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A40 393i "�b— 13-02 .��: : 15f� � Q. . . . . .� . . ..--. . ..-- . . . .. .�,13 � � ...._ . _. ... . .��--�"' . I� ^ . p � � ���a�: �� -j`j '� �1 J . � �c A�r��k '�--� �. A.:�aaurtlf��d: l-/_�r? � . � c;.T-� .. �-d- •. � . � �`:.. u��` ,"c S �F � % ' ' � ��i� O\ _ �P'�at��k %- cv / ,� � V;��- � ._ �/�? 1 �'�=�� '�.��� � � �� � �,/�; �) ��'�.-� �` y+ � ���.tf'.L�F. � f/��i .._..,+=-- .� .JL • , . ��. – �a��Es.w$ I�'3C�-+47�. _:: L'. ���: , �:a �•:�a; P.02 i;�o-�i4�3. � NYALI�_ � - � '� � P�".�t �s�d 3�!►? Q+�rn��� �i= � � ::n.-r� j�.! �ti=f�r�-�l . Htil�'10 �ii01� � � � �� :�� �— A� �'.5 �•LsY E:' �Yc�� y � $IS�1M� i�IQI� �,- ::,7 :, �% �/ �J ��/ Hp j'�ii115&! iDl� �d�t� 4f Ci{17'�i� O�Mt: �� i� c�?r+-d� • '-.-'. ✓ 1 . . �03 �� ��q► �.�n: �..� � ..,�� T� `�!� �� ����.�_Y �� ��'-- �i� Dii'�lo�s Oo tt� �t,y (� rosd, nnfre�e � tt�t�w's): —�'�"� ""^ �����r , fr4 . _.� �� i�a�d Up aRd � p�; �wdr �h o! the �a c�tt�ia� �) �d � � �ds�in9 _. '�iPe ot si�+x�urac � yNdtiX.� p,a . bi � af Bedroom� IHumbat e� oc�.up�a o� peopie bo b4 aatva�t .,,�,,,,_ �-"'— c) ' 9�emenk Y�s ;,, Nn _, V1�li it�r+o be pt�ar�ing in 1lse ba�trseni4 • .. c� C�b�pe �k Yes _,, wa _ . :�� ul�e�r �Pi�Y'�Yf� PrwaO�' �!�r�r �... �'.eod�ins .�. �a_, �t ..,.., sP� _ . �s��eN � a► ad,la�r� p�ty'�Yoe _ No _... IlYe� F1e�e �dl�a�a �+ao�s 6��{on an tt� a�a pi�e. 1 ' • , �) � tl» p�ap� voa4i4 p��y ���i wa�d�? Yes _ No � ��'�.�1� NCiE Ti� !� L[� �. . � A Pl.J�►7 OF't!E �`�Y t�t SiT.E Pt,J�N YLI�T P!� � WRii 7HIS AppLlC,ATi�; � PI�tiPFRi1f L.11IF.� �ND i�18T 8E d.F�RLY 111��. � 17-ll: �P08� Lr0['.M77�DW ah A�,9.., ��;�� � � ��11GLD GiL �l.�►�. � 7�NE �'9'� �iLISi' ��ADIi,Y A�LE WR ��1N gVALtJATi�Q�N BY THE I�ALTH DE�+�r1�iT SiAFF. ��r ��n to ihe P�+on CauniY He�lh Oa�r� fi� a� e� '16c'Itu� cp-ei� pe�� � ��d ��y � a�r�e Utat tt� � a� tfubs �tlq� ane ttue �d r�reeec�t ihe m�m �`��tas Go ba on tt� p . I �fi ftua s� ia ai�ed ar iite irtten�d u�a ct�a��g�, iha � s� � ����'�yr��'`� �� ��� V�:1�i{ W aTr�� Rr�ci�1''� ' ( ;7 ,Z L•' F' / y • --:^ VCW �.►}fl. l� ioiliiQi a�a `�`1�� i , �� �1�G ��J �� �' � � ���� 1E��.a-��� ���.�.I1 1HL�,�.Il¢Il�. Applicanl Location: � T��x PlG::��� � ' -:�,rc�-c�l .� S�u}� ei i v i:�i �.n % -.�� a 'P ia;a�ti.c� � S e.c ti o�i�� � L.a t# �prmveffient Per�t Pe�amit'�alid for '� �'ive Years. rTQ �rirat�on �� Y P� �u i Type of Facility: ;' � � � � New ✓t�ddition '��ter �upply !/� # of Occupants L # of l edrooms � Prnjected Daily Flow �C� g.p.d. . Proposed W �tewater Sy�tem: �.� ,.�e�t ' � � � . Type: �L � Proposed Repair: C': v�<� ': � � Type: ��. Permit Conditions• ' S� S, Owner or Legal Representative Signature: . Authorized State Agent: � Date: �^'� j `� �' � Date• � ,2� �- o 'The issuanco �of thia permit by the Health Departmcnt in does not guarantee the issu�nce of other peanits. It is the responsibility of the �PPli��P�P�Y owner to in 9ure that a11 Person County P�lanning and• Zoning and Building Inspectiona requiremente are met ThIs Improvement Permit is subject to revocation if the eite pian, plat or the intended us@ changes. The Improveanent Permit is not affected by a•change in uwnerat►ip of the property. This permit was issueal in compliance with the provisione of the Nurth Carolina `Laws and Fulcs for Setva�e Ti�eatment and D�osal S`vstems' (15A NCAC. 18A .1900). Neither lPeraon County nor the Environmental �[eaith Specialist warrants that the septic tanlr system will continue to funcdton satisfactorlly in the future or that the water supply will semain pota6le. � � AIItI1O�lZati0ll to C011�ti'llC�'�a3t�`P�&$e�' S�Ste�il (ateqnired fos ��tildi�tg Permit) �` See site plan and additfonal attachments (�. Proposed'Wastewater System: (�i�cr�-�c���f Type,� Wastewater Flow ��.p.d. New ✓ Repair Expansion So� I.'�Alt: •� g.p.dJ ft 2 Type of Eaciliiy: 3!3/Z �%�,, G��./ .�s-�'n�/'�-.-�. � Basement Yes �No �astewater Sy�tem R.eqairements � Size: Septic Ta�: /DA3 gal ,. Paffip �ank: ^� g�l� Grease Trap: — gal field: 'I'otal Area: /�� sq ft Total I.ength r�o ft 1Vla�mu� Trene.h �Depth -� � �n eh W�dth 3 f� Nyini�irm Soal Co�er: � iia Minimum Trench �epazation: � ft : JDistribution Box Speci�cations: Author�zed State Agent: „� Perrnit Expiration Date: Serial Distribution Pressure Manifold Date: �'-:�y o `� The type of system permitted is /Conv, tional Innovative Alternative. I accept the specifications of the pennit. ' y � . O�vnea�l�..eg�l �epr�se�tuta�e: � , �� Date: � � 2- g ' � � � � PCHD7/30/2002 �"��,;,5, f ����J'�� �_.= � � � ���� �'`.'�uad-alr-�nana���.�.�n.� ����n.11.��n Applicanl Location: �� Tax M�p • Parcel # � Su�bciivision �• .. . Phase Sect+ion Lot # • # of Bedirooms Operation Permit System Type (In Accordance With Tabie Va): _��, 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 COIVSTRUCI'IOIV AUTHORIZATION. .' g � ao_ �� Authorize State gent Date Installed By: �.1-d- � Date: Q-ao-�N b�� ���i c.'� ` � s'w'�a S'H��� , S'V � S 1 5`c� (J6 qo' .5 O � y-� �1r / _�9'� u� `���1� � C{����4 C�—Ic�--t74 ��—ft9� s-��-3au 35� �% 3�� 1?� � � �1 �r� �_..._ . . � �,,-- . , � G � PCHD, re . 07/29/04 s��nc z���c ��s���-noN c���x�sz �r� n � Tax A�IaQ # �co Parc2! # 3�3 System Type (Tabie Va) �11� , OvmedAQpiicarnt �,.,:,, , �� . Subdivision �,�,,,� �S AddresslLocation-� SeclPl�ase !�t # l u3 �� � . . . Septic Tanic n cation es n . . State 1D/date �-i�--�y S�a-3a� G� - T�+enct� Width ft 9�2�-oy CaPa . �-rs -r� . 9al. -� Trenct�. D a� m. � . . Tee and Fiiier �� � Trench Len � ft ,� Baf�e � � �' Tcenc� Grade � � � Sealant � Trencfi S aci� � � � Riser rF licable Rodc De and Quai' ✓ Tank Outlet: Sea! � - DaEnslSte owns etc. • �� � Pertnanent Marker Pressure� Laterals � � � . - - - Pump Tank � Hole Spadng . . . t2�e e � � o e .. . . . � . . . . � Ca city . � Pipe Sleeve . � . . . � � . . _ � � Wat roaf /Se�larrt � Tum-u Protes�ors � . . . . �� � . Rtsec � � , �Requined Setbac�Cs . . . w�r�r t� - � � F�om w� �. � � � � �, -ao-� � . . pump- � From Property lines � � . . . �edc Valve/Gate Vaive . � � __ � Structur+�sJBasemertts.:: � ".� � . . . i on o e . . . - es rai � e � a � ✓ : .. . . . . �� �ioatslStiviict�es.�: . �� . • .._ . . Surface`Wabers . . . _ . y . . _ .. . � ... _ . Alarm visabie and audibie Public Water Su Ges �. • Eiec#rical Com nefrts Vertical C�ts >2 ft . � Rate m Wafier Lines A� roved P Mode! Veh�ie Traffic Btoc�c Under Pum Ad�aaerrt� ms � � �� Pu Rert�ovai Ro e/Chain Easem ' trt af �A/a �- �Distnibution System � Othe� S"erial Distn�ution ' q��y Easements Recarded .� . ��e � e r �tract L.iow Pressure Pi e . Tri-Partate Agreemerrt r. Pi e Mate�a! and Grade • v�� � � . � .comments� . { . pcf�ci rev. 3113/01 a �� � �-.���. �� I�I��3� ��T . ------ �== � � ���� 7G �� a- � ��.e � �.�.Il IE��I � �.Il �1� SITE PLAN � N Name � �r- ��' Tax :�Iap # ,T yo Parcel # 3J�'3 Subdivision Ov "�'c� e S Section/Lot# /03 �%�- S -�3 �- Aut orized State Agent Date Sysrem companeats represent approadmate coarours only. 7Tie conmctormust flag t6e systempdor to beginning the insta//ation to insure r6atpmpergrade is maintained YE�L��GTQ(� aF���IE ��' F� �'�f N �/ � �D 72 , �nSfi� %� �-s� /07 � Cal 1 ��eS �S �p�n L.✓i �l Q�l�6 y� . V' Scale: � � = SD � I �-tiJ.."f"�� �.�:C'43' 3��rE PCHD, rev. 09/12/01 .. ♦ �����,�� f ���� �.�.. V i ��. � �.�� � � � � � � '" � -�S.�a1Z"��*'n'*�rn ��.'��1.� ���.��1Sg. 9�0� 5.:� u• a'�lGjlil�/� 1 �I,�� ��� A'3"3'AG��� �'�.AsI�T F�� WEI.�, Sg'�'� ����J�' 'I'ax 1@i�ags #: � �arcefl # 3 9 -� '7Cowns%i�p .,���, �� �'�A�e.^ ��pinr.�aa�: .�� �� �:z Subdi'�a�ao�a:. �� � �^,'r..t�s � �t'�''t��: Se�tio�n: I.m�: �� .j �ca�ioa: • . '�'�e of Water Su��1ar � diPidual Community Public Rea�anaa��neaat�: Site Approved bp C� '7 - 3- S�-v �i Grouting Ap roved byC� 7- 28-�� Well Log ��7- �F� -� Well Tag � S �j-2o-oy Air Vent JS � 'Zo -o� Hos� Bb �iS q -2v - Concrete Slab ti S 9' Zd"� We� Da�.Y�er. � � a �l ��. W� A.�s�ra��es� ��r: ��,�e: � -Zo -o� '�S�e A�c�esi �ite Sketc9a� 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 condib � PC.�ID, rev. 09/07/01 ���.s� �I��:��� �o�oo� y� - - = � � ���� ��,�,���,,}��,� ,�,1��JQ �� �aa�n�r��ta��T-�+ ��:a��.� ����.��� . L°Kslli�l� LJIfU�UI�I°J ! ��C7 `d �� Grout Log Owner: �\� F'L- Tax Map./��0 Parcel # c� g 3 Location: Subdivision: � � �2� S Lot #�0 3 Well Construction Distance From nearest Property Line (Minimum 10 feet) �� Distance from Septic System (Minimum 60 feet) l�"� Total Depth: �O ft Yield: C� GPM Static Water Level: �► T ft Water Bearing Zones: Depth � ft 5 ft ft ft Casing: Depth: From � to l C ft. Diameter: �_ in Type: Galvanized Steel �� Weight: Thiclaiess: l c� P, Height above Ground: �� in Drive Shoe: Yes No An y 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 � t�C� Ft. Materials Used: � No. Bags Portland cement Weight of 1 Bag Pounds If mixture (sand, gravel, cuttings) — Ratio to ID plates: � Yes _ No 4 x 4 slab�_Yes _ No Liner: , � Depth: Date Installed: Grout: Installed by: _ Drilling Log Location Drawing ��� � � ��, �� � ii .s �.� - �� — , � �Y���=�,� � • �, I���' ' �`� �� � ���. I . � � �� •�/' �� j�� . . ���� ' a • , ,� � I hereby certify that the above by the Person County H�1�I Signature of is conect and that this well was constructed in accordance with regulations set forth ID #�`l� Date % '��'0 � Pump Installment Pump Installation Con ctor: ���� State Registration Number: �C2� � Pump Depth: (J� ft S tic ter Level: �2 .5� ft Pump Make & Model: G-c��-�? � Pump Size and Rating: �hp �a 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 this rec en provid to the well owner. . Pump Installer Signatur ` � Date: PCHD rev O1/27/04