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D.B. 265-270
D,B, 133-177
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Charles E,Hall
D,B. 265-270
D,B. 133-177
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Linda S,Hall
D,B, 208-348
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Charles E,Hall
D.B, 265-270
D.B, 133-177
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��� D��� �'��' ��'�. s�:�� ,�Y�� ��'iti�l� ��''�
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TownsM�r P►N
New �/ Addition
Crn�aP�r�ern@n� ��r�aii�.
Type of Structure � Q�_
WaterSuPP�Y W '` �
� of Occupants ��� # of Bedrooms � Other
Projeded Daily Fiow: 3 4 g.p.d Permit Vaiid For. nre Years ❑ No Expiration
Proposed Wastewater Syst m-
Proposed Repair: �N = _
�wner or Legal
Authorized StatE
System Type�.
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Date:
Date: ��"�'�fli
�t
The issuancs of this pertnit by the Health Departmertt in no way guarantee.s the issuanca of other permits. The pemiit holder is
responsible for checfcing with appropriate goveming hodies in meeting their requirements. This siie is subqect to rev�tion if
4he siie pian, plat, or the irrtended use ct�anges. The tmprcvement Fermit shall not be affecbed by a cnange in ownership
of fhe sifie. This permii is subject to camptianc� witf� the provisi�ns of the taws and 92uies for Sewage �reatcneirt and
Disq�asal Sy�tem� of �e �larth Carolina Administrative Code.
�wthoriaaieora ?o �rastruci 1f�astewat�r S�stem 1Reauir� for �uitdinc� ��rtnifi�
WastewaterSystem Description: �i�11A1� WastewaterFlow: 'V� .p.d. Type:�q
FacilityDescription' ���1 �'es' ' Idew� Repair�Expansion❑
Basement? � Ye's "'�No Basement Fix�ures? a Yes 1�..No
lNastewaber Svstem Requinemer�ts
Tanicage: Septic Tank size'� �� gal. Pump Tank size gat. Grease Trap size gaL
Trench�: Total iength v�� fi. Trznch �dth � ft. Tctal Area �� � sq. ft.
Max. Trench Depth: �� in. Aggregate Depth:� in. Soii Cover: � in. Trench Separation 4 ft. on center
P�„� �;��on �te: _J — — o � .
Authorizad State Ager� Date: t�— c� ��
*See attached site pian and addendum pages for additionai permit canditions.
The �ype af systerr� g�ermi�ted � does � doss not difFer �rom the type specified on the agplicatian. t acc�pt !he
specifications of this peeinit. .
OwneNL�ega1 Represerrtative Sigrtature: /� Date:
�oerartion Pertnit
System Type �in accardance with Tabie Va) �
This sysbem has been instalted in compiiance wiTh appl�able �11o�th Caro(ina General St�es, Laws and Rules fior 8ewage T�+ea6merrt
and o� ana a!! conaitions of ihe unpro,rement Permit ana consisuct;on �u�OrQaticn issuance of mis permii im�es no
g fhat led wiU fruution properly icr arry givc� period af time.
_ I_ I� oa .
uihorized. State Agent. . Date
- PCHD, rev. Q3/07lQi
s E,Hall
�5-z70
33-177
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Contral Corner
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Towaahip
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Tv�e �f 1Nater Su��iv: Individual Communiiy PubGc
Reauiremenis:
S'�te Approved by 2_�.—�2
Grouting Ap rov � by � � � � . .
Well Log 2�2Z—D
Weil Ta � � . .
Air Verrt �
Hose Bib � . �
� " Conixete Si , .
Wetl Drille�
ved B � � � Daie: � 3 � ��
Well Appro y• . �
�*See /�ttached Site S�$c6�'`"'
Welis must be 'f 0 feet from property lines. �
�1�yells must be 100 feet from septic systems. .
Wells mus# be-at least 25 feet from any building foundation.
Other candi�ons: �
PCHD, re+r.11/29/99
;
� j�) � .� ��� � ��� � D�ri;lle�r ID � , �
1 � "
( � (�) [ V ' � - � " Com�p�ny N�me •:!%�,L� ll '
i -,., , i i.- i � i, D�t�e Drililed a r�
- - , ,� �
Owner: �
Location: �
Subdivision:
Well Log
Tax Map � 3 2 Parcel #�1
Lot #
Well Construction
Distance From nearest Property Line (Minimum 10 feet) (p �
Distance from Septic System (Minimum 60 feet) �� �'
Tota1 Depth: � ft Yield: �_ GPM Static Water Level:
Water Bearing Zones: DepthZ36 ft ft ft ft
�
Casing:
Depth: From [� to �_ ft. Diameter: �C� in
Type: Galvanized Steel I,/
Weight: Thickness: ,�_ Height above Ground: l�� in
Drive Shoe: ��es No Any prablems encountered while setting casing? _
If "yes" give reason:
Grout:
Neat: ✓ Sand/Cement
Annular Space Width
Method of Grout: Pumped _
Materials Used:
Yes
Concrete GraveUCement
inches Water in Annular Space Yes
Pressure _ _ Poured Depth
No. Bags Portland cement Weight of 1 Bag
If mixture (sand, gravel, cuttings) — Ratio to
ID plates: Yes No 4 x 4 slab _ Yes _ No
Drilling Log
Pounds
No
_ No
to Ft.
Location Drawing
From To Formation 'P�C�I- G'�ld
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I hereby certify that the above information is correct and that this well was constructed in accordance with regulations
set forth by the Person County Health Department.
Signature of Contractor ti,z. � � ID#'25 �� Date ���'
CHD rev O1/16/02