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A32 152. ....... . .. . . . . . . ' � ��. �Q� 1�� � d, . . _ � ,� P_/ , �� p.naale�don• �Ee, z - 0 2 ... 1 n�, J ���, T�c neo �k � . or�,- /�.,,,� �,� - , . � : � q'a . ��� � - �.,`��� � . I�I�I�� �� , � . � �-�-� . � . . . � - �,�.,�.�� �c,a�t� �t:�. .�tt.• . :+ : .:t:i •�..�_a: 1) P�+a�lt r+�WMbd by: (Own�� Hom� Pflon� �ineas F'hm� 2� Name and ulcL+�ss vi cam� c�vime� = WHICKER ENTERPRISES (919) 732-7532 Quality Homes of Hillsborough, Ina _ 241 South Churton Street - Hillsborough, NC 27278 3) Propfrty Qisexiptlon: L.at atze: �. y'1 TawrmhlQ: g� DlrecNo�s bo tlte prop�l (lt�ciudin9 r�a+d. rr�rr�ae �nd numhers�: J . . ....... _ � _.._ .�_._�._ ..n..�_ Lot�R: �1S C a, � � . . ' Ga �-�l � ��,� c�. '�'o A� e'e� 6-►1 s � � ��rn i�rr Ohlile�flu� C�caVe. C�„1� Qd `Z.MiiE�'}U�cx1 �Gf �' b�l �t'GG?LQOdti 2rn��as�+.�r�af� oh RydysFar+�nAd ob 1Mc1e. on �eR+ xGWt�tck�r �+o,n- 4) Prvpa�sd t1s� and �rtt�Cture L�vm ansvuer �cti a� ttx9�(�ou�rir�g queaticne: • e) �P�e� ����g —, �IPQ of Sht�clure: �ot�ble.w�dc M H VlAdttr.. 28 p�p�; '7l0 b) Ntmtber of 8edroom� �_ Numbe�r af ocx�panta ar paaplo bo be sarv�ed: 3 •' , . c) Base�ndtC Yea „�, No ,�„ WBI there be ptumbing tn the heae�t�t? � d) C�arbaQe Disp�aqk Yoa ,.,,, No �,C, � � ��' �{�p�fl �IP� p� .�i (� 1� ar aod�ting ,..,,, Puba�c_, co�rxmtty _, s�na ..._ Ar�•erry w� on �djolnhg P�e+�tY? Yoe,� Na ,�„ Ityos, pleaee Irx�s�e app�mdrruiie lop�tlor� an tha elba plen. 6j D�s ths prop�tiy c�nbitn p�evio�l i�nl�d Jur�ns�1 �? Yes�,_ No,�(, �]L ►.' � • _. � '➢ A PiAT O�T�R PROPER7Y QR �i'� PWr lIUST BE 3i.l�i77�D WCf}i THIS APPLICJIT�ON: ➢ PROP�RTY LINEB AND CORf� YU$T � q.EJIRLY YARiCID. . > THE P�fJPO� L�OCJ1TlON OF Al.l. 9iRUCTURES A�l�T �E 3TAl� OR FLAGC3�. • 9 THE 517� �iUST BE READ�.Y A�IBLE FOR AN EVAI..11AT10N BY THL WEAI.TH nEPAR'T1�IT STAF�. 1• herobY msl�aa tio the Pe�son CouMy Hesith O�partrn�ttt fior a s�in evek�tion tbr ihe a�-eib �ew�e dlaposa! sy�rt 1ku Crfbed p��Y I ��' tt�e c�ntientr at thia �4Gation �na true and r8pres�en# the ma�cunum far�ti on the pD�rt+YJ �e�'td if tlte sr�a is attered or tfie Inbmded use dtar�gee, the pemVt �tra►1 a-��-�s z D�a �.��.s.�- ���.��� �.. - ������ ���n�^¢rnaa�a��rn��,� ��a3�.�.��a Applicant: T�,X ���,, , Scrf�clivi�s�ion P�rc�el # - P�h ��s.e tS e.c�,t�i,o,n IL.o,t � �dl�-L��{—_l�rrn�e `/I.r,t �'�=C � --�7 �,� � � 1�Ufll.� `S �-Rw✓i �- -� ''� �i�%• dvt �Q�. Improvement Permit Permit Valid for Five Years No EzpiraHon � / Type of Facility: _ New Addition Water Supply �(/� ` # of Occupants�g�� # of edrooms Projected Daily Flow L�� g.p.d. Proposed Wastewater System: _ 1/' � � Type: Proposed Repair: Gd `'1,✓� � � Type: � Permit Conditions: � SrY� 5��L1, Owner or Legal Representati Authorized State Agent: Date: 7���� � t� Date: � Z2,�v z The issuance of this pertnit by the Health Deparirnent in does not guarantee the issuance of other permits. It is the responsibility of the applicandproperty owner to in sure that all Peraon County Planning and Zoning and Building Inapections requirements are met. This Improvement Permlt Is subject to revocatlon�if the site plan, plat or the intended use changes. The Lnprovement Permit is not affected by a change in ownerahlp of the property. This permit was Issued ln compllance wtth the provls[ons of the North Carolina 'Laivs and Rules for Sewage Tireatment and Disposal Svstems' (15A NCAC 18A .1900). �' Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments (_ j. Proposed astewater System:�n-�,U�O,�.�,f,�/L � Typ�� Wastewater Flow �g.p.d. New � Repair Expansion _ Soil LTAR: . 3� .d./ ft 2 Type of Facility: Basement _ Yes �No Wastewater System Requirements Tank Size: Septic Tank: � gal Pump Tank: gal Grease Trap: gal Drainfield: Tota1 Area: l0� sq ft Total Length �� ft Maximum Trench Depth �o � in Trench Width � ft Minimum Soil Cover: �_ in Minimum Trench Separation: � ft Distribution: Specitications: Distribution Box Authorized State Agent: _�[��'l,� Permit Exnir tion Date: T/ Serial Distribution Z—a Pressure Manifold Date: �—Z� `a 7- The type of system permitted is � Conventi nal nnovative Alternative. I accept the specifications of the permit. /-/ Owner/Legal Representative: Date: 7 �z�-•�Z� ration Permit � � . System Type (in accordance with Table Va) The systera has been installed in compliance with applicable N rth arolina General Statute, Laws and Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pe ' and C struction Authorization. Iasuance of thia permit does not guarantee that the wastewater eystem will function properly for any ' e period of time. � (� ��-da Authorized State Agent: , Date: � � r � � PCHD rev. O1/23/02 I�l� k�° �,�� s�- I�1��.��� �� � � � � ���� ��.���� � ��¢�.� ���.�.�� Name ✓v�. �Nl�'� SITE SSETCH Tax Map #� Parcel # � �� Subdivision Section/Lot# � �T��� � Authorized Sta.te Agent Date � System components represent apprnximate contours onty. The contractor must}�.'ag the system �rior to be�innin� the installation to insure that t�roper �rade is maintained. �' 0� � l��r-�e., �� ��� � ��t �l�s ► ��S ��� � �� ���� � � � �u�a-�� s - � g, � 3 g-�� �6 � o <;�r�Q; � 1 � �`S � `�� ,a-( �. �� Y� � � as �-. �, �- `rt� �� ���r� ( r ' �n i �'1 'J�j QCC'��'� ��►�1L� ��� ��� . ��,� � � � � � .- ( d� � �d3 3� � � �D � � � a . . . � : � � � � � ���;�. �� l��1�1�.��I.�T - � � � �� � . �+ .Y 1 lY ' . •�� p� . � �. �:����. .lL � . . : .::-�---. . . . . . ]E��a-m� � ����.D: ]E3L�.�.Il¢]k�. 4 :�: Tax Map #: �c� . Parcei #: �. j o� Zoning: Townshlp: ' Subdivision: � '" � � � �::�s: � : , Section• Lot• Applicant: �i0.� �� �G.n (�1o�e , �ocat�on: �nd a F �u.d��Gr�n i�oad � ' � ��ration Permit �, Sy:;tem Type (In Accordance With Table Va): � THIS SYSTEM HAS BEEN IN.'�TALLED IN COMPUANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUTES, RULES FOR SEWAGE 7REATMENT AND DISPOSAL, ' AND L CONDITIONS OF � THE IMPROV ENT PERMIT AND CONSTRUCTION AUT ZAT O � . . - 5'--�0- oa . ' � thorized State A Date �� PTs � �Q S7� �4 9-�.o-=:Qa :,:_�,. , �:: :{ . L��� (-� IR3 , i 2���� °3' � �s� �1 5' 33 13 : � . Zn5ta1��� by �i�f K�tby, � i-f � .T-�5(����'cd bY . � �;,,� �a Z �cd qra,�Pa �`d bY 3.°.c. J � � �.�`� i � �.� ���.� �� �'= �- c� � �.7��T°�� IE �.��-�,.-,� ,..,�,� �m�.Il IE� �.�.a� WELL PE�tMIT� PI.EASE SEE A'ITACHED I�F.AN FOR WELL SITE LAYOU'� Tax Map #: �� Parcel # c�� Township APplican� Subdivisiori: Section: I.o�. Location: � T�e of Water Sunvlv: Req,uirements• Individual Communitp Public Site Approved by J 1�" GrouiYng App ved bp � ��- �Vell Log Well T , � �n � 02 � Air. Vent � �•/�� ao 'c�a Hose B� �' � �o -ao'�a Concrete Sla�� to ��oa Well Driller. +'� � Well Approved Bp: Date: � �D�C� '�°5ee Attached Site Sketch'� Wells must be 10 feet from property lines. Wells must be 100 feet from septic systesns. Wells must be at least 25 feet from any building founda.tion. Ot�ier conditions• PCI�, rev. 09/07/Ol �� S �A ��� �u°°' oo � a� � � , �\ � _' � 4 � �J.1.L/ � O �..tINYYt7 �■ f \ � � • �' 1 lJ �,�/ i.� �� `� ' � � ��T'I� iY �� � �' I���s�������.Il u 33L��.]1�I� ��'0 �� Well Log o��: I-�a�,4� .0 u� a � Location: � t.,((i(�5 O�VVn I�-,OO�Ci� Subdivision: 1�f (�� Lot # Tax Vlap �arcel # 1� c� Well Construction Distance From nearest Property Line (Nlinimum 10 feet) 3 g Distance from Septic System (Minimum 60 feet) Total Depth: O ft Yield: �� GPM Static Water Level: _ Water Bearing ones: Depth ft,S� ft ft ft 0 Casing: Depth: From �' � to .�� ft. Diameter: �_ in Type: Galvanized Steel r/� Weight: �� Thiclrness: Height above Ground: �a in Drive Shoe: ✓ Yes No Any problems encountered while setting casing? Yes � o If "yes" �ive reason: Grout: Neat:' Sand/Cement Concrete GraveUCement Annular Space Width inches W er in Annular Space Yes No Methocl of Grout: Pumped Pressure � oured Depth to Ft. Nlaterials Used: No. Bags Portland cement Weight of 1 Bag �_ Pounds If nuxture (sand, gravel, cuttings) — Ratio to ID plates: ✓Yes _ No 4 x 4 slab ✓Yes _ No Drilling Lo� Location Drawing From To Formation �. U� (� � O �S � ti . ��r � � . pc�L�,� 1� P�I n�u,� � �b v� I hereby certify that the above information is correct and that this well was constructed in accordance with regulations set forth by the Person un Health Department. Signature of Contractor � � ID # ���� �ate .S� 02°� � P HD rev O 1/ 16/02