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A32 214� ,� � �iica�ton Date: '� '%G � � Aenount Paid: ._�0 , U 0 �. � � �t�caiat #: .J 2 4 �5 �-'�- �Zf�rc S�� � va�s' �'srson C�unt� Fiealth i]e�aartment �nvironmentai O�ealth Section APPl.JCAT10P1 FOR SERVICES Tax �ao #: Parc�! #: �� d y as s r�v�e� IF THE INFORMATiON IN THE APPLlCA710N FOR AN IMPROVEiUlE3VT PERMIT IS F,4LSIFlED, CNANGED. OR THE SITE IS ALTERED THEN TFiE IMIPROVEAflEA1T PERMIT APID AUTNORIZAT10iV TO CONSTRUCT SHALL BECOME INVALID. 1) Permit t�quested b�y: Owne�a entJprospective owner): 5 ��• a(�: Home Phone: `� C��) - � �59� Address: Business Phone: =3 i�-'�3 �- ��--�c c. 30:Z 2) Name and address of cumerrt owner. ��� 3��� 'b� •e � , a� 3) Praperty Description: Lot size: °2 Township: c.�S K t Directions to the property (Includin� road names and n�mbers�: � a� ��� M11C.. �20. 4) Proposed Use and Structure Description: answer eacii of the following questions: a) Proposed � Existing � b) Stick Built J�Modular �, Single Wide ❑, Double �de ❑ � c) Number o# Bedrooms: 3-E- d) Number of occvpants or people to be served: e�-- Basement Yes 0, No t�3'If yes. # of basement fixtures:_.,: w.:�. `- -- -- ---°-- -� � _ ...-- _ . �i_.. Garb�ne �ispa�al: Yes �. No ❑ _ _ _..... n _ � , g) Dimensions of Proposed Strudure: Width: Depth: � � � � s �- '�`� �'t' � !•+' 't"k'ti'` ,5� Water Supply Type: Private �'(new � orexisting 0), Public �, Community 0, Spring Q . Are any wells on adjoining property? Yes ❑ fVo � If yes, lacation 6) Please indicate Desired System i ype: (systems can be ranked in order of your preferenc�) ✓Converrtionai ,_Modifled Conventionai _ Altemative tnnavative Other (specify): CLEARLY STAaCE ALL CORNERS AND LIIdES OF THE PROPERTY. ST�}CE THE CORNEitS OF ALL PROPOSED STRl7CTURES. PLEf1SE ATfACH SURVEY PLAT OR SiTE PLAN TO TNIS APPLICATION I hereby make application to the Person County Heaith Departrnent for a site evaluation for the o�-site sewage disposal system for the abave-described. property. I agres that the cantents of this application are true and represent the maximum faalities to be placed on the property. I understand if the site is altered or the irrtended use changes, the permit shall become invalid. I understand that as applicant, I am responsible for identifying and marking properry lines, comers and making the site accessibie for the personnel of the Persan Couaty Health Departmerrt to conduct their evaluations. I understand that i am responsibie for notifying the Heaith Department if property contains any wetlands as designated by the Army Corps of Engi ee ' , Q/�/ � � ' wner or Legal Representative D e PC}iD, rev. �a�uss _�, 0 � � � • ` � S s � � T '� `n `� v d� � c,� �` � ,`� � J � t, o �, o d � � � �' �- � U � v oo � `� v� J,� � J ' i " ` ������ ti � �� � s r ti � � � � A s � � .� N � � `^ , v � � � �1 .� . , ' r, r� � v� �'1! N (`�} � ' ; t� v, � _� � " , s � •` v � �, � �► v� v` J � � � V .. ., y� C V �- � � U � � ` � ` � � .J v' V � � � c�'' ` � `. �o � � (� � 1t y- t'b , � n6 .�` ¢o � � ` O 1 c� v`' � Qp Q� O� N s�� , ° 3`' o — N ' V � ,��J� `Q vO o . � � J H � A� � J ���.s� ���..� ��T �_ �_ � � ���� I���a-��� ����.71 IL���.]t�lla T��x Ma�� � P�rcel = S�uhcliivi,s�ion � ��'� %� Ph�a�se�Sect�ion Lot # � Applicant: ��t,f,P � (�,r � L ca.ti �� ` e Ss --� � e- Improvement Permit Permit Valid for � Five Years _ No Ezpiration Type of Facility: S• �� New �Addition Water Supply � # of Occupants QaC # of B drooms Projected Daily Flow 3�c� g.p.d. �� Proposed Wastewater System: �si.�r,�l � � . Type: Proposed Repair: _ T,�,�ioUc�, Type: Permit Conditions: Owner or Legal Authorized Sta.te Date: Date: � �3� The issuance of this permit by the Health Department in does not guarantee the issuance of other pemuts. It is the responsibility of the applicandproperty owner to in sure that all Person County Planning and Zoning and Building Inspections requirements aze 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 ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for 5ewage Treatment and Duposal 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 Construc Wastewater Syste (Reqnired for Building Permit) * See site plan and additional attachments (_� ����r' ar � Z�ct�✓ Proposed Wastewater System: '�,�y A—�-✓�Nc1UI��Te- Type�� Wastewater Flow �E'� ' g.p.d. New � Repair Exp ians on _ Soil LTAR: _. ����' g.p.d./ ft 2 Type of Facility: �� ]�PS , Basement _ Yes 1� No Wastewater System Requirements Size: Septic Tank: ��o gal Pnmp Tank: l�� gal Crrease Trap: gal field: Tota1 Area:��� sq ft Total Length '�3� ft Mazimum Trench Depth %� in �h Width � ft Minimum Soil Cover: �o in Minimum Trench Separation: �_ ft��-• Distribution: Distribution Box Specifications• � �C�jy p -�- � Authorized State Agent: � Permit Exnira 'on Date: The type of system permitted is the permit. Owner/Legal Representative: _ Serial � Pressure Manifold _ Date: ���. 3—�t(' Conventional � Innovative Alternative. I accept the specifications of Date: PCHD7/30/2002 ��' 7,1..� �1l.G�� �� "�^.������ ]�uawna-a��*�+���rn��.11 �HI��.Il�7kn. �tL .' I.�..u, , � .i . �u'. / �' � �"/� 1 � � �� -� - `�- . SITE SKETCH Ta.x Map # �3 � Pa:rcel # � I � Section/Lot# g �2�-l� Date System corraponents represent apprvximate�contours only. The contructor must, flag the system prior to beginning the installation to insure that propergrade i.s maintained - V - +,,.,� - . -�.a � , s,�`'--�-___�.�� . � --.-�.�..,..�.�,� w �, �4 �� c� �� . ,,Q '� (�1��� C'��n � C� � (�,,/ �� y � ���ltiCl� Q'� � r�j -.'► �,��' p� � �,� C� ���e � � �le• .� o �. � � � �, �, `L� , at,c�- � v � ,� � �N�� ��� �-� � � � � ��� �e� � � � 5;,��,p�' ° u � r�i � � ;� l�„ l, ,., d '$,��i C St� 5�n'Ir -la d�'i �'r�'' � ',� ,�5����"'e' � �' �, �� �� � � �Q1.���� C�a�� 3�• a8"W . ..,..�'�" .� 131 ��6+ � � � � `�� 15 �R . '� �� s . . � '� �� ��`� ruS�aG � ��ri vc.� W'e� �r�rJ►��. � N o � � � � � � ca ' � � N � w � V rJ rrt � ' . j �' r• r 0 .- r � °� __ ,- �,�`% •� N �s��� �Q��' � � �',,�oo, . Lo°'��a�� � `�s� °o���., � �� �. � �, 'S f' . �� . , .sc� l�e . �<<���� � �Z �11�Cla.h�U`I'I�� cZ�n > }� �.�--� .�'L� ^� . . •� . ; . . .. • . � , J .• •�,; , � :r .� • ti �:� � � : . • • . � ' . . . . ., , . w�� � � ,, � � �da��� � s � � :�. 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Tax Map: A 3� Parcel #: � 1 _ Date: ��"'d � I�ine Tap Tap (Scl�) Tap �'low ]Line Length �'1ow / foot # I2iameter in) ( m) �'. ft) 1 Z Lt v � c� , o$'� 2 �2 c� � v �o 3 Z o � '�� 3 4 L � � •0 5 6 7 8 9 10 � �i21 � ft of line x 65 gal. per 100 ft= 21`fSv Z�YS� ; 100 = Z�5 gal 75% x Z! �ga1= �v gal per dose ✓ gal per minute (gpm) _�'low ltat�e Friction Head ,� Loss: • 7 ft per 100 ft of supply line x��� ft of supply. line =100 = �� ft � ft x 1.2 =��� ft of friction head Manifold Size: �" Force Main Size: a " PVC Total Dynamic �ead =�� ft of Elevation head�z' ft of Pressure head +S Sft of Friction Head = ?� � TDH �.'ump Require ent• �p GPM @� ft of He Drawdown: �o� • al per dose � 21 gal per inch =� inch drawdown per dose ��� r..,.� � � �� ,,�� � - � �,� — ��������t0 — • � � : . . , ,. ,. � � � _ ,: „ , . �[t�)l�Om00 II II ill 111 ..:..::,::::.,.:�:::..�::::_:;.:.:::: .._ . _. .. _... ............................« � � � � � , : , .. . :� : : : �: r,rra�eq maia� 5ize / � Taps Na Taps off one sfde v'/s for taqqin� both ; '�.» mjd 'h" t8 s '/+•• ta s i-- ua ►�'C��C � •ti.�.w.-±. : Zn' 4 Z � � g g 3 `�c ,..�.. s..�,:..-�..^ : 3 �►� 16 9 � �`�' 9mam� �s � ' � �n d11+ 21 72 . . . . . _ , " Flow er Ta Size iLlruerial FTaw GP�! t.4 " Sclied 80 �.j . �,2 „ Sciied ?0 7.1 �, „ �ched 80 121 ;, .. Sched 10 IZ..i