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A40 210
�or� : o Jun-02-00 01:31P � � �rt��...� a � -0 � � .�� �.....- a1m1/ iimM �p1�o�r��6�ion1 1� tiait� Phae�� � 8t� Ptiae�s. _; May. 21 2001 10:46AM P2 P.03 .. . ., .... �i •-. .G.. . � Nams sesd eddr�s� of WrriRt awner_ ��.Q �"'-�'.,�t t✓�C � � ' � �'. V �.c.v o.c/ `iti' "�1. 3) Alopsrly {7re:f�.tat�� �� ?a�#� f�,qr�C'�r,�.... LWec:�oeti m the papMY 6nCt�dln� rou! r�arnee � numben� --�wY �s� , y�•i< c.s ov:'7V o axBo G✓GS7- Si e /S7�^. �� ` '••t"�'+�:�M =t1d g�L1C�Ltl�� �CR�O� atlflAlEt qC3i 0�$10 """..``y �; a) Prapo��d 4 E�dstlnp Q b1 ��+1t 0.�to�lar C Wtda q Dcu�1a WWe� c) Nucs�ar o! 9WtooMs: � d} Nuc�dsr a o� ar p4opta ta bR sa�wc� � s) Sssas+er�t Yes q Na � tf �. i� d�Mrtt i6�,rax.,,�_ . � �G��YaCKoa � ��e�fulb�a a Pr�d S�tr�trs: VNr�lL p�p�r � Watsr $tippty�'1j�p.: P�r�O'�a►'s�� �Q Q). F'�b�c C.+ Cccisn�ty�y tI. 9pc�+p fl ' Aea t�► we�a oa aqoin�t4 D�P��t Yeis G N4 �!f �es� �octt6Ct� si Pfav� tetQcsd � : �� �Y� TYW �a can b� ranbd !� ot�d�r o�Yveu �� � Couy�tlaW .,,,_M4atR�i Cattv�Mtorptt �� � . ......� ��t hp�a�!l�rj: . 'f Ci.iJ1Rt.Y S7'A!� Al2. CAR�1�$ A� t,i�tE$ OR'f� PROPENTY: 9TAK� 7iii l�lERS OF J1l1. t�pf�00�p g�G�R�. PL�A3E Aitl�C�i SUR1►EY pl.l►T CR 3iTB PU►t11'O'!� A}�PS.tCA7tON �����r +�Ca �p�tlon �o a►. ae�on county l�salt� Glpo�trs�c�! tor �, sii. walu�on %r �,on�a ,.w�Iw d4o� s�,�rt, r� ProP«tY• �� R�i �se cOnients of fifs applp�on sts ��d tep�ssatt 1!w rt�s� br�a ao a�t a� ap�,e�nc, i,�, r�den�nd lf a,, s�. Ea a�ed o�th. a�ar,ded uss dW�. slss v.�tt � 6om�s�s bnv.od. � w�dascs P�° � � � �y� t�=Y �. a�cs atiat A�a�l d�S pecaa, cou�► we,ao, �r�i,«�t m car�dua ��ei rv�tlo�ss. � ue�deeabnd ti„�"�� � �Q H�i1l1 O�eRt tt m�l P��► Cor�M :�q wdl�rsds a� d� b7 � k�Y �p� of �s�s. OWe+�f Ot L.._._._� �.p�si �e�l�S '""'~ �� �d C � .�... FROM : 0 FA?C N0. : 9195981475 � , e.-a> �» . . . S�`� pia� - i,oi' 32 �1q+ R►vr�r �lan-�.�'o� �, � � �C�:.= �� �.`:. . �- .; �,�;;. . . ., . ';� ,����. i .. May. 21 2001 10:47AM,. Pa . . � � � , . ` • ; .� � , L • �G�. �� . ._ �� �' �� +� ��p . � � .. . ....._ _ .. .� �,. ` . � pa . . �. � . . . � . ` : �� � �'C . .. . . ��� � � . :;.�°.'` ' ,,;" . . 1 y �� �.. -� ' .' ; . ; y� � � ��r�" • r.�.wr.r'�'�+r� � � , r+Ge' l i i . • . f . Z ,� �r� �i�h :�.'�4� i�"!} ' • ' Na:`iµ .�r}.,r��.1: _,: , . . . y�. �'�v;r;,:..." . �• . :,s • ry � �;h':�•r.. • ' y! ;•l�Ye���:'���'' • • w:"��� 9• � • .. �.�``•. ' 7 ..�,i��:e , �'V''1' ��`�f:\ �:�r;it�� . , , ; . � �� �`�;-;;;; ;w;;y� - 06Li-L6S (9£�i�,. _ .����, '",: ;� _� �; • ; � i � � N ` 4 ?I ` . .� ' �:r,.. -: £LSLZ �I o 0 oao xo .�e::i :'�'s'"'.+�'�'- ���.; ";,.r. • : , 12a73$ lt[10� S'OZ - :• ;;c:. �, �''��' { ,. . �'t�d H.t'IE'� 'I�S,I1►�1iis0?IIL�N� '� ' � � . ���IIQ,H.L'I'��I h.L1�If10� I�iOS2i�d � . �'�'� . �:s�.'=-�'aS'Sf�.. NOS�I�d '. PERSON CrJUNTY ENVIRONMENTAL HEALTH Tax Map #: �_ New �Addition Improvemeni Permit Type of Structure ���� ��� Water Suppiy _j���_ # of OccupaMsl��J�6 # of Bedrooms ,� Other System Type�_ Projected Daily Flow: � g.p . Permit Ualid For. R�Five Years ❑ No Expiration Proposed Wastewater System: Proposed Repaic ' Permit Conditions: �,_ s ��`�-- SA,'e..T�'Ur I �rn►ner or Legal Authorized StatE oate: .5�� � 9—O ( Date: � �3"��� The issuance of this permit by the Health Department in no way guarantees the issuance of other permiis. The permit hoider is responsible for checking with appropriate goveming bodies in meeting their requirements. This site is subject to revocation if the sibe plan, plat, or the intended use changies. The Improvement Permit shall not be afFected by a change in ownership af the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposai Systems of the North Carolina Administrative Code. � Wastewater System Description: IJON �✓LTi d�L � Wastewater Flow: `� � �.p.d. Type:�_ Faciliiy Description: �g � j f��s' New � Repair O Expansion ❑ Basement? � Yes t�ido Basement Fixtures? ❑ YesJJ�-No Wastewater Svstem Requirements Tankage: Septic Tank size b U gal. Pump Tank size "�" gal. Grease Trap size _ Trenches: Total length L Q'� ft. Trench Width �_ft. Total Area �J� sq. � ft. gal. Max. Trench Depth: �� in. Aggregate Depth:� in. Soil Cover. � in. Trench Separation l ft. on center Permit Expiration Date: � Z � � � Authorized State Agent ���� ��il1j`�� Date:��'� *See attached site plan and addendum pages for additional permit conditions. The type of system permitted ❑ does O does not differ from the type specified on the application. i accept the specifications of this permi� Owner/Legal Represerttative Signature: vt� Date: � a' /� l Operation Permit System Type (in accordance with Table Va) This system has been installed in compliance with applicable North Carolina (3enerai Statubes, Laws and Rules for Sewage Treatment and Disposai, and all conditions of the Improvement Permit and Construction Autfiorization. Issuance of this permit implies no guara�rtee that the system installed wifl functfon pmperly for any given periud of time. Authorized State Agent Date PCHD, rev. 03/07/01 . , :::;:� �AppUcation #: . . � � Tax Map #: � . . . Parcel #: � � �_ � ' • Person C�unty Health Department Enviror�mental Hea[th Section a � SITE SKETCH . � :- . . . . �v��-d�s�` . �-Y' ��k:�r�n�( � . - . . ` T lCt� �►.V'Q-t- T���7� ��l-` �2, � . � . . . Appiicant's Name . . � _ ` : Subdivision/SectionlLot# � . . ,. : � � �5�,� '� � � �3�° t = � . � � . . Authorized �State Agent . Date . . _ , System componeriis represent approxinurte contours ortly. � The �contractor m� f!"ag the system _ ,:. � . prior to beginning the installativn to insure th� prouer grade is ntaintained -- � . i.ta �s' , �. �4� �� ti° � �,p'n,k� � . _ , : ���� . . . 1,� � t�L-�' `�'GS�.. � . � . . � . I�'`� 1 � . � . : ��r�-`�5���� . . c��� � . � � . � , � � C��.�-,�°'�,�'� C��^ '�° � . �i�:�- ° � . . � ���' : . . � t •�1�4�• . � . 3� . ��� .�-� �-� � � K� a �,� � ��;,�� . .� c, s^a � � ,,,,, .�,I�1151 �A f -�'" �� � . . .j5 • �. �� �td.�,. P�� � . . � �u"`���U�� . � � .� �. : . ��� � `c� � �`� � 3� �ti ..i.��\� �. .D ` ' 4 . - �� � . � � PCHD, eev.10J12l99 Person County Heaith Department Environmental Health Section Tax Map #: �r �� Parcel #: �%b Zoning: Township: �� � � Subdivision: '1" -•� �� Section: Lot: �J� Applicant: � Location: � �'J�cS �� Q�'�P�` �-i 1fL� Operation Permit System Type (In Accordance With Table Va): T THIS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AND ALL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION AUTHORIZATION. a �- � �/ thorized State Age Date Tax Map #: _� �t�l s��o � , � . �,,,.-�J I � I! 1 I ` ,, 1 . � � , . �, _ �55 ,�Z Lz=55 n L3 = $�. ,-� � � `� Z .� �'� ` � � L� �B2 L _ '�1 b Z �— 5►�' Parcel #: O� I � PCHD, rev. 10/12/99 PERSON COUNTY ENVIRONMENTAL HEALTH PLEAS� SEE A�'ACHE� PLAfV FOR WELL SITE LAYOUT T� �: � P�, # a� � � ��� �; Zon(ng Townahip Applicant Locatlon: ' �o�� ��� p%1 ��'� �-� Lot Subdivision• Well Permit ' Tvae of Water Supalv: Individual Community Public Reauirements- Site Approved by /7�—E'__ �'�'�`� Grouting Approved by � �'�-0� Well Log ✓ �-��"ol Weli Tag /h�-e� s�-�-�'/ Air Vent y�� �-�3-�� Hose Bib ��- �=Z3-�' Concrete Slab =$�.�--a� Well Dritler: �.�( Illfi-��— Well Approved By: ���- = Date• ���--� �� **See Attached Site Sketch** Wells must be 1 � feet from property lines. ��Wells must be 100 feet from septic systems. 111e11s must be �at least 25 feet from any building foundation. Other conditions PCHD, rev. 11/29/99 Barnette Weil Drilling Inc 336 598 5275 07/26/ol 11:2�A P.��2 i y� � � •. ' . �� O � . � � � ' YERSON COUNTY �NVIROKNENTAL H�ALTIi • , NELL L4G � . - liC�"7��1 • �_ • _ .s1� � i�r..-� ' . . . r • ` � � Lot # ;� � Subdivision Name: �' _______` Drilling Contractor. � ��^c � WELL CONSTRUCI'ION Distance from Nearest Ptoperry Line + v Distance from Source of Pollution f G a Total,Dep�th:;L��_ F� Yield:_1.�_ C�PM Statie Wacer T..evel �.3—' Ft. Water Bearing Zones: Depth.���t. r` ��_��. '�� Fc. Casing: Depth: From____C�___to�,.�Ft. Diamcter. isi�hes TXPE; Steel � Galvanized Ste�l Zf Steel, does owner approve: Yes No � Weighc Thickness: i S'f�' HeighrAbove Ground: I� InchEs Drive Shoe: Xes � No . Were Problems Encoun[ered in Setting the �asing? Yes No � If "ycs" give rc�on; Gxoui: Type: Neat Sand/Cemenc / Conc�ete Annular Space Width Inches Water in Aimular Space: Yes No__w___� .. .. Me:[hod: Pwnped � Pressure� Fourecl �' - • . Depth: �rom O to _.� � F� IvlateriaLs Used: No. Bags Porcland CemenL Weight of .1 bag___�_^lbs. 7f mixtui�e (sand, gravel; cu�tinps) - Ratio: to �ID P�ates: Yes� I3o � � � 4 x 4 slab Xes i No� . I HER�BY CER'T'IFY 7HAT THE A��VE INFORMATION IS CORR��'T' AND TH�T THIS WELL VVAS CONSTRUGTED ZN ACCORDAi�ICE WITH R�GULATIONS SET ��RTH $Y�THE P�RSO� C�ui�TY HEALTH DEPARTM�NT_ , . . � ��Q� 5i a�urc of Contraccor �►� .. �