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A40 32202/88f1999 13:49 5971799 �u�Sy pazua��nd 10 PLANNIN�a AND ZONI�IG ts , PAGE 01 '� • `:� z : � r�-� • -paa»}�o� p�Ed s��.� iiE P�E P�on �wa�a9ll��ls uau���1ddE s�y�'�doQ y�t�H ay� �q a��s oy� �p uoper�ena oy3 �o �7Qp �u> >�i�E SA.�Q 09 u�y�tnn •�d�Q t�t�H �U� ol �v�dwd �ti3 �o ��e�d �(�n�ns � po��nt�ap �u �nEq I �uon� au� ut �Q� ptre�saapun � •�d�Q u�l�H �y� o� �Sv�do�d �y� �o ���d �an�ns E �u�s��d �snut X `panss� i1E� 7ilLU�d �ll]�UIOAOICTU]j UE 7�Q��i� »tji P1Si�l5]7r1Ut1 I�p�I�Au� �wo�aq Il�qs �xuu�d �yl'sv�trey� �sn papu�7ui �� Ja p���l� �st o3is �t� 3i pueys��pun 7��tu�da3d vt�y uo paas;d �q o� s�i�i�t��� tuntuixecu ��Jt �u�s�id�s puE �iL]3 �JL' U01���1(�dE SILjj �0 SiU�iUO� �l�I )EL�1 ���r`3E I •�t�xiatd poquas�p �naq� au� �03 m��s�is �esods�p �BBM�s ts-uo �� �03 uatyenjEn� �j�s E so3 au�tu}.��daQ �j�i�a� �una� 11os.taa �y� ol uo��xaiidd� ��Ecu �qo�a� I � •s�n.�ant�,s a�soaot�a z�r� ,�o sx�t�o� �xz au� x�.��aoxa �s 3o s��t�t�o� Zz�► ��ss a�x��z� ��' :pan�vs oq ol �lda�d so s�u�dn��o �a aaqtsmH •g �aznlx� 3u�uaasEq ,�o #�os � o� [� s�� ��uow�se g �j oH ❑ �� i,lEsods�Q �88q�? 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N,:e .c• Ila� �ui�s�xg o���da� — . (vot�iPP�') »w.sad r�u�tis7no�dw� — 11�M Ma� ao3 �iuu�d ""` (a�Elda� �woH o��qay�} �ruu�� siL�wana�dw� �"' � wazr�(S a>>das �ui�st�� aaE�da�>>rd�� � (ld'� pap�0���un) 7ttura� s�uow�nostiu��, i�so�� u�a�) us��s,�S �uliszx� ,�o uoria�dststo� —(loZ p�p�a�a�p�ys��qE�s�j ��w.iad s�u�w�noadwX "" 0 a� eQ o � �,g,�- �' _..,M ,.;,:. . . .._... C� ►� � m �-. : W N 1 �7 C3 V3 i�i V1�L Y.,J1 iSA[1 1' �•��.Qf �-�^ •y Or V ��-l� 9 �, � • b9�`I , . �' �dta��e z Q ��o� � •��� pzQd auno�,b 94 � :r _.� � , ._ _ , ,. . _...,, . , . PLEASE SEE ATTACHED PLAN FOR M #. V Parcel itl Tax ap . Zoning � Township F!a-� 12i ucr Applicant: � �����n� LocaBon: IS J �' CtFF led, � 1,�5��/tS 4.a G LD� O/) R fj�FDre C(a. l-cl�-S�e Subdivision: O y�f�4G �rC'S SecGon: Lot: �� Improvement Permit A buiidinq permit cannot be issued with oniv an Improvement Permit New �Repair _ Addition _ Type of Structure 1'11 i� Water Supply �ri ��- W�- ( i # of Occupants # of Bedrooms � Other • Basement? Basement Fixtures? Projeded Daily Fiow:c�o � g.p.d. Permit Valid For: Five Years ❑ No Expiration Proposed Wastewater System T pe: � (1Utl1�1'onal Grav,ty Pump Required? Yes �No Permit �onditions: Kec{� (.JC- f I %(7 � 0/t,�S F�a r�'� ��tr' G�'Ys� /'�S` eC �,�O�i G S�!'S�Lf'►� 1`(1 Owner or Legal Authorized State Agent: nature: � Date: � �� ^ � � Date: o? 1 ' �� The issuance af this permit'by the Healfh Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate goveming bodies in meeting their requirements. This site is subject to revocation if the site plan, plat, or the intended use changes. The Improvement Permit shall 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 Carolina Administrative Code. Authorization To Construct Wastewater Svstem (Required for Buildinq Permit) Type of Wastewater System C�� � t� �na� Wastewater Flow: c7� vg.p•d. Facility Type: Ob I �C �� New 6� Repair DExpansion� Basement? 0 Yes I�NNo Basernent Fixtures? O Yes No Wastewater Svstem Requirements SepticTank Size:,��O� gallons Pump Tank Size: 1��� gallons Total Trench Length: �i'� feet Maximum Trench Depth: �_ inches Aggregate Depth: o� in. Maximum Soil Cover: 0 inches Trench Separation: � Feet on Center ��" ���' I� Other: mGC� Efi,,s O(1 Jll �C. �rlOr 't o��r�.Sf.a ��lt-Fi �O/� Permit Expiration Date: �vl � � Authorized State Agent: Date: C9 a� -�Q The type of system perr�itted ❑ does Q does not differ from the type specified on the application. I accept the specifications of this pertnit. Owner/Legal Representative Signature: � Date: 6 � � --0 6 ?CHD, rev110/12/99 • . ' . ' • � Application #: Tax Map #: � Parcel #• � Person County Health Department Environmental Heaith Section SITE SKETCH . � ac,�k�'nS C�Kr t dqt R�r�.S 3q � ppiic nt's Name Su division/Section/Lot# C� al-� Authorized State Agent Date Svstem components represent approxlmate contours only. The contractor must flag the system � E—�-- I10 ---}� PCHD, rev. 10/12/99 , Per�son Counfiy Health Department ' Environmentai Health Section Tax Map #: Parcei #• r c Zoning: Township: �loc� ��� Subdivision: �O��v�idq2 t-�Ct(�S Section: Lot: 3� Applicant• �vv�ru� �-�'ac.�t��wS Location• Operation Perm it System Type (In Accordance With Table Va): �ri����o'�� -� THIS SYSTEM HAS BEEN INSTALLED IN COMPl1ANCE WITH APPLICABLE NORTH CAROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AND ALL CONDITIONS OF THE IMPROVEMENT PERMIT AND CONSTRUCTION A ORIZATION. ' -7 .� ��o Authorized State Agent . Date Tax Map #: � � � Parcel #: ��` a' PCHD, rev. 10/12/99 .� 3� To SflP���� � Person County Hea(th Department Environmental Health Section � Zoning: Township: F� A� ��� Subdivision: �Q 1�r �d�c� ���° � Section: Lot: 3� , Applicant: aw-�,,, aw�- � Location: 1575 R U ��^si'i�.5 ,,.� i.-e� o� �b�� ��-�e-�G Operation Permit 1. LOCATION AND SEPARATION DISTANCES �S A) System meets .1950 setback requirements �_ B) Distance from system to any wel(s � rn�n�mK�. C) Distance from septic tank to foundation 7 � ��w��q D) Distance from system to property lines as_'T�/� toa �S'�� � � 2. SEPTIC TANK J A) Visuaily inspect the exterior wails and top of the tank B) Visually inspect the interior walis, baffle, tee, filter, riser, lids, air vent, bottom, and water tight outlet ✓ C) Date of tank manufacture 3�%'4a D) Tank serial number sT� ��a, E) Liquid capacity of tank r o 0 o gallons 3. SUPPLY LINE TO TRENCHES A) Grade �/'a�n (1/8 inch per foot minimum) B) Material supply li e is constructed from 5' �i �a �C C) Diameter 3" D) Length 3 � � E) Distance from tank to drainfield/distribution device �_ 4. DISTRIBUTION DEVICE S) A) Type 1/ � B) Is Device water tight N�� - C) Distance from the distnbu i�device(s) t the trenches /V i� D) Is the device on a level foundation 1� f� E) Does the device perform according to its desi n specifications �� F) Record the inlet and outlet elevations N A 5. NITRIFICATION FIELD A) Trench depth Zo inches B) Trench width ,�inches C) Distance between Venches Q�f• D) Number of trencfies y , i / E) Length(s) of trenches 33' �/ �F'. l a5 I> 7 <�0% ���r F} Agg�egate depth �_ inches '--� G) Aggregate material and size �� H) Record septic tank outlet elevation 3�'� I) Trench grade SE'c ���xu�ia9 (< 1/4" per 10') J) Step downs � a. Minimum of 2' of undisturbed earth � b. Proper rise over step down � es , a Solid pipe used Qs d. Elevations of step owns s�� ��'%„ (Record elevations and show on as built) See "as built" plan on attached sheet. PCHD, rev. 10/12/99 PERSON COUNTY ENVIRONMENTAL HEALTH �' � ' ���A�E SEE ATTACHCD PLAN FOR WELL SITE LAYOUT t Taz Map #: / 1 �O Parcel # �� Zoning Townsh�p FI C�� �� de r Applicant: �mm � I ,�-�-W" "�' y LocaUon: �u �� '"" � A s��i Subdlvision: ���r�e��` �CrC`S Section: Lot: Well Permit Tvpe of Water Supplv: �Individual Community Public Re4uirements: Site Approved by Grouting Approved by � �Q Well Log Well Tag Air Vent Hose Bib Concrete Slab Well Driller: k�•c�v Well Approved By: � Date: %� i�"Oc� **See Attached Site Sketch** Wells must be 10 feet from property lines. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from any building foundation. Other conditions: K la�-ll � c� � ! 0' r� lu..S �•a�:� �%G SYs-�ms. PCHD, rev. 11/29/99 Date: �-3G •� ' Owner: �c�rn.n� Location/Directions: PERSON �OUNTY ENVIRONMENTAL HEALTH r•s WELL LOG � Subdivision Name: ____ (�G. Lot # Drilling Contractor: � �c WELL CONSTRUCTION Distance from Nearest Properry Line 1 v Distance from Source of Pollution ( G a Total.Dep.th: � 0 Ft. Yield: /� GPM Static Water Level a..r'' Ft. Water Bearing Zones: Depth ��Ft. / v Ft� Ft� Ft. Casing: Dep[h: From 6 to,� � Ft. Diameter: Inches TYPE: Steel � Galvanized Steel If Steel, does owner approve: Y�s No Weight: Thickness:� '� Height�Above Ground: /�/ Inches Drive Shoe: Yes ✓ No . � Were Problems Encountered in Setting the Casing? Yes No � If "yes" give reason: Grout: Type: Neat Sand/Cement / Concrete Annular Space Width Inches Water in Annular Space: Yes No _ .. Method: Pumped - Pr�ssure � Poured � . _ . . Depth: Fr�m O to �, U Ft. Materials Used: No. Bags Portland Cement Weight of .1 bag lbs. If mixture (sand, gravel; cuttings) - Ratio: to ID Plates: Yes � No � � � 4 x 4 slab Yes i No I HEREBY CERTIFY THAT THE ABOVE INFORM�TION IS CORRECT AND THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTTH REGULATIONS SET FORTH BY THE PERSON C^v`vi�ITY HEALTH DEPARTMENT. ►.