+Gi� OUT' �" �7a�t �Po�qra��i�/� � I� � V � i . 1 G, SC►41.�� l,►-50 � . —�., � � � ������ �. � ,� �,�rr / . i o, .,� �eA / `�6� ,.. � �w � � a��`,a Q� . d0� . ``,�,�+�������o���, �`� �� ���i -� ---_ _ �li. . r p�� f° � 5� � �d� b� � � T tiu r� �Z �r1T[l�i tri�'I'I�� poo . �. � ' . . �,�$ � a}az�uo� �y � , • cazt� }to� adag 'dTd �hdOtiH�S ��Z uoi}nqrz�stQ oZ;s�}np L • , euiZ ' �iw�`J }uatua� puej}sod ICIdd K�.A1 Pg[IT.3 �xivadp � ' �4• , - - o[}R�rj � � }nau� a;az�uo� purj}�od�-�"�'' ^�,—L: I,�f�'� 1: , ' • , . uot}ezsdaS ��9 zass�j a}az�uo� � caiy PxO'J dFZ LJ �'r, ! u�A : ��e �}Y� P��I.I: �P1.bZ -� }?�R�O� 81i.L30'Pu� 'i}°H IYaS }n'Q # lo� uoi���vS, �•s����ld uoisino,��c��nS � # Ic��.r�d � cI��W x�l . 1 • • ' • ' . • •. � • • �1• �� I � iISd OOS6<�i} �S?�a}4y� �;• • Kuty a}az�uo�;ceaaxd . , t.:� . .� ��' .i30 dumd- isavT "ti°'I �iC�H dII) � �xQ ' . ��x p �'�. ��oZ xodeA,� ' � a . �� uo dum� - j*AsZ �x '" " �uot;�rdaS .9� ' ja.►eZ utzeiy xa}e�'t�dcg "'ttA . ��� � adid aAd Ob H�S ��tr � �iLH u"'�D� }nau� }uaiva� pur��zog �.L �c�des uzoxg iajuI . °IoH u°'idtS T;uV • K�t1�A P�[IT3 ?ucuadp • ' � ', . " ' � '. • _ _ .:� � ` �' � • ►' � • • � • j � �� •�. ; _"• . _ - •,� : . . � . : ! � � , . . • ' •iaao� csa�ay ' , . ssAo� ��Q � . �. . - .., . I �3?�0� Ir�u}�ai3 uai}sxtdaS .Zi � ;sod pa}eazy axnstaad ��ti X ��fr il L � i�d [°x�uo� xajduzTS Xb VY�T31I za}s� pa�g o,L padojg ��.�-m��IE�� �v��v.��nv�¢ara�Qn.�cu.�c�-u�'�L � � � A. �+. � � � Y T � .. ~ "�"\ .b. �Y.� ���� S> ���� ���.sf I���.���T �---- : � � � ���� '/ . ,�//� ��':nn-viin-annannn�nnrC-. nJL 7E ]I�-.�.11,c.�ta Owner: /l ZUin /"��lns TaSc Map: 3 Z Parcel #: 1OS� Date: y- !a' D!¢ Line Tap Tap (Sch) Tap Flow Line Length Flow / foot # Diameter(in) ( m) (ft) 1 Z � D •0 2 3 • 0 4 0 8 5 G 7 8 9 � lo Z �d it of line x 65 gal. per 100 ft = ;' 100 = 2l�ga1 75% x gal =( Gc � gal per dose � gal per minute (gpm) = Flow Rate Friction Head Loss: �_ft per ] 00 ft of supply line x'� 20 ft of supply line = 100 = 2- ft �_ ft x 1.2 = 2• y ft of friction head NIanifold Size: 3 f� " Force Main Size: z" PVC Total Dynamic Head =� 0 ft of Elevation head + 2- ft of Pressure head + 3 ft of Friction Head = ��TDH Pump Requirement: �9 GPM @ l� ft of Head. � Drawdown: �_gal per dose .= 2l gal per inch =� inch drawdown per dose General Design Information '' � - - = y =\1'����t� � -- � � I���i i � ,. , � � � � ��i�)��0000 1�1 1�� ��I 1�1 iiiiiiiii�ii�iiiii�iii�i�i�iiii ���������������������i��������� � � � � � y. 2" min Schedale 40 PVC � 9 m c�a Iya.t'hmd�e. Iad/mmtaa �-D S Mani%ld Size 1# Ta s nifold Maz No. Taps off one side �ize (Reduce b'/: for ta in both si lh" ta s '/." taps 1" ts 2" 4 2 3» g 5 3 q�+ 16 6" 40+ g 5 21 �2 � Flo�v er Ta Size Material Flow GP�bt ;c " Sched 80 5.5 ;." Sched4U i.l 3/, :. Sched 80 l (1.1 3a .• Sched 40 1?.� 0 . ��4. :�•.i�.. 3 . .. ; . �.�.. . . . ...: •� , . . . . . . � ,=; � � �.. -. y' . # < . .:c'-+}�c.'�'..+ -�� _'��,v< ���� ' � �•���.�^:i.'�Ji'•;� �� �p.v�. ��;y!� -'� • •;n�,—�•'.j" ny:,_..�' ft r • •t f ���j(��� ,q • �a»r��i <:•:•_•:,.r:,-+c-•t';�•,��'iw.a y _: � ::i,.�,`•'� • ±; `.;r 'w.`�q":!"'.—is . � � ?�,'�.,' ��,,.Ti� .y��7���i1w4 f�L�'+�,�.�.r..� , ' 97�JL.18.71E�1bB � . • . �La�LL'�171W iw�.a.. �. $YL� �n'tw�Y �� i�4 n••w •a , 178SJC� x ,� S�� .►: / :�� � ' .� r � � � � : �I�� � ,� .�� �� . L � � � �� -� ��� � �I�j,�� , • . !� ,w��� .� r. u .e - .s� . . -. . • .�/ • .. � . . : . � �� � ��iTa#�a� 3�p�p: I�vi��l � �Y PnbliC � ,, '$eqlmire�e�atr ` . • ' � �- " Sito Appmved By: � Line� . � �. •firouting Approvod By: ' � • �nstallod 1ry: . . WoIl Lo� • - . ' Y)e�th se� � . • � T�. � - � � �Vell Ta� � ' Date: ' ' . '_ Air V� ' . � � Hoeo Bib: • . water Sample: ' . � �B� . - Canc�ote 51ab: • � ' � . . �li'd1 Dnil� � • ' Well A�oved by: � Dat�:. - ��**�ee � ��e Slre�t**,�'r � Wella must be 10 fezt fmm pmperly linea. � . , Wells mu�t be 100 �t from sdptic 9ysteuui. � � � Wells naust� lie at.le:�at 2S fe� �fmm aay buiiding fiovndation. � - . Other �tiams• � - --- - ' ' . � �G� rev 0112'T104