Loading...
A41 35� _ ��e �;r �>�r� , . � The D�str�cf Heatth Deparfinent Orange, Person, Caswell, Chaiham, Lee Couniies SEPTIC TANK PERMtT Date � � — �� r � � � � Name of owner: � � Y4ttyvnctq� . .i Name of contractor: Address and Directions }�! 1• �V� ! (Y iC i �� �, .�� n , 1 . . /n ���- li Person or firm doing installation: / Address � No. of persons to be serv � Bedrooms 1, 2, 3, . Additional appliances to be used: Disposal, dishwasher, washing • �-,... machine Recommended: Septic ta /� ; Nitri�ication line: ��'1 S�✓fi"rc��-�-�1� 04 X 3� o� � on �D.Z,�,-�'i, d��bove recommezidation based on information receiye and observed Ic`��`ksoil condition. Septic tank and nitrification line musi be inspec2ed and � approved by a member of the Districi Healih Depariment sfaff before any portion of the installation is covered. • Date Approved: / �-' yb� SignecL Sanitarian By: O. David Gazvin, M.D., M.P.H. District Health Officer Countersigned � rs � � �.. � ������������ �- ■■���������■ ����������■■ ������������ ■■. .■■■■■■■ ��� ����■■��, ■■��.■■■.■■� ■.�.■.■■.■■� ■■■�■.■■■��� .��■�■■■.■�■ ■■■��■�■■�■■ ������������5 !!!��'ir"ii i'r.%�����i�■ Ii�ll�l�����C��1�� �1.." '�.�i"i�"ii�t�!��■ �✓������■■�■�■■ r��;�r.�������o■ rir����������■ ����,��������� �i r/�■�■■■���■ �����I���l:�l�� ■■■■■■■■����� ■�������i��1� ■.■■■■■■■■�� ■■■■■■■■.■■�� ■■■■■■■■■■■�, �����������► ' ����.J� ���� � � 1 � _.: -�� �- C� � ��T�� I��d-�a-��„-„-„ ����.IL I����.I1�II�.. Applicant: �JI�edC.t-�G � /�� ��'v1 Location: , i r � Permit Valid for !� Type of Facility: � # of Occupants � Proposed Wastewater Proposed Repair: � T�x M�� � P�rcel # s���n����5��0„ Ph�•se Sect+ion:Lot # Iinprovement Permit Five Years No Ezpiration � � S� S New Addition Water Supply of Be�rooms `Projected Daily Flow _� g.p.d. . System: � Permit Conditions• �� Owner or Legal Representative i Authorized State Agent: Type: Type: Date: /� � � Date: The issuance of this permit by the Health Department in does not guarafftee the issuance of dfhei �ermfts. 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 Lnprovement 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 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. �Authorization to Construct Wastewater System �Required for Building Permit) * See site plan and additional attachments (�. - Proposed Wastewater S stem: C �;1%� �j�� l Type�� Wastewater Flow ��a g.p.d. New Repair� Exp ion Soil LTAR: °� g.p.d./ ft 2 Type of Facility: ��� ��� _ Basement _ Yes �No . �`5�,� Wastewater System Requirements Tank Size: Septic Tank.� gal Pump Tank: � gal Grease Trap: gal Drainfield: Total Area: ,'V � sq ft Total Length � ft Maximum Trench Depth c� in Trench Width � ft Minimum Soil Cover: �_ in Minimum Trench Separation: ft �-iJ � Distri6ution: � Specifications: Distribution Box Serial Distribution � Pressure Manifold S� s����e ��e"� 1 A� ����� C� (( S�i�=(� 2�. Authorized State Agent: ��� Permit Expiration Date: Date: – Y�� �/3��� The type of system permitted is on entional Innovative Alternative. I accept the specifications of the permit. �— � �� Owner/Legal Representative: r Date: — � - � � PCHD7/30/2002 \ ..��� � � IPI��.� �0� ,.._.: • � �C �� �T�'IC'�Y 1E;sa-�ar�anana�ean�mll 1E-3[.c�.�.JL,EILa Owner: tS'i �;}}- Tax Map: O f Parcel #: 03S Date: ��,� �,ine �ap �ap {Sch) Tap g+'low Y.,ine Leng#h �'lo�v / %ot # Diaaa�ete�(�) ( �a) � (ft) 1 D.l �oo , o B 3 4 5 � • 7 S �0. � 9 &0 � � ft of line x 65 g, per 100 ft = ; 100 =.jg� gal 75 °Io x 1R 5� ga1= gal �er dose �� gal per minute (gpm) _�'low Ita#e Friction Head �/ I.ass: d� ft per 100 ft of supply line x i.•74� ft of supply. line = 100 = ft l•? ft x 1.2 = 2•Z ft of friction head I�Ianifold Size: ._ .?�' " I+'orce 1VIain �ize: Z " PVC �ot.�l Dynamic lE�ead =10 ft of Elevation head +� ft of Pressure head + Z•Z ft of Friction Head = 1 � TDH P�mp Require ent• �v GPM @ t�. ft of Head Drawdown: �al per dose = 21 gal per inch =_� inch drawdown per dose �.�� :r:. .� ;� � ��:�,, � • �� — ��� a�����■cs — � . , . . , ,. � ._ '� i i i i , . ��c���o�o _o -�-o-a -�- - - - -o-�- - - 1�1 1�1 (�) 1�1 ., ���i*iiii�����i��i��iiiiiiiiiii �.... �..- . . 1*��1.����Nl�N��l�l�:�!!!l���i� � � � � : a : :: v 2» m�a �c3ie�nie �30 �� I�aadlfm�R ]ewtlmweto: 9 mc�s I �S � • l�[�nifoid l�Ianiiold 1�'ia= 4 9 / � Taps Taps ofi one side for ia in both si a�� {apg g» }e Z � 3 ��'-'1 ( 12 . . .. . - . -F%w erTa Sie sYlcnerial r'7o�v GPYI c• ,• Sched 30 �.5 �..• Sc;aed 10 i.: ;, " Scl:ed 80 10.1 ;; ' Sched "D j? ; 0 NEMA 4X Simplex Contml Pazul Y ''� 4" X 4" Pzessnre Treated Post � I Sloped To Shed Water �2• Sepuation � II@CtT1Cil COYldlllt .I 6" Covar • ' . Acces� Covez• .• , ' . ; ' 1 ; � � • — � ' .. . , • . ;, . • �� � ; 't•. .. �., Openins Filled With �}i Siphon Hok' \ P lan,d C t Grout Inlet Fmm Septic Tank °� s� �� H�� 4" SCH 40 PVC Pipa � ��� . Valve , �Pe Float Wires � � High Water Alaxm Lev+el : � (6" Separati�on� , ' Hi�t Level - Pump On i. :. ' � �� �VaporLock i � F7oata :.� , �, Hole • ' . . � Drawdahm �Up Hi11) � rrRem�ovable �•�. � ,� F7nat Trea .� Low Level-Puxnp Ofi . Duct SealHoth Concreie Riser Ends Of Tha Conduit --� 24" Minixtaim +� �� ' ' � � ' S" Separatiott Threaded Gate Yalve ; Union . •,' • , ' :i..[j.t/' . ��-Poztluvd Concrate ( �; Mutic • - ; Zip Coxd � � Opening Filled Tias Supply • Portland Cezne: Lix�e • • ' Outlet T� , u.a,,.. 2" SCH4( r. ' pu�ttp : ,. S Precast Concrete Tank 4" Concrete �, ;.; (MatesialStren�th>3500PS Block � I " �:•`.:�.' ; •� '-_� '. . ,'• . : . . '� . • �-ti,. ' • i � GAI,L�N PU.NIF' TA1�TK . ���+�� �� i ' � � � � `"' - ��,O�T�i'�'� ��.��-,�,., -.,.,, :���.�.11 IE-�,��Il�� � S�'�. S�'���I. Name �-� �iD� ����, Tas tilap #�Pa=cel # 3S� Subdivision � Section/Lot# A th ' e State ,Agent � Date . ° sy.�� �m�o�� �,�f�r �p%�����nrou� �ry. �''ne coniractor musfflag tlae rystem�ri�r 2a begiazning tdie instaAatsmn to insure thatprojierbarade is mainiained ,. . , _ ,.. . _. �• �� _ > , p� .. :_. '—t� ..__ . _.:..:_ .. ,:.: ,. . . . __ _-_ . _ _...__.---.._._ ._ _ ._ _ ......_ ._ , • ...... ...y. � . - . `�^ ..__..:. _ _........._ .,. �...... . _._ __ ... _...._....�. ...�:. _.. "_"_ L - ` ^f � .......... t v � � � � � � ,;� :�. � s � � G�, � � � � �, ` e� � -� � � s .� �. � � v� 3 � p� �' . �r ;",,.. S �.. J �'+ `Y � � ' �1 �� �"> �.� ~� �` �. s' ; � -� y � �,� 3 �= � o � � � �+ � L � � � � � � � ' � � � � �i ` o ___i__ � —.... . � � � � �! ,� ^ .--� "C .�e �� � y � � � �" � �...v�..v�y ii� � a 5 . , � C;; �' - — c:,, ..�� �..�—.. ��s.. � � 6 3 � � �- � t o f � o,y 'g j�'� 'r�•ly � � . Z c. oJr� o/y 'g �K • r�i-✓ ��. 6 � H "o— , 0'00� .�?' , o � o � z S~ � , O ` O 0��>=-�„ /�"� . � � v `% Z , - - • • - . _ • , r i �'C./ a�, ��d�t hs �n oh h� ,,a ri._ i ' c . { � `��� � � � � y l, �; 1 � � � } � � � -r j \O i . � \V � ��,�. � � ���4� 1� � �-y-�.�- � �--�� �� ��.11 I� � �.1I ��. �r�,tt a�l�r� ��I I ��c�0 N� S ����60� ������� � �off °-oi o0 3 Applicant: N�+— z��-�, t`�Y�,��r��e. . Location: � `� � � —i�'la N��r�\e N���\� � �e ����� � � �� . � �Z ���� System Type (in AccordancQ Wiih Table Va): T�?1S �����?J� �]�� �BEd� ��lS'd',��L��J' itV Ci36�P�1;�PlG� V�i i H���Ll�t��L� .I�QRTH � C;�F�i�Llf��� G��9Es'�.�L STAT�lT��, �UL.�S �aR ��i9iLA.Cc i r^c�.�i�I�i�T A�D DIS�OSAL, . �ND P'1��. CGf��9Ta�i�S �� � ii�E lii�P�Oii���?�T ����i(�' r`�N� COI�S 9 RUGTION All�NORl�T10�. ' Auihorized State Agertt Installet! 8y:_�'h►,,v,�� L_.ewis \�c�- � F � lD� ��;5�.,-��� L �``�, �,, I _ '��� - „ti, ..�.° . �. S� �� ��Z� .r2� �2. ,�Z�� „2i�� , 511 ,2,� �/ � �'?J SI��W d1\'f"�-� zL2L Ga#e , Date: � �����I �v`'-� 'J L�.s�eSCa 1v� � � 3 - �►-°x� s/�" -+�s `?-�s ►� � b� � !1 r� . i ;' !C`✓.� li ( �%�/1�i=� � ���7�� �'.�,,�� j����� � ��� ��?��"���� a { � ��� �8 � ���� Tax iVlap �-J�'� I rarc�! � 35 S�si�s� Typ� (TGb�e Va) i������_ Ow�erlA}�plic��t �1�- • Z�� Pc�r�>naQe Subdivisio� Addrzss/LocG�ior� S��I�h�sz �ot # � v���sc �°��k State � iD/da#� C� aci Tee and ��iter � - � B�f�fe / SeaiGnt � Riser i� a lecab[e - �'�nk Ouil�t 5��1 Perrnan��f Nlarker ��tma� �'��� Ca acit al. VVat� r�of /Se�lant Riser i/Va�t�r i � ht � ��r�a� Check �✓alvelG�t� �Ial�e Alarm (vica�le a�d audible) Electricad Cornponents Rate (9P►�) Approver� F�mq �VBode! Z�itQr i� Block U�der Pum� � Pum� Remova( R�pelChain ��is�raba��6aa�. ��s�ea� �e�i�l Dis�trib�tion Pressure Il�«�s o! Law Press�re Fi�e A r. Pi � M��efiai and Grade Vaiv�s a���Eaul���� �o��'��c��ao�u ����� � i r�nc� 1�lQdih 3 �t. � � � Trenct� D� $h z� ia�. � . T.r�nci� Length �� r�. � � i �� � Tr��c� Grade � Tr��ci� S�acing �oc;� D��th ae�d �uaie� Dams/�te�dow�� �fc. Press�re L��er�l� � Hol� S����ng �. m � iZB Plpe. S1�9ve Tu�-ups/P.roie�tors ��quaa°�d� �e���c�s� � Fram� UVells I From �'ro�e� 19��s Surfac� Ut9at�rs Public VVa$�r Suppaies Verticai Cuts (>2 �t.} V�ater Lines Ve�iicle�TrafFi� � � � �as�r�i��ts/Ri i�q t of i� ��e� �a�e�ner�t� Recarded ��� �� �ra�or oi �'ri-Fariat� Aareosnes� ��mme�� / J 0 / / --�h�l� ���,� � ���. �t1: �a � PERSON COUNTY HEALTH DEPARTMENT SIJBSURFACE WASTEWATER SYSTEM MONITORING REPORT $-13-1�. �-14-oR .1�� .�� -3� Date of Inspection System Installation Date Ty Tax Map Parcel # �`L�2 �rc��2 %�i ��S l'�c�. Property Address Instructions: Check yes or no for appropriate itcr,�s a��d explain in space provided for remarks and comments. If an item is not applicable, indicate by "NA". If an item is not or cannot be evaluated, indicate by "N" and explain. Note that this monitoring form is not totally inclusive for all systems. All maintenance and monitoring items specified in the permit are to be carried out. INSPECTION RESULTS COLLECTION SYSTEM: Evidence of leaks ? Tank risers accessible, free of infiltration and surface water diverted ? Septic tank needs pum�ing ? Inches of solids: 2 Septic tank filter cieaned ? -YES �/ N� LJ / l�J d�o,,._,/ ❑ � L1� (� � [� No� acceSsi ��P. EFFLUENT DOSING SYSTEM: Required pumps p: esen: & functional ? [v]� / High water alarm operating properly ? [� / Floats, valves, etc. in good condition ? �/ Control panel & components in good ,� condition ? I�i � Effluent free of excess solids ? [!� Inches of solids(pump/dose t ):� Elapsed time readings ? Counter readings 7 Drawdown rate: DISPOSAL FIELD: �/ Evidence of effluent surfacing ? hQ / Evidence of effluent ponding in trenches ?❑ / Surface water effectively diverted ? �/ Diversions/swales properly rr:aintained ? ❑�,/ � Vegeta±ive cover maintained ? L1Q / Protected from tr�c/unauthorized uses ? [� / Distribution devices in good condition ?❑/ Field free of settled or low azeas ? �/ ■ ■ ■ REMARKS ❑ $�WA��. SU�0.Ce. a'�' Mavlt�t75�� �� o��� ❑ ��Gear. ou�' �oraKe n A�i' Ma►'u'%o � ❑ PRESSURE DISTRIBUTIOi1 SYSTEUI: , �' Turnups/cleanouts/valves/tapsintact& � f' bro�en' S.¢��� Puyvtip►h� Orl �� accessible ? ❑ / � ��an6�zT ( . � c�rcun d (� � re c�e�e� i� Pressure head properly adjusted ? ❑ / [l� � ,t � Sa � COMPLIANCE: Compliant � Non-compliant � Needs Maintenance r EHS �