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A40 374:°�b- 13-02 ��? : 15� P.02 .��� ...__. . :'._ � ��. • .. ...._ . .. .._ . . � . _.._ �a��u� nm►: �� "!`3 "° "� . ._ . 1 ,�� � � -� � r i�---� z., A,�;t�o�n�i'�i�d: <� CC,� � � � �.� � . • . �'.���` ,�e .S4S i � . , ._ , ..p�al;�; .``-- e%`% .� � � . . . U� � �� �+ ,� � l- : `� � --." � /� •��` i.! ! � �� / ' � ���''�" � -�-�� ...� • � � 1� :�.. — ��.�o.+�.�6 �3[�+ &�71�06•. _'�: ��itL! ��. -:a _• aa; �`•it�_�-9- � NYwL�_ - � — �i �t r,.,�,�.aa �r; . ��;���= �����--� t�m�t�ha� �3� � �� " �"�— �e+es� � � s"` � � �6� . . � 8��sa Pl�on� ,� `� � s`;p h�Silw i1lf! ad� af Ciq'�'� O�C. ___ �- C�?r.-(7 . _ . J- . . . . V� ►� ��r �1On: Lot sfz� /� Ta�a� `�/� E� �f��`L:.��� ��%� Dif�lio� 6o tt� �p�y (� t�.md.�e �tq �r�e�a�; . � v��� � �-.,...�. � ��„ �1 �d ii� �nd � � �r �a+ch af the �8 � a1 Pr+apo.�d ,... ade�ing 7�jpe oit S�urat • yy�dt�X.�,,, pbp� � bj �lur�h�er a� 8adrocttte� �� �N• f�mbae e�f p�nia ar pe�pie bD R�e �� �„ c) ' 9�nenk YMs ;, No _ VV�1 tt�re bs pua�tg in it� ba�sr�eni? • .. 'a% � � YOs �, W�p _ . �3 �' ��Iy lyprc Arh�aO� �-� ��nsw „_„ �t, aod�itt� .�. Fut�c_, C�rt�t�t ....., �q _ �• �Y ��� P�1� Yee _ No ,... i! Y'�. P�� g!�.� �p+ooc�s [a� at tt� a�ie Nen. I � . , �� �a�s � p�opr� co� p�au�iy 1�d I�� waq�? Yea _ No � � . 3� A PL.�►'i OF TF� �� SiT.E Pl.JIN rYl�"[' �+ �iiiii'�D W117�i "i7�18 Appt,x`,.,q'� . y �nr � �w� �t � c��.�r �. �' Tf�i� p�P08� LOt`.ATl�3�! C� A�.,�,: �:�r� ��� C�2 i�AC�6�. �' Tk11E �'7'� Ali�'i' � READiL.Y A� �R �iN �UAI.UATiOtrt 8Y TWE 1�AL.TEi D�PI1R'I'1�yT SiAF�. �� ��"!f rt� aQp�morl fio ttte P� Cau�iy NeaNh pe�rtr�t tb� a� ev�tl�tbn 16r 9tte o�-sifi� e�upa�� d�os�! �Y�rn hu tls aba�.d�eec��e� p�p�y, �� th� it� � ar tftl� � are true �d ropr��t ihe ma�utrn ��ittes bo 6s � an the p . I ii fhe � ia a1�red ar i�te i�tende�d uae chang�, tha p� shall �ome �nvaia.��y ,; .. J. vYr✓YM�/ ; � : L �(.,<�� OtIRl6r Oi' � �� - ? — � 2 r� .� � _, �� F�:iD. t�t10t1?ATl ���.�� ���.��� � �' �= C� � ���� �,���.a-��,.-n-r ���.�.IL I�-���.I1�II� Applicant: Location: � � ,-, Psrmit Valid for �ive Years Type of Facility: ,: # of Occupantsz # of Be� Proposed Wastewater System: Proposed Repair: Permit Conditions: T�x I��� � � P�,rce�l s�Ubd��►.s�o►, v � , Phas�e Sect;ion: Lot # �i � � � �nprove�ne�t �'er�t No Egpir�tion Owner or Legal Representative Signature: Authorized State Agent: � ,� j'� :'✓�;,T� �Addition V�ater Supply e��i/ �ily Flow ^ ��d.�s- io-a5 ' Type: � .1[ c, _ Type: •�'� 3I'Q Date: g"� -d� Date: o �/ 03 The issuance of this permit by the Health Department in does not guarantee the issuance of other peimits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoning 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 ownerslup of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules �'or Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Iiealth Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. _ __ _ Authoriza�on to Cons�uct Wastewater S�stean �Itequired %r Building Peranit) * See site plan and additional attachments (�. Proposed Wastewater System: ��.v'�vi7;�'dn� � New � Repair Expansion Type of Facility: -� .S',i,�/e �-r'r�w,` y !�p_S"r'o�'.r��� 3��..'. —� ank Size: Septic Tank: ��c� gal irainfield: Total Area:-�Z�sq ft 3(00 Cs o-us Type ��2 Wastewater Flow �.p.d. Soil I.TA12: �.� g.p.d./ ft 2 Basement Yes �No Wastewater System Requirements Pump '�ank: gal Grease Trap: �-- gal �j(�b Total Length � ft 1Vlazimuxn Trench. Depth 30 an �rench Width �_ ft 1Vtinimum Soil Cover: 6 in Distribution: Distribution Box Serial Distributton 5pecifications: �.� S� p� ;��,/ R�O Authorized State Agent: d�!- Permit Expiration Date: Minunum Trench Separation: � ft c/ Pressure Manifold � ' ' ,. / ef - -- o 0 te: ld - I `�^d � — S I o S C1•��Q � -te �u � ' `�`- The type of system permitted is � onventional Innovative Alternative. I accept the specifications of the permit. ,/ �wner/Legal �t�prQsentative: N � Date: g- /.- �s � P�HD 1 / 17/2003 :����+�� ������ "—��`V�� 1L IE�.�3-0„� ,r,,.,, ��¢.�.]L 1E���.]I�aEIlz. . /{ � ` ,� � 1 � .. . .. 1� . .._ .!1�:�:y... , ;. � .. . . - . . ,,. • � �. S�'��. ���C�. Tax lYlap # A-�fa Pascel # 37 Section/Lot# �� ' S-/� -os Date . �� Systc�r�i com�ionen�r represent ap�mximate�contaurs onl,y. T.;ie contrdctor must, flag the system priur to beginning the instaAation to insure that propergrade is maintained : � t� � _ , � \G� \ ,�y- �Y U- �� n�� r �- ` � v J � 13� �" �� 60 �� s`� ��� , 25� ,� '�`o� � . H��� � . . t.,�, �- �' ��fiiC C�Qa. -- �1 l �s e. en ��cc9 �t�,-'�`�- • ��� � be.Z 3ba c�� L�O� �a Cv�,`v����� �" �'¢h,�. ���-, "'C !' �or�J2n�1.�+�c�C ' �'S$.�10 � Sv' � �;c,�,� -n c.x-./ J . ' S� �-4v"1�.�.� 2Z -�. �C.�.�- � ` , pG�, ;c7. 09/12/U1 ��� j ����� ��� �l/ ���� � . _ , o /-"Y �1�/ ` J' � � V 1L � � ��-n.zc- � aasrna�� �.�.11. I�-� � �.11.�I� Applicant: Location: �x M�p � I I Parcel # Subciivision � � . , - � � Ph�se Section: ot # � ; # of Bedrooms �1 <t ' '; �� .' , u „� � � � : � System Type (In Accordance With Table Va): e�ra�r'� TH1S SYSTENI 0-1:4S �EEN INSTALLED If11 COfViPL1ANCE WITH APPLICABLE NORTH C�4ROLIRlA GENER4L STATUTES, RULES FOR SEWAGE TREATNiENT AND DISPOSAL, • AND 0�1LL CONDITIONS OF � THE !tU(PROV�NIENT PERMIT AiVD CONSTRI]CTI�N AUT Z,4ilOi�i. � � �'.��'�S - Authorized State Agent � Daie . Installed � Date: �- 3�'�,$r ' .,�e � � �l—IoZ L2—Io8 �3'!� 7 �y'�,. - �s�' Q`L i PCHD, rev. 07/29/04 � �E��iC °�'AN� IG��P���°3�� C�$E��C�9��'°' �'Y�e "IB - �) Tax Map #�_ Parce! # System Type (Tabie Va) Owner/Applicant Subdivis9on aK ' r Address/Location Se�fPhase Lot # � State�ID/date � - Z Ca acit 5- 0 � Tee and Filter � Baffie Sealant � Riser if a licable Tank Outlet Seal Permanent Marker . Pumt� Tank lSealant Riser Water Tight ' f lJi'�i� Checic Valve/Gate Valve Ant�-s�o on o e renct� �dth � ; � ft. rench Depth ,3 �) in. renct� Lenath L��7o ft. Grade � Rock Depth and Quaii Dams/Stepdowns etc. Pressure Laterals � Hote Spacin4 � I. Pi e. Sieeve Tum- s/P.rotectors Ftequie�ed� Set6acic� From� Welis � From Propertv fines Alarm (visable and audible) Electricai Components Rate (gpm) � Approved Pump Mode( Bloc� Under Pump Pump Removal Rope/Chain . � Distribution. Systern Serial Distribution p-{,a, . ressure ani o � Low Pressure Pipe Appr. Pipe It�lateriai and Gra� � � � Surface Waters Public 1Nater Suppiies Vertical Cuts (>2 ft.) Wa#er Lines Vek�icle �Traffic � � �Easements/Ri ht:of W Othep =zl-r�� Easements Recorded Coanmen� 0 pcf�d rev. 3l13/0�1 � ���,.��� �'��.��� �.� � � � ���-�- ����������.� ���.���. �� ���� P�SE SE� A'3"g'AC�iED PY..�N �Oh� WEI.L SI'I"E �Y��J7C �'ax lO�Yap #: � � Q Parcel # 3 � 'F'ownship ,�/a � �'v�e:� Applicant .�� f%L✓�S�izs Subdivasion:. `t�^�'c�s� fll'r�� Secti.on: I.ot: �`f I.oca�ion• • � i % �%' r/% o // 0 � �' /�` l J. �/ / / A / 0 /!�' 1 � _�_ �'�i� 6 % s � � c 'I'y�e of Water Su��l�, �Individual Community Public Rec�eagrea�aents: Site Approved bp �_,_. Grouting Approved bp 3" Well Log SS W�t T '' �-3 l- �S Air Vent -�5 Hose Bib S� Concrete Slab �s . f0 � S�s WellI2riller. �Atn�.l-�-� Well Approved �See Atiached Site Sketcfi� 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 building foundation. Other conditi � �yircz�6 PC�ID, sev. 09/07/01 . ... . � .: . DD U WOC3U �DD Lr r i ( � .. ' . ������' ���: ����� ����� , ` n n� �� �♦ t.. Q Q M.fi elj' n'Ya� ���-�`CJ�✓ �:� �� 1L � '` � u.u�,uu� �snwna-o�a�n*�+ ��rn.�.ffi:� ����.��.� . LXsllSl� LNll�UI�I°J � ��`�' ' �7 rJ Grout Log p��; �p..�,,5 d�� v� S Tax Map Parcel # Location: � Subdivision: 2�5 Lot # Well Constraction � Distance From nearest Property Line (Minimum 10 feet) � � Distance from Septic System (Minimum 60 feet) /�J Total Depth: �C� ft Yield: o2CJ GPM Static Water Level: � ft Water Bearing Zones: Depth fOCQ ft/�c a ft%�� � ft� ft Casing: Depth: From � to �% ft. Diameter: �_ in Type: Galvanized Steel Weight: Thiclrness: ���� Height above Ground: l�/ in Drive Shoe: / Yes No Any problems encountered while setting casing? Yes �No If "yes" give reason• Grout: � Neat: Sand/Cement Concrete GraveUCement -� -. Annular Space Width inches Water in Annular Space Yes No Method of Grout: Pumped Pressure Poured !' Depth C�� to s 2� Ft. Materials Used: No. Bags Portland cement � Weight of 1 Bag Pounds Liner: If mixture (sand, gravel, cuttings) - Ratio to ID plates: �Yes _ No 4 x 4 slab �Yes _ No Depth: Date Installed: Grout: Installed by: Drilling Log Location Drawing 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 ID # ��8 Date � � 3� � � Pnmp Installment Pump Installation Contractor: s-�i?'� o-(_ w L9.� State Registration Number: %��- �� Pump Depth: d� ft S tic W ter Level: c� S� ft I Pump Make & ModeL• c' � Pump Size and Rating: �� hp l� gpm I hereby certify that this pump was installed and the well head completed according to the Person County Well Rules in effect on this date and that a copy of th_is record has been�rq�yided to the well owner. . Pump Date: �3� �Q PCHD rev O1/27/04 �� � �� - S l7. 3 ovv {� �{� ��'� � `f PERSON COUNTY HEALTH DEPARTMENT 355A SOUTH MADISON BLVD. ROXBORO, NORTH CAROLINA 27573 BACTERIOLOGICAL WATER SAMPLEANALYSIS Name of Owner or Tenant `� �P ��� `� JP��p�`�/ S Address S � �e^S �? y � vP - County �e r' S c� � }� ���(P %l.�t�llS - L���� Collected By � d� d�� `� ��'P�� y Date Collected d��k�b y Time Collected �v ����—r Source: ��ell ❑ Spring ❑ Other Location: ❑ House Tap ��ell Tap ❑ Other � ONo Charge � harge ****�������*���*�������**�**���������*�*���*�*�*�����*****�**��*����*���*��*** **�**�����**���*�**��*��*��*�����*��*�������������*��**��*�*�**���**��*�**�*�� Total Coliform FecaVE. Coli Present ❑ ❑� Results Absent � T� • . . Reported By � . � Ca � ( Q � �' `� �.(' � /^Ps� li'S %v � � � — $' ��-- � C�vC� bactreport