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A23 131t � � .. . Person County Heaith Department ; � _ Sewage System Improvements Permit Date:.��d..This Permit Void After3Years c� ��d �� Owner. � SR# Location/Directions: �� ii ��r ___ � 1 r �''�, Subdivision Name: �` •�Lot # � Sizc: �i T of Dwelling: . �ter Supply: Private: Public: Community: Bcclrooms: 3 Garbage Disposal Basement Basement F'ixtures r ` �FORMA C BY �I11L�7�71: oµncr or rcprescntat vc REPAIR: REEVALUATION: Size of Sepdc Tank: �%�c�. Sallons Size of um� T •� c' � Nitrification Line: � � Depth of Stone: 12 inches Max Depth of Trenches: ' Altemative Systcm: Conv. Pump LPP Pump D,�t ._ Remarks: P�'" Date Well Approved: Well should be 100 ft, from any sewer system 1 Sanitarian �[e Sewage System Approved: BY Sanitarian ,�CERTIFICATE OF COMPLETION �ontractoc ' �-.� � y„� � �, :; ,. ------------------------ '-3 � Sewage System location, installadon, and protection must meet state and local '� regulations. Septic tanlc should be pumped out every 3 to 5 years and shall be maintained � by owner in such manner as not to create a public health hazard. Septic tank and'd nitrificauon line must be inspected and agproved by a member of the Person Counry � Health Department before any portion of the installation is covered and put into use. If thc site plans or intendeci use change this pemut is subject to revocation. , (G.S. 130 A-335F) Location of sewage disposal sewage system sketched on back. (OVER) w ' . 1 � -C c �� ' � Aaalication Date: .r%`�v~� � Amount Paid• Receiat #• Person Countv Health Deqartment Environinental Health Section APPLICATION FOR SERVICES �ax Maa #: � `2 3 Parcel #: i 'j / 1) Permit requested by: (Owner/a�ent/prospective owner): 1'1/�1Y� � m o a n�"' Home Phone: _33� 2-`��L ?iSl � Address: � 99 j'�'�'I (�.��f'G� 1-2�' Business Phone: m i LT a dv;��,�— ��T 2) Name and address of cument owner. �.r� vy+ �.- 3) �.�� „.. �,.��s� d.�--. Property Descrlptlon: Directions to the prope � 4) Proposed Use and Structure Description: answer each of the following questions: a) Proposed �, Existing � b) Sticic Buiit ❑, Modular �, Single wde 0, Double Wde 0 c) Number of Bedrooms: d) Number of occupants or people to be served: e) Basement Yes �, No � If yes, # of basement fixtures: � Garbage Disposal: Yes �, No 0 g) Dimensions of Proposed Structure: Wdth: Depth: 5) Water Supply Type: Private 0(new 0 or existing ❑), Public �, Community �, Spring ❑ Are any wells on adjoining property? Yes ❑ No 0 If yes, location 6) Piease Indicale Desired System Type: (systems can be ranked in order of your preference) Conventional �,,,Modified Conventional Other (specify): _ Altemative _Innovative CLEARLY STAKE ALL CORNERS AND LlNES OF THE PROPERTY. STAKE THE CORNERS OF ALL PROPOSED STRUCTURES. PLEASE A7TACH SURVEY PLAT OR SITE PLAN TO. THIS APPLlCATION ��.�r��a� ��arb�-- I hereby make application to the Person County Health Department for a site evaluation for the on-sfte sewage disposal system for the above-described property. I agree that the contents of this application are true and represent the maximum faaGties to be `, placed on the property. I understand if the site is altered o� the intended use changes, the permit shall become invalid. I understand that as applicant, 1 am responsible for identifying and marking property lines, comers and making the site accessible for the , personnel of the Person Courrty Health Department to condud their evaluations. I understand that I am responsible for notifying the Health Department if my property contains any wetlands as designated by the Army Corps of Engineers. �7-,�C�-t3C7 Owner or Legal Represe tative . Date PCND, rev.10112/99 � Tax Map #: AppliCanti , L.ocatlon: _ � � PERSON COUNTY ENVIRONMENTAL"rt�ALTH ED PLAN FOR SOIL AREA AND SYSTEM LAYC #� Township Improvement Permit PIN PhaselSectlon Lot#� New t� Addition Type of Strudure �.iiR�v YA�it /� �s� G��vrCsz _ Water Suppty # of Occupants G� # of Bedrooms � Other Projected Daily Fl- 0�6o g.p.d. , Permit Valid Proposed Wasiewater Syst �' v u/� Proposed Repair. �o�..� �,�SG� r-e 4�.� Permit �v. � Q L'�'s-- �/'i '�/� �7 c�j (�.s l,ca-1-� r /� �� System Type� Owner or Legal Representative Signature: Date: Authorized State Agent: ,�_ , � Date: l'o :2 /�' 4/ The issuance of this pertnit by the Health Department in no way guarantees the issuance of other peRnits. The permit holder is responsible for checking with appropriate goveming bodies in meeting their requirements. This site is subject to revocation if the site ptan, piat, or the intended use changes. The. Imqrovemerrt Permit shali not be affected by a change in ownership of the site. This permit is subject to compiiance with the provisions of the Laws and Rules for Sewage Treatme�rt and Disposal Systems of the North Carolina Administrative Code. Wastewater System Description: � �ir� �i � v Wastewater Flow: ,�6 b�.p.d. Type: �� /^ ' t. r Facility Description: � � ' c � New Ll� Repair O Expansion ❑ Basement? a Yes �o Basement F" s? ❑ Yes �iQo - Wastewater Svstem Requirements Tankage: Septic Tank size �� gal. Pump Tank size OO� gal. Grease Trap size "'� gal. Trenches: Total length �'p ft. Trench Width �•S' ft. Total Area a� sq. ft. Max. Trench Depth: �� in. Aggregate Depth:� in. Soil Cover. �F' in. Trench Separation �ft. on center Permit Expiration Date: � ^.� � � � Authorized State Agent �� T�� - Date: �� 7�-C'�� *See attached site plan and addendum pages for additional permit conditions. The type of system permitted �oes ❑ does not differ from the type specified on the application. I accept the specifications of this permit Owner/Legal Representative Signature Date: � � Operation Permit System Type �n accordance with Table Va) �� This system has been installed in compliance witl� applicable North Carolina General Stah�tes, Laws and Rules for Sewage Treatrneirt and Disposal, and aU conditions of tfie Impr+ovemerrt Permit and Construction Nutl�orization. Issuance of this pe�rnit implies no guara�rt ffiat the stem installed will tunction properly for any given period of time. V '%� ��', ��. Authorized State Agent Date PCHD, rev. 03/07/01 �■• . .. _. .. . .. .. . I�'�,�► �Q� � �� i� =ar�or� �e�unty Health Depar4m�; �� . � ��avironmental Health Secttv . T� �� ; �= . � � Parcal �: l3/ � � �iYE S14�TC� . _ _ . . .. - Gi/�c,�,�,.� a�� - Applicant's Name . A riz�d State er�t �^,'• � �'��.-. ��6 Su divisioNSectfonll.ot# ��077'' � � Date Sys�ait con�poneirtt �resent appraualmote carttours only. Tlu canbwclor nucrt,lYag tbe system prior to �e�iit� t�rs instullation m ir��a�e that AroP4' 1�� is nwlirtained �r��'�1 �� -e,�� -s�P ,� �Q �r (,�, �^�(�'( �a c�.�t��'� /1c,,• n � � ' )�OG��Gt � io' u�.��1 ��y) �Tu✓r►�� , � � �s�� C(ea `�w c� ,� fu�o�J � � ,� `� �-3 `pc� ,�«�l� � l �ar� ✓�L�U�2 ' �i _� Va�v� �onij.) �io � / �r µPs� 1 .� ��'c � �'r� '�1�� ,� s�`�°� � �;.� ��{,S' • `, �;�?S Cl/`G �l// ��D/1Srj(� l/CU7�- �/O1^S �C9V� PG�t �in�, on dic� l"a�v� .�� a.�S QYe_ ��iSS�i� er n�v-ec� a n� �� o�, s�� l/,6Q �% cti,�� f d"! /, � a� C�p�r� S�' � or rL�v► � /s � �s no Yeec9�t ��t-� r��ar' �o��tiS'7r�1��'Yro�t. ,, �ev�va.f � v�� e ��'o, � ''�b �cs! �w� sca,e: / -�c, ' % � ul l� �e�. ,� , is wf (��L✓I'�µ� �� << PROJECT : Heritage Harbor Lot16 W Moore COUNTY : Person REFERENCE N0. : DATE � : O1-10-1980 SUMMARY OF DESIGN ----------------------------------------------------------- ----------------------------------------------------------- DESIGN FLOW . APPLICATION RATE . TOTAL AREA REQUIRED . TOTAL LATERAL LENGTH REQUIRED : TOTAL LATERAL LENGTH SPECIFIED: NUMBER OF FIELDS . LATERAL LENGTH . NUMBER OF LATERALS . NUMBER OF LATERALS PER FIELD . SLOPE . SLOPE . FIELD N0. 1 LAT. LENGTH ELEV- NO. ATION 1 48 99.00 2 48 98.85 3 48 98.70 4 48 98.55 5 48 98.40 TOTAL 240 FEET FIELD NO. 2 LAT. NO. 1 2 3 4 5 TOTAL LENGTH ELEV- ATION 48 99.00 48 98.85 48 98.70 48 98.55 48 98.40 240 FEET 360 GPD 0.15 GPD/SQFT 2400 SQFT 480 LFT 480 LFT 2 48 FT 10 5 3 PERCENT, FIELD 1 3 PERCENT, FIELD 2 PRESS. HOLE HEAD SIZE 2.00 0.156 2.15 0.156 2.30 0.156 2.45 0.156 2.60 0.156 PRESS. HOLE HEAD SIZE 2.00 0.156 2.15 0.156 2.30 0.156 2.45 0.156 2.60 0.156 HOLE NO.OF FLOW PER FLOW PER SPAC. HOLES HOLE LATER.AL 4.00 12 0.41 4.87 4.00 12 0.42 5.05 4.80 10 0.44 4.35 4.80 10 0.45 4.49 6.00 8 0.46 3.70 FLOW TO FIELD 22.46 GPM FLOW VARIATION 24.0 0 HOLE NO.OF FLOW PER FLOW PER SPAC. HOLES HOLE LATERAL 4.00 12 0.41 4.87 4.00 12 0.42 5.05 4.80 10 0.44 4.35 4.80 10 0.45 4.49 6.00 8 0.46 3.70 FLOW TO FIELD 22.46 GPM FLOW VARIATION 24.0 0 � � LATERAL PIPE SIZE MANIFOLD PIPE SIZE SUPPLY LINE PIPE SIZE SUPPLY LINE LENGTH TOTAL DYNAMIC HEAD DOSING VOLUME PUMP TANK INSIDE LENGTH PUMP TANK INSIDE WIDTH PUMP TANK DR.AWDOWN . 1 1/4 INCHES . 3 INCHES . 3 INCHES . 2100 FEET : 85.24 FEET . 150 GALLONS : 10.00 FEET . 5.00 FEET . 0.40 FEET MINIMUM DOSING VOLUME: 93.6 GALS MAXIMUM DOSING VOLUME: 187.2 GALS SELECTED DOSING VOLUME: 150.0 GALS VOLUME IS FOR EACH OF 2 FIELDS �a� e- � Q. �� (SCHEDULE 40) (SCHEDULE 40) (SCHEDULE 40) (PUMP RUN TIME : 4.2 MIN.) (PUMP RUN TIME : 8.3 MIN.) (PUMP RUN TIME : 6.7 MIN.) PUMP RUN TIME FOR ALL FIELDS iF',' ��l'� � O�/"Ltw�cJ�� OS �c?✓' v'1�1ri�i �e �� /!�%7-t<t� (YYD�l3tv<Z .S`�ec�/ ,� ��;r 0 / .{-. /uo-�� :/��e.. 7b �i,'q`L l�eacf /�e.evlC��3' a4J.- 7"�-ris S�sYP,p-, � cz Zo e%/�Pr' /11a�`l9/ a l��J )� � � � / Yli�lt ��-�/ �1K� !J" %��j/�/�1t2ft�CG�� 7a/' �`�i3 !��-r�//��Qrt rS �QI" �e Pc�a�'r�, ��.. �/1SC��/1/� Cs'-�8'-0l) %.� Z se� Atta�ed 9�eac For Electricai S�ficat�ccts � �.. � � �� _ �ri = �t� _ �� 111=tt1=nt= ��111 =111=111 / , .a � ' • • • .► � • . � • . Unde�grc��av1 Cable In Canduit Siith Suitable Sealer In Boch Fnria O£ Coc�duit �i .v�r� ~ • .. •�,■ � •� ,• - _� . - ..� ... _... ..� .. �... . . - . . � .._- • - �'■ •• �: � 1 �� 14�� • �{,p r�/',1ct7�'� •. � U �� D �r 5�� n'.s DO g a/. r' / L'/'�i _ #�—Z'� Suiuersible S�n�e Efflisent A�q �•�'PE'� 8" Concrete SLoc�c :_�. �z a,.�1 �.�..� : � �Single � P��i �� . �� T�itli N�sti�„aczi �� tsit inish Grade L I �p � � V 111 = I�! = ilj =. 1 t! ! 1�1 = -- t 11 = 1�1 .-= i�t ____ 1 t I— t , 1� �= l�� = t 11 � I 1 j =,�i1--....- �-�'"`"_ • . , � : �.-•�' : ' . • , 30" > 6� �-=c,ailoa r�tc . , � - � . � . .� � �,,.$tl�iy T.2218 TO •� `� � ► Diaaete= Scheduie 40 PVC � �a '• pi� � � g� A�rr;a�l- � •� • C�ate V3ive ' • �1C�E`d vR10It • . Qzeck VaLve 3/16" 5yQhon Bre�ke= Fiole . . ?f�drr� St� .�aax�. P�Ll d-� � Alazm Float (elevation) "Pt� On" Float (eievati.on) ' ` "Pt:nQ Off' Float (�-��onl _�: ,� PUMP RATIHG Pump�st Be Rated To DeLiver � Gallons Per Hinute °' Against �� Feet Of 'Tota �' ' Dqnamia Head (TDE3) . . . • . a n � ' ' � � d � � • d � Q � �, • . s • 6 � � . � � , . , , . 'I�v.s 'I�c s�au r� af a Sta� F�oa3 Rnp 'T�k �' � �3 g$11 be Ia�k � Q'r�it� See Folloving Sheet For Adclitional Specifications, Notes, And ExpLanations. / PUMP SYSTEM DETAIL SHEET � � �g�i '�:E59i1:2 �I2aL24� �76SL •): ?QC'_V3:AI1L �lex Control Panel With Built In Alarm p�,�-�� Hote: lhis is �� K oot a niring NB� 4% . »� � diaqrai! Consnit 3nclasure an glectrician! -' idater tiqtit , + Dact Seal • carrosian - �stall ? ci;cuit cesistant � . .scuanect svitcb • � � panel does sot � , � . �pe a dead.front ?' �:4;��a � �� aannal �iscoanect. �ae ��gbE � f , ote: A 6reaYer d�es , ?o4u�if '-- t canstitate a _ ` ' � _ scouuect) i 12' ta� — � . fiaish qrade� . . �nap �apply �ircai: � - 91ara Circ�it ;ackiaq S�:3�s �ater i�ght 3ea1 � ' 9ydraulic ceaeat� • _ _ -� � Schedule �9 ?YC 7arsess Szcess :a:is Supply �— -- --- — - -- • -- -� _ _, -- � l�10�,e. ; �foJ�c��. an .��a,pseo� �� s� /rt�r Aw-� edei�7` ' U_ ��in7��er W � �'� ��-�r�a �,p � .� r yhDr; ��'� � �� `U �,�Q�'C%�'��j� �J/15 ,j��?%'�q,-"Y►�t�°iS , y 0 LPP (Low Pressure Pipe System) General Specifications And Permit Conditions Page 5 of 11 1. See pages 1-2 of 11 for LPP System Location and Design Summary 2. Pressure laterals shall be sleeved in 4" corrugated nitrification line perforated tubing. (See pages 6& 7 of I1) 3. All drilled orifices shall be drilled 5/32" holes facing upward exce t for two holes 1/3 of the way from the beginning and end of each line which shall face down. (See page 6 of 11) 4. Use one 90-degree bend for lateral turnups not one or two 45-degree bends. (See pages 6 and 9 of 11) 5. A cleanout with above ground access shall be provided on each end of 3" pressure manifold. (See pages 1 and 9 of 11) 6. A gate valve one nominal size smaller than the effluent supply line shall be located 2' to 5' prior to supply line — to — manifold connection. (See pages 1& 10 of 11) 7. Lateral lines shall tee directly off of manifold using 3" x 3" x 1'/<" reducing tee and not by "bushing down" with reducing fittings. (See page 8 of 11) 8. Elbow the manifold-to-lateral connection over an earthen dam to prevent drainback into manifold. (See page 6 of 11) 9. Lay geotextile fabric over trench at the gravel-backfill interface for entire length of trench (See pages 6 and 7 of 11) 10. A minimum of 4" of Group II or III soil cover shall be required over entire system and extended 5' laterally beyond all trenches. (See page 7 of 11) 11. A pre-construction conference shall be scheduled with the installer and a representative of the Environmental Health Section of Person County prior to beginning construction. 12. Trenches shall be installed on ground elevation contours. A layout of system shall be required and approved by the Environmental Health Section of Person County prior to installation. 13. A signed contract with a certified operator shall be required prior to issuance of Operation Permit. �ro-�.,-�b� Sle� �e ��a��-�. �v 5 �a.� ra,/ 7'tern -K p � � ��:s�Q��.�.afe (s�.�/Q��e.reo%C�,�J Com�ac..`�cf �ar� ,%>a� Geo � �,'� � jsL .- - j � - � � % �,/// j/ . / /� (�� `/ � ,l �. �\ ,ir � ��,`1��.� i.1ww 'A1.� f•'� ' �'( �7'�i�- �7%) ��' �i<� � .\�; / �' RF�iGt�.3 v �. • .Z � � �, i � � +� j � �. ��. � t � -� � ��/'"1 r / „ � ^ 2 �� .i 1' �,T�� .' / / / / � �� t �.�, 4'�,�..�.�••�- � r'�:,- (•' r�� `�vl�. �c t�1/��, �: 5 .� / � / < � /�� . ��f�-� •� �� 1 ��/i/�` � .�� •�. �� ,�•��I~ ^'i'ti-�I �i�� '��t'�'� / / � l � • —1 / �� ! r „ i '�� r`� I I I I I I I � � / % /.: � ( � � �� il llll�, r I I � ., I � � � 4 ;, ; . ; /�/ -� _ n�. . . �_ ,%{� ^ � - ,, . � � • ; , � , , ,� • _ „ r - . � —,� r . _ . , `� �, r--� . � f , � / Clr; r.'ce. , % ` l : �. �c ``�'� d� `� � J� ` � �� < ' -� � � f- , �.` �. ` � �� `� �tc �, ,�� ,�/-}• ,�, / �r4 r�l S/.s� � � ,, ,. ,. , , - , ; �-- �-i `�-�. •T ��, J� .�, - (� cL � �.�.,. ��/"t � / �` /� �� '�.. �♦ L �:� �� '' ��}_ , ��r�i 5 ��- �,�1• iL�a J'r��i y�J�—c ��•l� L�„�y � ��r � � •` / �mve� '�"re�+,cfi �-t�J' La.�er� / - cw:f� d r;�'; �� Dne/►� a.,) ��l�5�a.�c� .�oe S/eeJ� ' f � i �� ' ,� -/ //.// -Sa Pp�aM�'-�,D �c� �3 �� Op �� S;�e P�'o �'�2 ,l�a./ o� LPP T��ti i��ur.l1 �' ossS��ie� o�-' i?�s�.'��c%��-��ra% � COn�l�,D� �°��- 7 °� ti �en��i tJi ��i � �rG.� �r�ss ,.��; v�'1 ��'a.� ra � / �;"/f1in. C�ou2rSo�j _�_� �°��X�s��e ��6r.� _ ^ s _� : PCt�'ora'��of �;�2. � � � r.. � �� . � � � ; — ._.�GroH►� s'tir� .\� , ,. S�CC t%e� � � ' �'" `� �'`` /� � ' � aH WI r ��•i� ' !- / �9>"a- y,��-� l / I ' ' � �`r'1`' � , i� � ' � - � � �� / � / � 9~ �� ,� �� =/ � ` �� /i.� M p�� t�.��1 : . L � _.. �� - _ , � , ,- / �,. � -,,,,, , . , *.;.� � ,, �/� � E-�;s �,�,..�------�' , ` � � ''` � ��-,/?j.'h' - "^ � � ra eo� . . � ,!r :";` � . ` . _ f��p � �rerw�.�rave�S�orr� G��tc�'s'�tcr� , c. � _ .. . .. �� 1�� . � sa; � / � ��„ � . /� / � � � � 1 % u1�4,�,� � 3'"X 3 "x /!� � �'��Cca%n� fee �'� �p��y r��,�e�/ (:D pr�7' ._---• J�a,�2 $ o�' !1 � " �YC 3" SN�,�o /� I�?aN� �rt �.o✓'r ��- s�o�e.,�ro�l��a.�,�.i� a� Cvr�ca7' S�,p/°�y �llah: �`olc� 7�v -�7'Pi^�./ ur ✓ �'O��Iec.�or/ �� — , • . � ... . v . �• . . . ` . � , , � . ' � ., . Tt-tRE.l�l0�0 G4�° � . , • . . � , .� � +' � " . .. . . • - �� _'• • g" SU? � TN P=�D � - • _.�',�--il a.. • �pU p�llJC� • _ _. ' -' b� . . -� _ - ` • �; .. . �'� ' gu PVC PI PE . ----� ,,,��' - � � I- - - - - - , - . . -• � ,. G�AVEL -- . • ' � '' - ��•. � � � , ' , ' . .��" , • ,��,• 8" , , .. , �^ �� '°d°a° b�s � •' - .' . o.o•o'•o .. • ` 3 „ �G , ;; , ' . . • . • . �"� M�J�FOI;D� ' • •�'.�8:': �ll qo PvG SY�° . � . . . . . . . • • •�' • ElB�l,c1 I SU P � T�+�F�.D� � . � ' � . � �1%i�AI�IIROL,D�C�.��A:NOUT DETAYL . .. . . . � . , t�ri's ; , . . . : .. . . ;, , . . . . . • ..: . . •, . • . . . , . � � • ,.,; . . . , , • . . �• , PWG • � , �, •: , . :: . .�: � . •'�.••'` r • ' ' ,, � `i �,� � � e� ,. - - • �. �� p� � 6�� SUP X THREAO COUPUNG . . . . . •� � . ....1 . 6�� PIPE - • : . . . . d; ,�'�p' ,� . . • . : • �� 8 SLEEV�..? . , �' '. • � .� . , , . �.1�0� •a , • . � .�. --.-r,-,,--+ ..;.; 8 �.n.`%{�i4 PVG 90° ELBOw • ' : • ' ' �.R/I��/�L, � , , •. � . '' • , r , - . , . :,•, • . • • .;� ..' : T1Rd►TNFTF.T.�'t.f''�':•F.�N(lt1T i�FTATT, .� � � • (o SCN 40 PVG �� . . .._ -- 2� �-,�� l4 �- �/ . .z. � z� W/St,iP ou � ' _ _ . i.E��' F�u�SH G�G.�E . Z� , : (,' PVC 3' MIU. .��.ss �2s BQo�zE . C-�e.7E VALV E � a • �� 2' M�►J. �' , . � t'u..'c'� /tijr)Iti' 0 • CZUSN�D STOUE � • o� G�.VE� ' 'I'YPICAL VAL'VL S: VALV� 130X U�'1'AIL N"l'S . _.._--. � .. i �� ..r zs j•. 0 � � 1 • ' .SCH. 40 PV� 0 ....., . •rcoet [�� FefJ�UT r��e /� ��!i �''YPiCAL DZSTRxBUTiON LA'I DETAIL 0 Y�n��rr. mnrr r � ��,�� I�.� �� _ _ _ � ��- �7taB'11.1C�0"rt'7�r�n'n�7L�¢.�0.� ��a"�.�'�Jia WELL PERNIIT PI.EASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT Tax Map #: i�_ Parcel # I�_ Township (.�f% � . A Applicant: Subdivision: � Section: Lot: f � Twe of Water Suvulv: �ndividual Community Public Requirements• Site Approved by �� S-7-o� Grouting Appzoved by /l�C� S 7-�� Well Log � Well Ta� !%� � Air Vent � �Hose Bib Concrete Slab Well Well Approved 7,07-o ar .� r � _l _ �ln � / �7 � � 1� ��'P.. Z � •r� -� � C��1 �� Date• � � � '�°5ee Attaclied Site Sketch'Q°k 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 conditions: PCF-ID, rev. 09/07/01 ��.s� � �.�c�� _ �� IE��-a.�-��m��c.�.0 IL�L��.11�I� Drille Com��n N�me � � � D�t�e Drilled Owner: �'ell Lob `' n `. Tax tV1a Location. P,� �-3 Parcel # �� Subdivision: � � Lot # � Distance From nearest Property Line (Miniiuum 0 feet)onstruction Distance from Sepric System (Minimum 60 feet) �� Total Depth: �� $ yield: _ f v GpM Static Water Level: Water Bearing Zones: Depth �� } ft ft --�.� ft -- ft Casing: � Depth: From ta ----�-_ — s� ft. Diameter: � � Type: Galvanized Steel �— Weight: �_'��essl,�}�( Height abovc Ground: Drive Shoe: ✓yeS No qn roblems encountered while settin =� in If "yes" give reason: y p � �•—.Z'eS �--No Grout• Neat: SandJCement v Concrete Gravel/Cement Annular Space Width _____�_ inches Watcr in A.ruiular Space y�s ��o Method of Grout: Pumped Pressure ��ed Materials Used: Dep� —_ � to � c1 • Ft. No. Bags Portland cement Weight of 1 Bag Pounds If mixture (sand, gravel, cuttings) - Ratio .Z to __�___� ID plates: ____� _ No 4 x 4 slab �s _ No Drilling Lo�: � _ _ , __ _ I hereby certify that the above information is correct and that tlus well was constructed in accordance wiLh regulations set forth by the Person County Health De ariment. Si / gnature of Contractor i-L �w�_, , , ID # _�a-� I)atc _� '7, d Z� PCHD rev O1/16/02 PERSON COUNTY HEALTH DEPARTMENT SUBSUI�ACE V6�ASTEWATER SYSTEM NdO1�TITORING REPORT �z� rz-13 � -�� o� �� a3 l�� Date of Inspection System Installation Date Type ax Map Parcel # l�� G�o �; L-a�rP. Property Address Instructions: Check yes or no for appropriate items and explain inspace provided for remarks and comments. If an item is not applicable, indicate by "NA". If an item is not or cannot be evaluated, indicate isy `°N" and explain. Note thai this monitoring form is not totally incl�sive for all systems. All maintenance and monitoring items specified in the permit are ta be carri�d out. INSPECTION RESULTS COLLECTION SYSTEM: Evidence of leaks ? Tank risers accessible, free of infiltrati�n and surfacE water diverted 7 �aptic tank needs pumpin� 7 Inches of solids: < 3 ` Septic tank filter cleaned ? YES / NO ��S ❑ � o��° � ❑ �� I y��- -� ( �- e (��.�Q � � F,FFLUENT DOSING SYSTRM: Required pumps present & functionat ? i High water alarm operating properly ? J Floats, valves, etc. in good condition 7 / Control panel & components in good condition 7 � Eff:uent free of excess solids ? „ � Inches of solids{pump/�ose tank :� 3 Elapsed time readings ? 2Z S. �f� Mi h s. Counter readings ?_ O � Drawdown rate: DISPOSAL FIEI�D: Evidence of effluent surfacing ? � Evidence of effluent ponding in trenches ?❑ Surface w ater ��ectively diverted ? Diesrsioasls N�les pTOperly main±ained ? Vegetative cover maintained ? Protected from trafiic/una�ihorized uses ? � Distribution devices in good coadition ?❑ Field free of sett(ed or tow azeas ? � PRESSURE DISTRIBUTION SYSTEM: Turnups/cleanouts/valves/taps intact & accessible 7 ❑ � Pressure head properly adjusted ? ❑ � COMPLIANCE: Compliant Non-compliant Needs Maintsnance AilDITIONAi. CONMEi�TS ■ ! ■ ■ ■ � ■ � : ■ ►= ■ � _„�-�� c�- � f �� ,��( .� �umP ��tK � �mu�� %��— �Y�.- �,P �,.� , ,��r� �,,,,�� usr'� t�/IkS�Pn�1Q V�r � o�� 5r�� Su��• l��s ��p W-e,r-- Q �- �-c,+►-� --�.i��ti d �1', I SS� i� �`{ p r , PERSON COUNTY HEALTH DEPARTMENT �'�'3 �� I SUBSURFACE WASTEWATER SYSTEM MONITORING REPORT 4/28/17 Jeff Vau�han 24312 Date of Inspection Certified Subsurface System Operator's Name Certifcate Number Permit Number Date of Operation Permit Tax Map Parcel PIN White 124 Lori Lane Semora, NC 27343 Permittee Address of Property Instructions: Check yes or no for appropriate items and 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 mrnitoring 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: <3 Septic tank filter cleaned ? YES / NO ❑ � � PRETREATMENT SYSTEM: NA (Sand Filter or Peat Biofilter) Filter surface maintained ? Evidence of ponding ? Filter effluent free of excess solids ? Peat modules free of damage, accessible, properly ventilated & free of insects ? Samples collected at this inspection ? EFFLUENT DOSING SYSTEM: Required pumps present & functional ? � / ❑ High water alarm operating properly ? � /❑ Floats, valves, etc. in good condition ? � /❑ Control panel & components in good condition ? � Effluent free of excess solids ? � Inches of solids(pump/dose tank): 0 Elapsed time readings ? 239:09hrs Counter readings ? 1539 /1 ■ ■ /1� /1 ■ ❑ � ❑ ❑ / ❑ ❑ / ❑ ❑ � ❑ ❑ � ❑ DISPOSAL FIELD: Evidence of effluent surfacing ? ❑ Evidence of effluent ponding in trenches ?❑ Surface water effectively diverted ? � Diversions/swales properly maintained ?. � Vegetative cover maintained ? � Protected from traffic/unauthorized uses ? � Distribution devices in good condition ? � Field free of settled or low areas ? � �o / ❑ /� /� ■ ■ ■ ■ REMARKS Alarm count = 174 Float enor count = 47 PRESSURE DISTWBUTION SYSTEM: Head pressure not touched (see previous Tumups/cleanouts/valves intact & comments from prior inspections). accessible ? � � ❑ Laterals free of excess solids ? � �❑ Laterals flushed this inspection ? ❑ � � Pressure heads properly adjusted ? N SYSTEM PERFORMANCE: Did not measure due to broken cleanout Design Pressure Head (ft): 2 Adjusted Pressure Head (ft): 1-2 Design Delivery Rate (gpm): 44.92 Measured Delivery Rate (gpm): 34.53 % of Design: 77 Dosing Volume (gal.): 300 Note: Delivery Rate(gpm) = L 8 _inches drawdown 20.5 gallons/in) 4.75 minutes of run time Dose Volume(gal.) = 10 inches between float on & float off 20.5 gallons7in. COMPLIANCE: Compliant � Non-compliant ❑ ADDITIONAL COMMENTS: OPERATOR TEL. NO._(336)504-9277