A23 110�
�
d� `�a` q �
� -��
.�
�� o
�°�
� ..
�'1 y
w ;: �
��
�
zo �
A � M
�b x
R�o
�w.. w M
O "�
�
� c ?
� `�q �
°» G o
'�y A �
K �
° = o
b 5' �.
. o¢
y 0
o � .-
� o °
��
� y
� � �.
'� m
~ �• c.
5
� � d
m �
�
�
�R
� �
� �
� o
O ►s
a x
M o
�
x o
d
.. y
. �
� A
�
� �
o x.
H y
w b
� �
�
fD N
R w
�. m
�
F�., x �e 1r..� i�- � +Lo N s�-
t,
�o ����o
�Rq-��3'7
�,�- .�2�
Person County Heaith Department , �
Sewage System Improvements Permit
Date:��.s:Zd�This Permit Void After 5 Years "��
OwnC[: ' $R# ��_
Locauon/Directions: "'
�
�
Subdivision Name: � Lot #
Lot Sizc: Type`of Dwelling: .
Water Supply: Private: Public: Community:
Bedrooms:��L. Gazbage Disposal
Basement Basemet►t Fixtures ,
INFORMA R D BY
5����. oµncr or represcntative
�pp�; REEVALUATION:
Size of Septic Tank: —��— gallons � Size of mp Tank: ----
Nitrificaaon Line: �
Depth of Stone: 12 inches �"''r ' �'^
Max Depth of Trenches: ��� 9�
Alternadve System: Conv. Pump �P ��►�►P
Remarks:
-------------------------
Date Well Approved: Well should be 100 ft� from any sewer system
BY Sanitarian
Date Sewage System Approved:
gy Sanitarian
CERTIFICATE OF COMPLETION
Contractor.
�
�.��.���������.������.������������.�� �
Sewage System location, installation, and protection must meet state and local '4
reguladons. Septic tank should be pumped out every 3 to S years and shall be maintained �
by owner in such manner as not to Create a public health hazard. Septic tank and �
nitrif"icadon line must be inspected and approved by a member of the Person Counry
Health Department before any portion of the installation is covered and put into use. If
the site plans or intended use change this permit is subject to revocadon.
(G.S.130 A-335F)
I.ocation of sewage disposal sewage system sketched on back.
(OVER)
e � `
,� 6 � � „ .,. . ... .. n �,, � c
i � � , 47 3 -j�`
� ���.E �A F,a,
�� s
�q �GJ' � � � � 6 �- � l�- O'S
N- 2 ' � � � `: .
�� s 0.92 AC. �', �
�8� � p. 92 A c. �, � p, 92 A c. �' 9
�'� � 18 � � ° � � � p �i
,� .
, 3 't � �3'2 .9� a' 6� , �v, Q--� •� ,J,
, ,
� K
�
N� 6�z� 0.92 Ac. � � � �E :�
�j �p tis (�j R
�,; sy �r : a � _- — ---�. -
�9 ` � .__---�--- ..-- 69 31,
j 9 � �
, , 3c .. ,
� O ----.... . __. .. ._ 79
!� i
6S " h� _.. �. �--�� �.� -E " t a 6. l a - U� �E -
0.92 /-►C. ' � —���--- ___._+.- 78_�4-G4 � � N_T8 �- :
%� N_ � 6� 2 7, 2�6.1��_ - 10
6� � �- �
� � ,�, .
` _ E i ,p , � �t� `p4• p0 _!•-.1 '' ! _`_ F �
N- 87- ��• 26 , � � � �;
� ',
aoo. oo ,, �-- � _:�so,:d�4 � n
_ �,
. .:, � _�� — a
. ,� , / ,� � � � �; � r
. 20 _ �
o, .9 " �
� � , �
, . , v �
{y N tp Sy 00 �� ,
�0. 9 4 A c, �� o�'��� � w�.. , N�,.4.. � �.
� 4� W - ` p 1�5" �-�+' ' '
c� � ` 7� �,. ' p O``' -� a N, y I C ' Z 5
, `,, � " � 3 rn 3e �y � �,
Q � � � , 3�'c,.
� a'. \ �" 4' Cr _ 'h _ va �
ti t � (,� /� C i
�N �' � 2 i �� c�: t� � ',� 0.✓ I"'� •
�- N Cp �
�. / c � � @ 9 ,
s� o, S ' 2 3 0� 2, s �
0 9? Ac. ' '" '
�s. s � .�
• � O �� tij�� � Fr? O
� , ��,• . s�,
� g � � 2 2 � 0. 9 2 A c. ��. .,�, `� �,� �, .i
� -' 6 o ye' 0.94 ��• � �� `,,r. ` �O G,
\ . 9
i/, T S 85-04-OS-W grO'� '���!- _
0' 'o -�
`\� ' � �2 �� ' .�.� ' �
_� 8 ` � \� c,,`7 l� _ _
� ��\ " �'. ' op � _ �1�1 j -- --- •
- > -r '� 1
A 1282
PERSON COUNTY HEALTH DEPARTMENT
WELL AND SEWAGE SITE, LOCATION IMPROVEMENT PERNIIT
Tax Map #�� Z.3 Parcel # �
Zoning Township �
Owner/Contractor Q�� Date -2 - �
Location/Address -e ; T L` � 4 � � s1 /�
� k 5� i�'- o C�-E- er� o rl e S.R.#
Subdivision Name ,� Lot# a y
SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area Size of Tank -
SFD �/ Mobile Home Size of Pump Tank
Business # of Bedrooms Nitrification Line
Max Depth Trenches � �
Permit Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site is ed or intended us changed.
Well and Septic Layout by
Comments:
Date 11-5-y� n
+ d �,�1�
� ,�5
.�
Comments:
Date
Installed by ,��` �- N S Approved
This report is based in part on information provided the homeowner or his/her representative in the applicatio s mitted for this permit 'I'F"ie
environmental health specialist is not responsible for false or misleading infomiation contained in the applic n. The environmental health specialis�
is also not responsible for concealed conditions on the property or for statements in this report that may have resulted from false or misleading
statements provided to him in the application. Neither Person County nor the environmental health specialist wazrants that the septic tank system will
continue to function satisfactorily in the future or that the water supply will remain potable. c:�amipro�permit.sam Ol/95 rev.1.0
ORIGINAL
��i�:r,::ur�� �:���►,v�rr I{I�V I 1tuNP:::N�rn�. iu�:nt,��u •
�.
�ri�:i.�. ►.uc: �
• - ' ' ' ' ��lL�:_�:_.%�-�� �
Owne�: �.lu.dy �-
Loc�,tion/Dir(;ct� Q_�,�
�a ; nrt - ��f� a-'f. ._... . ._.......-------_ ����
.
-------- --------� . . .....---�--
---_
�. .. ______.------
..c:l�;'�vi�i�i� :Nan�ic:: . .
�t'i�1i1� ...__..--- . _.___..__
f,,' CO;1LI"�1CIpi': _,�'��n-s }-� Y�" - �.�. .. ....._.._._______ OC 7
1��- �� �.! ��..�. 5 -i /� L .
. � D�sca��cc 1;ro:;i Nc•u , 1'�!i::.l .f C'C)N.ti�l'I�_l I(�'I�(( )f`_G ..___..__._ ----�_
.�cst 1 c�r���crty I,i►�c� /-��/�s .... Ijis�:i�lc� ,Cro�ri So
Pollution �� urce �,� •
Total llc ,� .
p.�.. �:�. l'icicl:
Watcr .geari ; y7 ;L _ _ ..._. % a-.: (:;. >
� ones: [3ep�.li __ ��0 1�t ... 1 n� .��:i.ic Watcr Level
. �,�in;;: �U�.,,�li: Froa��._� _. __..i � - .3._�,St�l._----- _rt.__ ��t. `Fc.
.
' ' � � c�
.
� Slcc.l •�.
.. . .. . ,ic. i
._ .
:. �, • y
)� •i► • .. .. G
`___---,..__.----... ...__.. C,:ilv:iri»c�cl �tc�l .� `"�`__"'--L�ches
X.( S[ccl, docs c�wlicr :i�,��rc�v�:: Y�::, -------�-- � •.
. � Wci`;1it:_____�.� '1 hi i� -----..._�__Nc� �---'__— .
�rivc: Sho C�`�✓�s:.----Ld��! .I�,(ci �1it �16o G .
c: ��:'�s_ ! round:�_���hes
� l�cr�: l'.roblc�i;:; I;licc>un(���.Nc„�l__�..._--- �
Zl� ., � . � t�.�nt; �.ltc C:11TJI1��� a'cs .. . —
,Y,:�'�� �1Y�; ]'t::lSU11: --._---_� ��tp C--_
Grot::: '�' ._..... __ ...._. ---_..
� Y.p��• Nca� ,�:,...__. _._...__ .._----------._�._
; � ------.___. I1<1/(,�C111C1][ �� • •'�''
�J�I11: a,i'. S�SCC; Wl('�(11 3 __--. �. -______.Concrc.tc � . . ..: ,
. � ' � -_�-- ._.�.. _ . "'-_ ' --- . �,iY
�l IC : : 1J 1 Cll C ti -'_"_----'-� .:..
� �.Illlll;:lr j )�l(:1:: ' :
'' M c t 1�:. �- � I 1 c� : �
� d. 1 tu,ij;::cl�ti�--- ,.;,., ...__.._. Nc� "
� � . .... _.. . . ..__..
� � �, . � c....,. u i _
.. __ ��:
�P � � �rom - ---- . ...__._.. 1 '�, t. . . � , .
u-ccl C�_
- ---� . _. � � � � --------�. _ . •�•
Matc: : als Uscc1: � �----_ ._I't. .
No. .Ciat;ti ,l'c�tl.l:tucl Cc>»cn[ '
Ifmi..:tu-c (szii<� � , - ___.... __ Wci �1i[ .
,f� � , f,r:i� cl, c:u��in,;�:) �- I�<►(ic�: L o.f.l ba�; ��lbs:�:
� 1..�cs: �'cs �--- Nc) --- --. �� Io .�
, �� x �I . :.ib �'cti -- _/ .. -Nu ..- � .. • : � • .
.-. _.. ._ .. .._ .
L..'. ----- _.. .._... _ .. ��� I� [ 1.1.1 iU( ; I .�X�;
�--
_.._
I;r�m ' T'o-_..__ __.._..___--...... . ... .._...___
- --------
----_ .-----._._... _ ..._. I:u�ui.i[ic�Jt 1�;;,
—�Q � .. .... ......�____.
� --- �—�._. . ---_ .
_ ...._ . ��. w�--
�___ ..._
----�- - -�.. . ..._. __ s��_� d , ._.
--..
_--�d _ �r . .S..Q � l
--_. _.. �..A:n c� bQa �Y ��-_.---� --..
�--�-�a .. � �j _,�- . � - .Gr�t-n , �--.�- ... _---___._ _ .
� �:
.l A :.��G.C7�rCL��,,l'1l"'.lr ��j•� ....•1.(1�.t.).�.���V ------�--_ •
�`: :;s wE�-� w:�'�s coNs ��,:ulCl'L1) l(v �" IN��UIZT���1'1'�ON;(S CORRECTANDTH% ��
�'. `T�Z � �`.TI-I � PLIZ ACCO1�llA,r1C,� W1TI-I REGU � � '`�'
.. SU: ..���N��1•y t�[I:nr:I�I-i i)I;1�n�,:�[�ML'•N���, . LA"ITONS��S,�
��
�
-: -�} . . _ �� _.�/� � .
.�1l�Jl�i�ll('C t)� �,Ofl(�.��:I(i1' ..__._.__ � .
Datc .
.,.,�-:..-..+ . . _
PERSON COUNTY HEALTH DEPARTMENT
SUBSURFACE WASTEWATER SYSTEM MOlvITORING REPORT
i o a� ►�
Date of Inspection
g� CAt�..
�s � �►�
System nstallation Date
0�...
Address
�.t� A�3 � �io
Type Tax Map Pazcel #
L ��
Instructions: Check yes or no for appropriate items and explain in space pravided for rem.arks 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 pumping ?
Inches of solids:
Septic tank filter cleaned ?
EFFLUENT DOSING SYSTEM:
ftequire3 pumps areser.t & fiu:cdonal ?
High water alarm operating properly ?
Fioats, valves, etc. in good condition 7
Control panel & components in good
condition ?
Effluent free of excess solids ?
Inches of solids(pump/dose tank): ��
Elapsed time readings ? tJ
Counter readings ?
Drawdown rate: �
YES / NO
❑ � ❑
■ ■
■ ■
❑ � ❑
L� � L�
❑ � ❑�
� � ❑ •
�� �
DISPOSAL FIELD:
Evidence of effluent surfacing 7 ❑
Evidence of effluent ponding in trenches ?❑
Surface water effectively diverted ? '[�
Diversions/swales proper:y maintained ? �
�eget3ti�e cever maintzined ?
Protected &om tr�c/unauthorized uses ? (�
Di�tribution uevices iii good condition ? �
Field free of settled or low areas ? �
/
/
/
/
/
/
/
/
�
/:
■
■
■
■
■
■
PRESSUtZE DIST�IBUTION SYSTEM: ��
Turnups/cleanouts/valves�taps intact &
accessible ? ❑ � ❑
Pressure head properly adjusted ? ❑ / ❑
COMPLIANCE:
Compliant
Non-compliant
Needs Maintenance
.�
■
■
REMARKS
5�ic. -� �.1K. +�►� A`-� s► �� q,b�v,�
�'09�' . �.c.oe►�� f1c,c�sS ��fi.
�. . .
' A��r. r1�r s�u'u►��z vars-s�0€.
i4"Z' T�11�►� � Ar�t'�. LO �4�C�u:1 �� i qC�
���
HTlU1T1V1VEiL l.V1Vi1V1�i11 J: GHF�` ��1'tl�+f" • r�'M` ��"�S��L '+V+�S� � M j��
�11�L ��-%�l L S i�VT' ► l�l � � �-l�C�.. �V �{�L..
EHS L�c.�i-i�1 U�- A• St'1 �"�