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A40 385
:°�b-is-o2 .�-4: is� �, . .. .: . . _.._. . :.__ � Ov . . . _ _ ...._ . .. .._ . � "j' j'Q �{ � � � \'�� `, �.�rJL� *�..��- , . .. � � � . . �. �,�,,, �'" � , A�:��d: �� rc� � � 0 F:�I c .S 4 _< i , . , . _ l . � : --P�al��k ; t,`% .� � �� � ,;( �;� ; � �'--- f /� � �'`�� '`�..��"'�� � � �� ' ~� � �'����� ' , , : : ��. - .o��+,,.� 7,�3C�-A-�e7�. _�. L!. �.,� r�-�.•ti�: P.02 ��i3. ��L ■I11/ALa]_ ` - � � �� � � �� {�nt . �:0� "`�•w�l• (d �°:�:Y� �2u��1�---!/ Mt�tlie Phw1t � � �� �6 �- Addnqs� � �.i �, u•1,��� �,,i�' �� �aa Pt�on� , :� , �, �J �l s�..� FZii10� SDd Sd�t q� Ci� O'�111�: �: ) C�?r..-(7 • ✓ J . . 7 q� ►� P�a�tqr Q..�saon: I..ai stt� �..�...G� . T� ��-�� �? �'l`J��.:�� �ot#: ?� -- /��2 Dii�D�! 60 th6 �y �� PO�d.fi�l:�'9d:ltld �,,,,�, /��ih'E✓•ii�;.fJ � '�"—^ .G....— �.��_�... '�� �!'ii�7� 1� itfd � Q�O�f: �Mdr' �6Ct1 0� �i]B � t��p(� a� �+�t�d .... �s�rct� � tiYt� � s�r� ' iliA�r�•�� a=� _.,,,,_ b) Wun�b� at 6edrnoe�n� t+Wmbar e� c�,p�r,b or pe�le �o pa e�av� ,,,,,,�„ c� ' Bweet�enk YNs ._, Y�i tt�re bs p� G1 ttts b�a�str�tt? • .. cn Oa��!�pe Ddp�tk Yea . tvr� _ . �� � � � �'� � ��� .._. � �8 .�. Puhia_, � ..,.,, s1�� _ . A�-aty � cn � p�cpe�iy i�. Y�e _ No _... IlY� ��� �s lor�tiart an 1t� a� �e. �� �s tlt� p�op� oos4iq p�y � Iv�i �? Yas _ Mo � i. 3� A PtAY OF "Ei� �ROPEit�'Y � SiT.E PRAN 1W�i E!C �ii�p WIi1i'il'HIS ApPL�C�►'ffpN; , . Y P�bDP6'R3Y L8�lF.� QND � i�18T HE �1RLY YAR1�D. �� e�oPo� t.�o��►� a�= A�..�.. �:�� s� i� x� a�t �►ca�. � 7� �,i'T� ii�i' � REAEiiLY A�BLF �OR �►N gVALW1TDON BY'i'f1E HEALTH D�P�R"Y�'T SiJ1FF. !• it�e6�f mala� � m tlt� f��t Cau�1f � Dep�rtrn�t f�oc a��nr�t� fbc 1tte� �+�om fir tl� abav�.d°sc,ribed p��l• �� tltat tt� e� a� tttis �tt� a�+e tru� and � � m�ruim �Come lnvaiid. �� p . I y�iclera�nd ii ttuz s� � aiiened ar #fte �eride�d u�e ct�t�gea. Ute p�rtr� strall /r � / �Lrrvr����� � ��%c�.�. r. •1 --.2r�..;- � Or�ter or 'L�� (��-�y,� ' � F�G iD. r� lott?/Ot , �} � � ( �x N��p � � Pa,rce�l # ` � ��� � \�� � . S�ubdivi�s�ion .: � E �� � � � Ph.�s -Sect;ion� ot # � ! � ..., ,.� ! 1 1<- I� ��rmit Valici for ✓ive Years Type of Facility: � # of Occupantsz 3' # of Be� Proposed Wastewater System: � Proposed Repair: ��,r �,r�1t :' Permit Conditions: Ignprove�e�t Per�aat No Ezpir�taon New �Addition Vb�ate� Sup�ly p �iJ�j Projected Daily Flow �_ g.p.d. Type: �'� Type: �'� Owner or Legal Representative Authorized State Agent: The issuance of this permit by the Health Department in does not guarantee the issuance of other pemuts. It is the responsibility of the applicantJproperty owner to in sure that all Person County Planning and Zoning and Building Inspections requuements 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 af the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for Sewage Treatment and Disposa! Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Aealth Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. l�uthorazation to Cons�ruct VVaste�vater System (ltequired for �uilding Permit) * See site plan and additional attachments (�. Proposed Wastewater System: ��rn.i"I�ii�r'dnc�� Type � Wastewater Flow �t-�� g.p.d. New � Repair Expansion Soil LTAY2: � 3 g.p.d./ ft 2 Type of Facility: �/� S';;�,� fz ��.-,` 4 j-�es,�ajp�,,�� Basement Yes �No Wastewater System Requirements Tank Size: Septic 3'ank: i dc�c� gal Pump �ank: � gal Grease Trap: �— gal Drainfield: Total Area: f C9� _sq ft Total Length _�3� ft 1Vlazimum T�ench I)epth � nn Trench Width _� ft Minimum Soil Cover: 6 in Distrilbution: Distribution Box �✓ Serial Distribution Specifications: Authorized State Agent: Permit Expiration S� � �-� Minimum Trench Separation: �/ ft Pressure Manifold Date: ��? r 5� �03 The type of system permitted is � onve ional vative Alternative. I accept the specifications of the permit. " �wner�egal �i�present�tive: Date: �O - / — D 7 . . PCHD 1 /17/2003 ��.?. � ��1LO.�.J �� _ . �—' '" � � ���� • IE�.�na-o�••• �. m�a�.]L IF3I��.Il�]fa ' STTE PLAN ) �� � / ��v Q Name � Ki/tS Tas ;�fap # / Parcel # �J " Subdivision /' Secrion/Lot#" �� ��� " w - ��� Authosized Sta e Agent Date System componenrs irpresent appmadmatr canmurs anly. The cvamct+ormusttlag rhe system pdor m beginaing r6e iastaU�rion to ias+ur rhatpmpergnde is maintsined : :. � i.: ��. HENSLEY AVENUE 5Q' R/W ,, A�_.�f PP�,>>.��C�,� ,�d.� � /• �.�v�A /� �3 �= /.� , �'� �o�r ✓. /;r�s A�i G�ti�oorr .r5 S%awr1. �, ,� /1p� /nS:�/�Sys�r:! .�. Gti�ri t�� �`:�:; �oi�tS; N J tS7 0 v 158. 4Q' ,, �p, S�� , �� 7%/ /ii.; - � V rcfm, ��. o�/�z/oi Y � . \ �c � .��.o , t�d � ��... ��.,.��� � �� t� ��! � � �h. ° ° OCaI � ttK '� . � � �� S `�." � � �. � � �.T�'� 1�� � �� � � . ��.�-�..�-��..�-,�, ���: ���.�.�.� �� �a � � �QPi;car�t - � Location: s -'�' ,o --� i3��ra.2. -� -'S ,` �NS�� -� �T n�l � �-�, �o � n � � �,r��-c� . , � r '�1 � l� . . � . . � : . . � : System Type (in Accordanc� Wr,�hh Ta�le 1ta�: S.C� . . TH1S S'�S TEiiA .� 8�� 11�l:STALLEi3 � IM CLJ�IF'Ll.�IVC� 1ff11iH ��LI�,A�LE N�RTt-i � �# ' . �'AF�t7l:.1,9qd�► ��'l��I_ 5i�'�UTES, RUL�S �%3R S�d�►�� TR.�T�1��i Ai�Ci T�#�#'�75.AL; � • Al�lD ALi. � C�NDIii�PD� • c�F '� T1�E 1�7�"9�fl�d��' P��1�' AAd�1 Ct,�t���'t�UGild�i • a�iJi�-�Ui�9�"Tl�lelv . � ' . , ' , . . . • � ",vK �jc; o9�c � ' . . • , � + . • ` . : Auihnrrized St�t� Ag�rrt � ' . D� ' , , ' ln�l�xi Hy: _ ��. ls,ScS __- � . ��fie:,�� ot"1 . . _ � � � • . . . -� � B� tt�M� ' . : , i o�s►- -ro • . . ' � • . . w� ��.. . . . . . , • , - F�Z.,n � � � . � . ' . . . . ' � , ��/•, ' • • ' _ \� �G . • ' • r • . � , � .. .. � 5���2 � ' . . • � 9R . � . _ ' IaU' e-�S�It ; `�'�Z � , • , 115 , i � ` 8`� . ` . : ,/ . • �� . `1�12 � _ ,i � � $ (�-S3 �T ,� . � � ; �� . � • ✓.. ' bL G19' � �.� • � � . � • , � ✓ ✓ ' � 4 � ' `�s ���SS ' • ', � � ` . . ��� ��t�� �������� ��'���� �7�� �� a �'� . T� Ni�p � ��cZ.,, Pa�� #� 3 85" � � 5ys�n Typ� (Ta��e �{a) � • ownedA�piicant Sitbclivision � Addi�ess���aiion Se�Pn�s 1� � : � Q�' HL�F _.`�.r� , � . ' r�m.os'� "es • — - - 1, . • . .'. . 0 �pplacant � ������� ���� �� —`.' � � � �J �� .1� �' �n�n��aaaa-n.�gad�.� ���.,m.���. ���� ���� I'�SE SE� A�'AC�EI) PI.AN FO� W�I.I. SI'I"E ��4IT�' % � � ����. # 3 � � �O�s�� �1�. � �'�:� : ' i!t �7 �i �i � /CcL✓/�,i2.S' _ Subdivision: /.f `t i^�'c��e �rt�,: Se�sioaz: I.o� � I.ocat�ion• • � � � 0 'I'�e of'Wate� Su��l9r, �ndividual Communitp Public l�e�ugrements• Site Approved by Grouting App�oved by o Z� o J Well Log /''i T Well T .Air Vent _� Hose Bib - t► �fslc�7 Concrete Slab ✓ �� � n WeIY I)riller. [� a�n � t,t� Well Approves� �y:�Yv�., o f��" Date• 1► �5 ��-7 '�See 1�tfachesl Site Sketcla�` 0 Wells must be 10 feet from propertp lines. Wells must be 100 feet from septic systems. Wells must be at least 25 feet from anp building foundation. Other PC�ID, rev. 09/07/01 Y#: =4. Y O.,v.?S�`•^C ~ - � O Q lJ • ��,�::= '�~°:Y _ - _ - D�IOc��� �3`� � - �=� -- ��y �"�=�{:�-5'� - ::� . ��: - .y. '':�Sf1J:�CL�! •�' i � :�`i. ..4- ' F•^"��•`1 Sf1J . . . � . :��.- �_. : .. _: �� q� � ��t� (,�- � t °� . � =.�. �:�=�:=� ��-:�:����.= .. . _._. : �:. - . - .:: ._ . - ��.=:�.,�,.-:�.�.;�:�;== ��:�:��:� . � o�aao� � �^ � �r -� � . .. I.or,�tioa aiuwl V1�1021: ka� � 1 rn G� cro� r,�►g - � Tax Map �l0 Pa�+ce1 # �� - WPII C.O�C�1011 Disi�nce From nearesi Pmpearty Line (l.�inimum 10 fcet) 1 D�" 13istance frum Septic Sysb�n (� 6o feet) [ t� (�- TotalDepth: ��D- ft Yeld: / S" GPM- Siatic WaterLeveL- ft Wate�' Beazing Zan� Depth r1�0 ft� 5� ft ft ft �rom to � 3 ft. n,��: b r�y �� . ---�- � c��a s�� . . � Weigh� Thictaiess: � L�8 Height above Ground: t 2 in - � � Drive Sho� _� Yes No Any problems enco�d wh�e se�ting casingi Yes �io If "yes" give re�son: " (�+ou� - . . . ' - . Neat SandJCem�nt �/ Canctete GravellC�t . =. A�uaar Space Width • mches Water m Atm Spac� Yes �No Me�od of Caar� Puna�ed. Press�u+e Pouc�ed � Depth d� to 2� Ft l�sateriais IIse� � _ No_ Bags Portiand �t " Weight o� 1 Bag Pounds . _ � If m�re (sand, gcavel, cut�ngs) – Ratio to - . - ID pla� �Yes_ No 4 a 4 siab ✓Yes No - L�er. - . — � - _ .ti �p�: Dax� Installed Grou� Installed by . D�� � - Location Drawing . I�om To Rorma#�on ` � . • � - �L S � � �� t�� ���� �°� .. - LL - �j : � �� ��� 1 Q . " - ��y � , . -�— . . _ - . . --_--- � . . �. . t� certify t1�t t}�e above� iufc�ati�t is comect a�d ffiat t�is well was cor�ted in ac�dattce wi$i reg�ilafians set fa�th by ti�e Person CaimiyHealih De�rar�t. . . �.J� ' �� ' f �� � �.rfV l�r� �� ID# Z�_ na� �_E o-?�i'-o 7 � �'amp I�meat ' . Pnuip 7nst�llation CflNractor: �G/he.. C�'( (� ��� State R,egistratioa Number. I 6 G I� �P � � � ft Si�ic water Level: z� $ � '�mp Make & ModeL- ,�� G�c� c{� � � piu� S'rze and Raxin�- �� 2 hp� Gv gpm ��Y �Y �� P�P was instalIed a�d the well he�d �compleYed acc�dmg to the Pe:san Cocmiy Well Rules in effed xi t�is date a� fi�at a cc�y of this racord has bem p�vided bo �e well owne� , P!wnp in� �re f./ , �- .� � Date: C ��"�^� P(�iD rev OU27/04 , _�' - • '7W _ "�'r t'e�+ `t'� J _ 3 a R `,ns���l�ed�. � �'�'a`�y �a�- � -i� 1o,a�ot'l 1 ``�'N ��e. '� �' !ri ti`� b�sf- 3 8,'�- 10�'�" �� �.vGnS ��s �''n�`j `3� . Ch�CK'P� w I 1�►1cS2,�r1� �nS�e do � �� -���' � �� �, . �e b�� ��- �� 5 a �, no-t- h�re. � h ,'� `� � '�5 ��� �� .� c��t t J�e,r�-� 41^9�" `�^.e, 1n� ntia��1-e 1not�.� �`( �'tns C�� ��5 d�U. a 3 �� `� �,�n ��e, � p P� � � `� � �I-�-6� _ � o �' � p ���� � ' � a L- � � -�-� �