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A40 363-s-"�b-13-02 i�-� : 15P �� , . . ��r� 3 -t.3 v .� A,�:tE�tn'�Cf�d: l-/_`�c�L� . ' c.- . .- �:�i� � .S 4. _� 7 • . �� � � �Pd �.b� 3 a-a. , �.o . �. 3 �^� 3v��9.� . _. .._ . (� � ���/1� u�g � V � AI��11:�� �'��' ,.i . --�;� ;- E�`i :� � ���� � � �,� � � �-� .� ��-� � �� � `r`_ � � ` �'�'�E'�`' 1����"� � ��. - ,o��.�,..� __� "L. � �.,- .r--a ....a: P.02 �,`R�G."_i_ 11�ri�' ��� Y7 1 - _ C ,,� �� P�tt r+a�ti�d ba►: (, '�lP� �i ��•:`n.:� �,�,ur � l�ara'w Phot� _3 C� t�6 � Adde+4saC 4�s"\ �� y��� . �t 8�a�naa Phon� f ,� � � � i�� �� ."�,� �3ifQ� iOd Sd�w � Ci� Ol�i1NC _� _ x--�C� ,,..(7 • ✓ . . ^� �3 . _r ►3 i�r+o1� QM+�rl�tlon: Lot sfz� ��G T� •�/� E�' �(�Z:-�.,v Lat#; %� �'_ ��2 Dit�tiDns �o t!� �ty (� ro�e�d.t�l7� �1d tM1n'fbela): ����/��i� , � ' � �t� "'-' ■ �1� OY I��ii�IrD �� �d Ua and � �on: �r �BC,l1 a! the ZbYawlc�A � A� ��.. � F�ds�ing � 7�e a S�araC ' VYfdtiX..--...,. p�P� -„� b) �IW't1b�r af Hedrao�t�� Numbat e� 0� or psopie �D 44 �ct ,,,�,_,� c) ' B�r�ea�enk Yas ,�, L�II th�t�e be pl�r�ing In itie ba�err�tCr • .. � C�t�pe Dl�qr�k Yes ,_, W�p _ . r �j �Va�t �P�Y �If� AtivaOa �`��t�l .._... a'. �� � p+�_, �/ ..,.., � _ . �'�N � � � P�Y� Yee _ Nv _.,. ItY'e� � � �pprooc�s lo� an tt�o a�ei �. S ' • , �) �s !h� ptop� � p� � �� w�? Yes _ No � , r� . 3� A PI.�'i OF TiE i�Op'g�Y ��i'T:E PlAN YU�i' �!L' � WRi� THlS AppLk`,ATIW�i; y�P�1f lslE� �Nt� ��lBT 8E C�ARLY I�A�D. ;'' 1'�il� �'�OPCB� t.Or`+NTIr�N Q� A�I.,L.. ���t,t�� �' � yli"'4VC�D U�!'�f.I►c�. �' T� �� iliti8i' ��,ADILY �1Ct�LF FOR AN EVALIIA'i�ON BY TWE HEAI.TH DE�111iY1�'T S7l1F�. 1� i�tnb�r msloa �t�t b ifte P�on Cau�► He�h p�n� t�or a� e�kt�ion tior 1h� �Y�rn �ar tt� abov�c�eec�b�d p��y, ��!!t� ih� � at ttt1� � ane ttu� �� � tnqca� �'��tties to b�. pl�l, on tt�e p . 1y �i th4 � ia albered ar ifta iatended t�e chat�gea. the p� stt�1 �fi1Blt�1�t�. ��' �Y�'✓Yr��nC� ,F/� '���LL�� •� ;ZG•-`' �' O+�er cr l� �i� - � . P�iD. t+M� SOtt'71fl9 ��� � ���.��� L.�.. -ti �• 1 � �-. `—,^ � � � � 1L � I��� aa-��� ��.��.Il. IFZC��.IL�I�a. Applicant: Location: Permit Valid for � Five Y Type of Facility: # of Occupants q # f Proposed Wastewater System: Proposed Repair: ��1Jv � T�x M�� � � F�rce.l # ' S�ubdivision i%' �' ' ��' I Ph:�se,Section=Lot # � Improveffient Permit �rs _ No Ezpiration New � Addition Be ooms Proj�re�cted Daily Flow �oV q< t V�, �,�nn�h,v� -,c- — Permit Conditions� '�2� �7t�- `�I�C Pc� � Owner or Legal�Represe Authorized State Agent: Water Supply � � p.d. � � Type: Type: �- Date: 3 � 3) � Date: — The issuance of this permit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoni.ng and Building Inspections requirements are 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 Sewage Treatment and Disposal Svstems' (15A NCAC 1�A .1900). Neither Person County nor the Environmental I�ealth Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. Authori�ation to Construct Wastewater System tRequired for Building Permit) * See site plan and additional attachments (_) Proposed Wastewater System: �-�i �/� Type�l� Wastewater Flow �v g.p.d. New � Repair Expansion / 5oil LTAR: ,'�� g.p.d./ ft 2 Type of Facility: "( ��r-�• Sasement Yes � No Wastewater System IZequirements Tank Size: Septic 'I'ank: �� gal Pu�p '�ank: gal Grease Trap: gal Drainfield: Total Area: �' � sq ft Total Leng#h `1�� ft li�Iazimum Trench Deptli ?� in Trench Width 3� ft Mi.n.imum Soil Cover: � in Minunum Trench Separation: � ft Distribution: � Distribution Box Seria1 Distribution Pressure Manifold Specifications: �,lnqv� ���! � � Z ��OUI� Authorized 5tate Agent: Permit Exx �',ti, � ��l'e� � _ Date: oC�o� �9 � S Date: The iype of system permitted is Conventional � Innovative Alternative. I accept the specifications of the permit. , Owner/Legal i2epresentative: Date: 7J 13 U�J PCHD 1 / 17/2003 ' , ���,:;�,� �11d��`�� - �,, � '�J � 1L � 7���3-�,m,,,,-,,.�m¢.�.]L 1E���.]1�7� :;r � •� ' � �L� . 1.. � • • � i� � �' �_.'�'�TLiI!,�� f � .�:�► � �: .. ••r -� ' •-• Tax Ma.p # Pa:rcel # Section/Lot# �3 �=�C'o�3 Date sys� �a�on�� r����t �pm.��� ��antou� o�y. The contractor must, flag the systern prior to beginning the irestallation to irrsure that propergrade is maintained i f��`I� , � �,� a C( �9-s D� ��� � " - � �� us a�. � �' ���a�� � � � � �� �� � � l� � � ���d�+�' � . � � "_ � ` PlL's, � � � s" � � a , _, _ �C�w-f-�-e�'-�� �s�- � o �- ��s��-� D� Co�, d-�u,� '_w � � S�-q < < a,�� �'�1• C� � � ��-�� Qu,��.�s �a'z-c��. i ( ,� t Sca1e: � ^ �� r �o ° I� io t?` � �1� . _ � , �, � . �- � r �� � � � Q.. _, � � —_ �s/ - � ' ` � .,�lG✓ � �. � ��QrC,p �-, �� `.= � � �� � ���� �� �'}, l,� � �, ., --�,� � � �1 � � 1L Il��-�a-�-R-n „-„-�, ��.�.Ii I�3L��.I1-�I}�. � Applicant: _ Location: ��x 14'l:�,p � � � �;r�c��l r � � ' / S'U':b'C�IIVI:S'.lQll y � � i . h:�=s� Sec��i o ���:�L,a t r �T���Oi� � ��' � �It � r � System Type (in Acr.ordance With `Tabie Va): . TI-I!S SYS'iElW 1-1�►S BEEId INSTALLED !IV COil�Pl,l,�►NCE- �1i1TH �PLiCABL.E N�R'iH CAROLIMA GENEFt�4i. S�'ATUT�S, I�ULES FOR �SE�AGE�TIR�Ti�iE�T AND i�iSPOSAL, . AND ALL CONDiT10NS ..OF THE INIPROVE9I�E�T PE$�IT �D. CONS�FiUCT1�N - �AUTH Z�►ifLON.. � � • . . . ._�.. ..� .: • ,� �c � � ,rv�e�. � : .. .. . . . . � � ��3 - . � � . . .. - uthorized State Agent � . . � . - • � Date . � :..:� . r-. . . . � :. . . . .� . _ � �.� . . � . lnstalled Ba/: t � .. . �Date: _ . .. . . Q—�e �Pc�: � . . -. . . � . . _ _�-- . ... . - _.� . . . . . � _ . . .. . ., . . lo-��_oa �' sfi�3a�f �TS lvoo ,��i � � �t o Da►� �i t�' �l� ' Fc� ►n, �v. 07�24�02 (�� S��'�G �'���C iNvF��"��3N ��E��3S'3" ('�'�e a! - � Ta: �iaQ # C�U �arce! # 3�� _- System Type (Ta�le Va) OwnedA�plicarrt� Subdivision � Addrsss/Location � Se�lAhase Lo� # Stat� 1D/date �e ! Capaciiy. lc��c, Tee and Ftter BafBe Sealarrt Riser (ifi applicabie) Width � �, fit. Depth .. � � m. / � � Trench Length � ft "Yrench Grade Trencl� Spacing • Rocic Depth and Quaii�jr Tank Ou�tiet�: Seal . � � � Dams/Stepdowns etc. �„a Permaner�t Maricer �- •— _� Pr�ssure l.aterais . � � Pump YanEc . •--- . . Nole �Spacing � :'�-� . � tate ate � . o e ize � . —► . . Capacity. � . . . � gaL . _ . : Pi e Sleeve . � . �?. � . . Wate roof /Sealar� : � �- � Tum-upslProtectors � "`-'` . . . Riser . ' � . . Requi� Seibac�: . . .. � Water Ti ht . From 1Nelis •: Fue�ap -- From Properly lines � _ Ct�eck Valve/Gate Va�ve : � �� .� S#rvctures/Basemenis . . . ..- . . Anti-siphon o e - � � . ... rt es ra�nage ays _ .... -.. FioatslSw'ric�es �: . . ...� . .. . � . , _ . � . _ .- - �Surface�ilUaters .. . Alarm� visabie and audibie Public Water Supp�ies Electricai Componer�ts Vertical Cuts �>2 ft Rate gprn � 1�/a#er Lines � Apprnved Pump Modei Vehicle Traff'ic Bloc� Under Pump Ad�acent�Systems Pump Remova! Rope/C9�a�n. Easemerrts/Right of Vl/ays . t - Des�ib�on Syste�a � �a�r � Seriai Distiibution ' Easemenis Recardesi . Lovu Pressure Pipe � j Appr. Pipe Materia! and Grade � C��atnesa�s � �c;-�� re�.r. 3113lQ1 �1�s 7���' ���� �� �--.-,' �— � � �l� �� I���-�-�� � �m��.7� ZE—�C�.�.]1�II� WE� PE�'� . i'L�E SEE �'I"�'A�G�I) PI.t41V �aD�t WE�. SY� ���I�' a� ��� #: � �� ���� # 363 �o��� , . .�. �. . ..�'�'![�11►�1. �� .. �:� 1��.��•�� , ' �� �...,�, • i� ��� �fw�.�� s���� �����ffi�mm�• , ! � - � .. . . -. .. . ... • .. .•-. .. � ; � - , :, � �' - .. , . w- .. , -.:��..,=t;, . �;�.. �..,, a.� �si;. � ,�.,i�.: � t:.r.a�a , - : . `�`=!a':t\'►i1�.1,���`ii1���,.�� , - \i',�►:�'1`1;1\�,!.�``.+,!;1p1 • . . �,�.:_. -..��- _- - _ � co���y P,�� Wel$ D�1��: ►� � � Wefll Appsoved. �p: � I�a�te• � �3�`� '�5eel�ttacflae� Sit� Sk�c,�a** Wells must be 10 feet from property lines. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from anp build'mg founda.iion. Odier conditions• PC�ID, rev. 09/07/01 ��� S ���� �� � OD � ���� � � ��� -- �—_ ' � � � ��- � � o ° t��t"'M1C�' %�trn � C' vc c . _ ����-��� ����.Il I����.I1�I� � �� .� Z�`�...� o��: s�, �. I � �1 Location: �.�'f Subdivision: ���r; � e �' ro ct�' I��g TaY Map�}y0 Parcel # 3�3 Lot # Well Constriiction Distance From nearest Property Line (Minimum 10 feet) � Distance from Septic System (Mini.mum 60 feet) Total Depth: �� ft Yield: � GPM Static Water Level: � ft Water Bearing Zones: Depth?�S �S #� � ft ft ft Casing: Depth: From � to �� ft. Diameter: (q � in Type: Galvanized Steel TS Weight: 'ckness: -�� Height above Ground: /� in Drive Shoe: _� Yes No Any problems encountered while setting casing? Yes ✓�To If "yes" give reason: Grout: / Neat: Sand/Cement ✓ Concrete GraveUCement Annular Space Width inches Water in Annul Space Yes No Method of Grout: Pumped Pressure Poured � Depth to Materials Used: No. Bags Portland cement y�� ��r Weight of 1 Bag S� Pounds If mixture (san� gravel, cuttings) — Ratio to-� ID plates: ✓ Yes _ No 4 x 4 slab ✓Yes _ No DriIling Log Location Drawing Ft From To Formation cr�✓�< ca, � �-� � lJ`j' TG I'OC� L /���' �i �� / `�f �-K �jc ya�`'�, ��a • ! .. � �,�d�,� r � �'. //� � 3 �, � :� 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 Departm Signature of Contractor �� ID# s� Date ,�`'� ��