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A32 199FROM : �HOUSE_DR.** FAX N0. : 9197327338 , , �u�-2�2t�f 02�3f '-r---_-- � �,6-� 1 � a✓ . � � � � aa� , ,61 . RI�� �� .. ��:���1: :.����.., � .. _ :. � .._ r,• =.,r--- Jul. 23 2001 04:12PM P3 P.02 T� '�ii� T -`_ :�, �. . . .. . . =;-_ ... . �.. a�-wm�a�e�.r�� o�.�: _�� �4c, i � K.i'nS . : . � ' � �`► I �.�ox . � � - a�l5y I �. � ,. • - � , � ► � ■i�l�t�� 1� ., . , . . -'.!l.i1.I��`1 �� :P.7iti���<���a�' ��.�1'�e"" ��T7�1[1�t7t7` � 1 � � � ��I ♦ � • � ��i.��,1 � I � ' . . � . �r�f#1 fliA , . ' ' � � �j ' dj NutllDif 0� OCCtJ�7� Q p�p{!6� to bC eOMO� .-,C_ e�. �eos� . Y�s l�o� a xy�y�( easen+.nt � - - . . . . . . . _ , _ . � S1 Q6aen�ionsat'14op�0sed • Vllfatic�0e�,ltr_..LQ .. :_. ._. _. ." _..._... •...: .~_. • .- • • • . � ���'�C Q�c rrar �m r�i � � � � w. �,,r � «, �� � fl it �, ►�,�,° , �3 l�ut�l��s � ° � �'. _ ���'� c�v�ms oan [s. nie�losd tn adnr w re�t a•i�i�ee) • r�+�ae.r _sM�o�a �ro�..- �a�� _,,,_,,,,4„�w. � ,..�t�Y)- ' • -.�._....�. .' CL6AI�.Y STAK� A�.1. CORN6iS JWD I.�l�i OF THE PlIOP[lt7Y. sTAI� TNE c�DI�iR�$ 06 ALL�ROPQ� $'f'�(lCTIAld�i. ��►e�-w}'r.�c� �t�RVEt► p�n-aR-atr�-a� ro r�e naP+xa►�toit � � � the Peraaa � F{�ltlr t�t�c a sme �on.:tbc �s►a�.ali�s�nra� at�poea� syasem tar tY rtrg�ae 41eR slf� co�oo� of tl�s �pprfomipen a� true �d np��ew�t� t1�ts: rr�t�tum A� ia de Pr�i an � pfpp�tY- (�dr�nd N 1t�e al� !s a�teeed or tt�a tmend� uae �eeg�s. tAe pes�sta�� te�d, l ynderssan� tl�et �r ePvl�+t-. i. �lc. c�.i0� i�ystv-e� n�ldelQ-D�overh-l�-aorr�.ss�r-,t,�ltt,o-�q � a�am�r �x a+. �� �at d me P.eo�o�, � O�t bo �uc3 �r evalumlon� 1� t�et I am roe�orm�lo !or nm�yir�a the �� ` '��t?t�ltmt�rCapsatGr�ts,.._. ,, ` �,�.�►�- �—�-`�--�- � . ra�+o. �.►. t ona�s Tax Map #: 1! 1 ��� Aarcel # Appllcar� �-�/ � LOC811011: K � PEf�S�N C�UNiY ENVIRONIIAE�IT�4L HEALTH Township PIN PhaselSection Lo� Improvement Permit New �,,�Addition Type of Structur�e J D t� ��2�r � Water Supply W L�� # of Occupants�� �1-,,#�o�Bedrooms 3 Other System Type�_ Projected Daily �low: ;5�� g. d. �Permit alid For. ive Years � No Expiration Proposed Wastewater System: Q Ovta Proposed Repair. 3 �' ' Perrnit Conditions: �'lp S� � ✓l�'�iC�' 1 , Owner or Legat Authorized State Date: oate: �� � � � The issuance of this pennit by the Health Department in no way guarantees the issuance of other peRnits. The permit holder is responsible for checking with appropriate goveming badies in meeting their requirements. This site is subject to r�evocation if the site plan, plat, or the intended use changes. The Improvemetrt Permit shali not be affected by. a change in ownership of the site. This permit is subject to compliance wiih the provisions of the Laws and Rules for Sewage Treatment and Disposal Systems of the North C�rolina Administrative Code. WastewaterSystem Description: 1� �'L ��� Wastewater Flow: 3 � s�.p.d. Type: �� Facility Description: � D�� 1���� New � Rapair ❑ Expansion ❑ Basement? CI Yes 1�No t' Basement Fixtures? 4 Yes o Wastewater System Reauirements Tankage: Septic Tank size L u Q� gal. Pump Tank size gal. Grease Trap sizs _ Trenches• Totai length -i d� ft Trench Width � ft. Total Area 1��� sq. fi. gal. Max. Trench Depth: � in. Aggregate Depth:� in. Soil Cave� � in. Trench Separation �ft. on center ��o_a�o �; ct v�� Permit Expiration Date: � '� Authorized State Agen� Date: �-�.� � ��� �t �� s�; f 'See attached site plan and addendum pages for additional permit cor�ditions. U'-'� v�` �` The type of aystem permitted O does ❑ does not differ from the type specified on the appiication. 1 accept the speciflcations of this pertnit � OwnedLegal Represeritative Signature: Date: OQeration Permii System Type rn accordance with Table Va) � This system has been installed in compliance with applica6le North Carolirta (ieneral Statirtes, Laws and Rules for Sewage Treatrnent and , and all cond' s of the Improvement Permit and Construction Authorization. Issuance of this permit implies »o gua led will tunctfon properly for arry given period of time. . � � _ � � �0� thorized State Agent Date PCHD, rev. 03/07/01 � �ONTROL `—'-- �— �=-_______` � CORNER N 85'30'52=� � fJ N? W � a� ` � , � . -� e ., h � � � �� � �� -� S�-� % N �" �C � i� d d � (J� � �� W N O � �, � -b � � ' � 6� � 's � " � �� � � y .: : � � ��� ; � ''' � � r 228 � � ,R 9� 10 . � ,, , �. . �: ` ,�: �? � ; � 1� ' • \�',�� + y . �_� � � S ' 85'30`52"; E � 3 �. � _ � � � ': �"' � � I:`� � � �. � I -1 � "` p �° _ • � , �, � -�' � -�= W N i�- �= a �` - .� . � � � `� -� ,v� — :s,. W 6' '-' o, � ' , � � � � a � . � ; �� �- c� -�,:a�N �� a o � �- � w^ �'45_31 "W °�' _ a , 04.53' — � N85'32'14"W x j �� 67.23' / ,_ � � � _`___�� COY T. HAWKINS nnzo►ro �z� PB B F'�6 221 PB 9 F(3 139 11.59 ± ACRES REMAINING AS PER DB 201 PG 227. ..= , . .... . _.. N' �N v� �p 1 �v �� �, °° . . �iV . � �' o �' "o Sa4'27'46"W m � 210.Q0',`> � o � � r _ ... .... _._..:,._�. _,..... . � , " � z ' -�a� ,, s� �� � � � � � � � ?�dl� o�.' �� � a-� y�. `� � � w r,C� . oo �\,� � aJ Z : � �� � N U, � Q� o . N, W _ . ., _ ,. m i � � SO4 32'1 g"W 8 ►v $42.5,• Ix--= -- . �� � � - aa�w�r� -194.6; �- , . - ,-a,--- N s� � �o� o .��3� „ 1l�` � e� • Sa�t j� a� N � � P°�' l�s �z Z o � s �� o � � � �k os �, o ' / � ol k�'a�J� �ro � ��W� U 1 `'' )]�l� '� � S� I� � c�� ,09.45• � N04'27"46• X es.st' 14.94 ,y 210.00' X ���Vl�� � � � � 01 ���1� . I �� � Z � 1/�l� J �-. � N N f � (1� ' �P�`�l ��' a,,,, ��� � � � W � � � � � s �� � � � � Wi �`� � �� � �c�� b �+ o . � � � o��.g?Td� --}� � �1 � n � � � ,..� ( " ` o �� �� 7�" C7 7d � °° � • � \ o �� �a� � � �� �-" .)� ��N� � � \ . ��, � u� . � � � � � � _ so � M�� � � � � X _ ��? — - 40.00'— �o� N \ \ _ . � �p�, � � v � � � x 10�6 30„ � / 1 �� C.� \ 100.84� W �n� ,� _ � � �"'� -- ___ _ '�`���� ,D �''��.� f ,' �� ��dJ �, S l � �� ,b11 �� � o �� � �� � � ,� '��� � � , �� � , .�,, � � ,� z :� � ��% � � � ��' � �� : � wf � -_ � - � , � . � :�, : ���St�� �t3l�N� ��!`�@R�?R9flfl��1T�L ��,L?'� ' �'�.�5� ��� :��'���3E� ��.,�u� �i3Ft'��.� Sa�'E �..��'�13�' � �- 3 �- � � . Tax 6Aap �!: p� � Zoning AppUcattt _ "/� ��V1���Gv Townahip �� � . $�Y�i�01C $OaIOIL LOC Hi@�� �@rRllt `; Tv�e of Water SuQr�iv: Individual Communiiy Public / Reauirements: ��L j ` - �' ' _ 1� � • `\ Siie Approved by � , Grouting Approved by,�_s �-Z �i . � • � � Well LogC'S� ►-�-�� Weil Tag l' :55 r �� � - �L � � I '7 9� ` , . i �; ;- Z, . Air Veni C35 l�i�. - bZ . � � Hose Bib c� r-�,. - oZ � y`� �� _ _. � Concrete Siab �`�' J i�- �"z � _� Well Driiler Weil Appro 9 . **See Attached Site Sketch'""" Wells must be 10 fe.et from property lines. ��� yyelis must be 9 00 feet from septic systems. Wells must be �at least 25 feet from any building foundation. Other conditions: � ; PCHD, rev.11l29/99 0 SQp-10-01 01:48P .� PERSON COUNTY ENVZRONMEN'TAL I�EAL'CI; WELL LOG Dace:� o Owne . �._ SR# _ r.uc J.I`/�yQVFV����/YVVMV��J• . - • �/'o� l�' /J� i /I. s �Zsv ��w��%► _ r Lo�� • , Subdivision I�Iame: ._� .T _ . Loc #_ Drilling Contr�actor: ,�c.�►�i�r,�r � �ve o .Me ��.c ________ w�L co*l��rucrzor� T�istance from Nearest �'raperty Line � Iaistance from Source of Pollution I,ff 0 � Tocal.Dep.�h: / f � Ft Yield:__ 3�_. GPM Static Water I.cvel �02 Fc, Water Bearing zones: �pth �Ft. S� F� �q FL Fc. Casing: Dcpth: �rom�to a� F� Diamecer .� Ynches TYPE: Steel ' Galvani2ed Steei � If Stcel� does owner approve: Y�s No , �Weight: Thickness: I�� HeighrAboveGround: ��? , Inches �,?tive Shoe: Ycs �" No . Were Problems Eneountescd in Setting chc Casing? �cs No� /_ IF "yes" give rr.a�nn:�� _ ,. _.. .�...._-.�... _ , vrout: Typc: Neat • Sand/Gemcnt v Concre[e Asu�uIar Space Width �nches WatE� in �ular Space: Yes No _ Mcchod: Pumped � • Fressure .,____�� Poured � � � - � Dcpth: From a :o r9.� F� Materials Usod: No. Bags Portland Cement Weighc of 1 ba�_ lbs. If mixture (sand, gravel; cuttings) - Ratio: co ID Platcs: Yes�_ No ' � � 4 x 4 slab Yes ✓ No I HEREBY C�R"T�FY'THAT THE ABOV$ IJ�IFORM�1'TTON YS CORR�CT AND THAT THIS WELL WAS CONSTRUCTED IN CCORDE1riCE WI"�'H REGULA'I'�ONS SET �ORTH F3Y•THE PERSO�C C^vGi�1TY E� TH DEPAIZ EN�', � � /��a a �� �►� p�p�pg, Signaturc of Convactor �a c �OA�� � ��-'t6 �