Loading...
A23 210� ; ' . c:: ; -, __ - --- - _.. _ ____ .. . _ _. ... . _ _ . _. _. . __ . _ _ __ _ .._. _. __._.. . _ � � �tyt� �i� ]7. ��P"-� ���� Sa�� �? � M;� �� � � ! .r„ � . N�""1 "1 iM� � �� 5�.. • s/day � ibility' of et. ThiS affected a-`Luws; nmental; ply wiil; ay' � ,��°` _ ft. ( ,�-- � :K�-c�l( � � � 3 �- zZ the coriditions �- � a r� � p�� r���� . C� �, - � 1h� s�..`� �,� � `� ��.,( � �-- � s ' � � ��. — �' � ����� � 2 ,���� ,� �u s� — 3 t s�►�p lY 3 r�� c� �-e— — �� c c ,P.� � �.���,.- r�� �5y� , � S ,` n . �� ��n..-2 � � �.� s-� -�;,rv� �.'� S�r�ai�-�( � �� �P �t; �t . 11 .: �'w'�' ' E-��� � � ' i � L _ _�.�_ ��✓� �JVl1�- ? ���D J��f �l�Iki/ u�P � �c�. �-e '� -� Z S�,-, c�,a�.— o�w� � � ,' : ���,s� ���.��� �,�, � � ���� IE�+e �-Ya �- � ������.Il I�3I � �.11 �I� Taz Map: �3 Parcel: �� b Subdivision �t�� �— Phase/Section/Lot # l�, —� Applicant; %2ti C�Q� � �t/a� Address/Location: —�-��-�-- �_�_ —��-���-- � — —"`_��.��_J���__._._---'r��24t+�,,/'e.�Qr _ '^ • — � Permit Valid for: Five Ye rs � Type of Facility: r ,2 . Number of: Bedrooms � / Occupants Proposed Wastewater System: ��� Proposed Repair: `�.; p w % �re Authorized State Agent: (X) Owncr or Legal Re Improvement Permit Non-expiring New � Addition _ ��nEmplyoye�es / Seats: Y,(.��'I��e �O. �— ecs• � � VVater Supply: ��� Projected Daily Flow: f� O gaIlons/day Type: 3�q Type: �g_ �9-l� n�dt�f; The issuan�e of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibility of the applica�nt/property owner to insure that all Person County Planning and Zoning and Building Inspections requirements are met. This [mprovement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement is noi affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws �rird Rules for Sewa�E Treatment and Disnosal Svstems'(15A T�TCAC i8A .19U[)). N�ither Person County nor the Environmental Health SpEcialist warraats that �he septic system will c�ntinue to f�nciion s�tisfactorily in the future, or ihat t�e water supply wiil remair �ofabfe. ----- - — -- _-- --_---- Authorization to Construct Wast��vater System See site plan and additioMal attachn:ents (�). n Propos,e,� Wastewater System: �-�p v✓� � e.` ` I y�2s,-'�-►�-'f (*1TYPe�q Design Flow ��o _ gal./day New �� Repair _ Expansion _� Soil LTf�R: � a o gal./day/ftz Type of Facilir�: `3�� 12PS. Bssement: _ Yes � No (*) System Types Illb, Illbg, IY, and v, require periodic system inspections by the Ferson County Health Department. �m�� Ma� � Q�o Wastewater Syst��trRequirements �����a(, r.��;�,.�, .-}-�KK Tank Size: Szptic Tar.k �_ gal. Pump Tank �_ gal. 8tzase-�p gal. Urainfield: Totai Area l�� � sq. ft. Total Length ��� _ ft. Max. Trench Depth `P in. Trench Width -- ft. iVlin.Soil Cover �P in. Min:Tr ch Separation Z ft. Distribution: Distribution Box / Serial Distribution+_ / Pressure Manifoid x��O�a4l� C��� �' �S ecifications:�,,,S�ft �� -F' /' ,,, a ('cp,r ,� c�. v,. Authoriz�d �tate Agent: aS � � Issue Date: 1r31—( �j Permit Expiration Date: � 3(— ZZ T'he system permitted is: Conventional /Accepted / Alternative / Innovative �. t accept the cociditions and specifications of this permit. {X) Owner or Legal Representative: Date: Person Counry Environmental Health, 323 S. Morgan St, Suite C, Roxboro, NC27573/ph: 336-597-1790 (rev 5/12) 0 0 _---�'�'� � % DF LOT 2_ - —.�" �..� _-��' �. �,��1 �., � ,<n ___ - ,� ,,. :�� .l �� o __-- /� ______�� '_f .I _ � � ,; � . � .�'> ---- - -- �, ` �:� . _,.�' .�—` ` _ � � � � / ,--� � ' '" � - �-- ` — �.�_ % � .;,`� � i -�"' /'� � / ./ ,� ' -^�� Cr�' / �`i'� � / � / � ��� ` -��� _. • � / � � `,� � / � . i � ___� •. �� ;:- _ � / DF LOT 1: - _ --='��, �' = � � � � � �,. ----- �; � . �-��� : � � / � �,� / � / �`..---� � / � � ny �� j / . . , , <: � ... / / _ �Y. , j .. _ . ... .. ^� � / - ' ' - , . r •^�,.,,,_ ;:. �. ,,, ,_ . , � , ,. , � � /—' -- / i� 'pi�,� ' -/ . _' j � /, � / � / �!=�' .� / / .,• ��,. � / .r� ` ' . . , ' � , . . � ; , % � .; ��'" ir ",,.� , „ ��,�' /r�.✓ i . � � � / : % �e gin � /�,,, �'� ' / �` "'„� �' / �' / ;/''�i � / �"� / ,••' % °r''L/ / / 1 � / /�'� r , '/"f�' . � / %e<''.>' � lr�, 'pi,'fe / ,-' �j, �''��"` , �.�./ .- . �.✓ � � C;�' � �'� i�. ,. r" �� � �'` � 10 �tul • � ��:� 16 pine E,.� �,I"" / ,�!, /� / / ,.,• �•� _,} ,�� ~/ --'� � � ��P �' ` i � 12 �in�' /t 3'� /�" 'C�i1' 14���ne� i j. � � . , ; � �� . � , - � / � � ,: i ��p � f � � ri ` ,�- ,�,� ,� � � 1. r / �/ /,`� l;` � /f ��,P � y� / ,, / J � �� `.` � ,' r J � �/,` r �����• �� la �/� /,, _ � I � 10 �u e, . E %f � , f� `�� � � � 1� / .% %�; �' �'` 14� �}i�i�� ��,,, �,,�'6� � � � �' i • � � � � ! �I � � A�,I�R, / / :� .- � " ,� + / Qi2 �p'�ne � ' � ', 7 / � 10- �,;ne � f � � ( � � i ,,6r�� � rl,; r�,� 14� pine 3< ( : �i l' / / / / (..�, � � / � � ���.� �/Qlh pinc t / I � �� �i/ 4! p i�i . � � %� � 10 i e F�� a' � =-' � � �! � // } � i � , � � � � �dl � � �� � / � / l l � � , � i �`� s� 14 pineQ ,: % ! � �i , 1 � ' r' � �ii i 10/ p(n(_' i � � � � I � 1 I � � �� t��r�, 1 ( 1 \ 1 � 1 � 10 j�ir�e . ; � � . F,fne � , I 5',, f�) ` `1 �` ,1 `p l Cr'..�, � � ' I � -i _ i .,9 � �� � ` � � , � i 1t� i lr'` , , I�} l,ine � ` , ` � �- \\ \ 1 1 � � o in / /v ( Y� , �,\ �, � ,�, � � �����i; _� � � �} 1 � r � �. � � i �, ,��� ; t ` ` \ ` 4.. LC ~� I � f,IC � � � � ` �\ ��� ����i,� �� in I . i , � t � �� \\ � 4: 1 �t� �1� � � � ��,1�� �� � � � � , I 1�,,.pine , � � ��..� � ,`?. \ 1 I ��.�� �\ � �2 pine�``19 fQu�c111�``1111�,i ` �t pir e 1 0 ',c 6 ` . ---____,_._.._..,_.._.____._ \ 1 � ' 9 � d� • \ � \ 1 "' ' ' t�� t�. . � � ��'� �� � � � � � �� � � �� �� � t� , � �. �1 'll�� ' ...��..�'i ��,..... \ \ � \ \ �' �__pq '�'.,,,,, �. ,- � _ . � \ , . ._ _. ,- . . _ ,.. _ . . ._ . . . � vi \ �. �� q: , \ ��. .. . - :. . .. . . , . ... .. \ ., . �..� . , � .. , . . : , -,�- - \ \ �' \ _ , �\ � �' c i � .(��r �(y' \\ _ � ¢.�i � �� � � f, .a � .. , . . . , , .� \ ` e \� ` ,.. ,.�..,� \ \ \ \ _ , �� .. � v, �\ . . -. � . . . . e :.t � Y-;c�- --. _:. '"'_.s , . ..... � :. �S , n .�_�...:._. _ . _ .�_:.:.� - ..�..�..:r��__� _ .�:_._._�.�.V.4� �'�� 12 PIYIc � ` L ,J c`r� � � � � � \ � � �'� �C/I.q \ � � � , D F L T 5 ` w� .� sw.� —�_�. �� % \ .. \ � � �.._...�'� ., _ � , \ Y � � � A S.� .. \ 14 pirie � W , � � \ i���� ,;;�;I .:�j ;n�t,ii ` � � � , . , �, � sW � �; '' ��, � � 1 1 pine � � ..., \, tt '' �l �� \ \' \ �— � � r ��� �'�.. 0 20 40 , 60 ��''„� �,. O PROPOSED P�RC—RIT� TOP—�'EED �UP�'LY �UiAT�IFOLD, 1" �CH 40 F'VC. T.E. �58.8 zQ PROPOSED RETURN MANIFOLD, 1" SCH 40 PVC. I.E. 458.9 (See Sheet WW-5 for details). �:�� 1�:���'(��':�x� :��:����.+�'�; _.�.. �,�1r�� �T ��.,�T� ;, �" ;���C; �,�-?,`�'�;..�'-�,.1,��, �GT���.��' :�..T���;�. Feb 01 1710:42a Barnette Well Drillinglnc � wE�L corrsz��e�c�rrx�co� "his Torm eau kie nsr� fer siagEeorrm�Idple adk i.��/d�COR�'1CtDY1aj0i7a82iQ� n ^ I ti .1 SYcn caa�Nr�ac .�� 7 � -� �TC Wd! Coanacrn�'Ccro6nboa Plumbrr Bacnet#e Well Dsiiling, Inc. Compaay Namr Z. i1%t1I �071521'�1GdDII PC17IIi�'.�_ � l.�ti afJ appllmhlr uY�l wrurn�aion permitr p.t Ccunry. Smta Yarvmre� rtc) 3. �Vdi Usc {eheet: ae� u9c): ZYzter Suppl} �L'tIL- QAp[jC11�N[L� �UII:d�O��7G' flGsothetmal (FiauinSfC.ontirsg 3IID�LY) ORcsidcntinl Water&upplY(single} OTnd•asviallCommaceI DResidential Wata Ssppty {stmtefl) �Vd1: r]�lquife[' Iiad7a�e i3fsmvruftvet.et.Ranedietian CI Aqtitthr Smr2ge and Recovcsn OSaliniir Barrter CtAquiferTest OStoanaraux�Drai� dEcperimcn�a!'fecbnology �sidenuContfnL ❑Genthermal {Close� L.acp) OTracer 4,.1]a[a Q►relf(s} Compltted� I•. ��'rII TU�€ %� � 3 _ �'y UvlAi �.DC.7QOT:: �� � �t� .S� L�17f" !� Faa"Gry/OrvaarNsmc ��ry � f¢�PN�k) a r7 .. _ . n fi . ._ _ i � . , � / �. I� l._ .n,�/ .. � n�.-. A f C'icg. a�d Zip 336-598-9275 p.1 Fcr Tatawt Use 4NLY_ 14: WA7bR203CE5•. ;f 5 DFSQ�WTIOIY C� �- �l 77 �` St tJ / { I 8 z r� /-5� � /D . fl / IS.OUTE[LGLSING •r.mafu�r�sed�cdis OR•LB`fF:li' ' TicibS F(10M 70 DE�ME'[�R TFQ MA L11. G, � • � �. b i �. �,� � i UC - - 16:II�7NkRGASI1�G0i11'OStPI lhcrostc7nsed-I- . �a�� ro nL�xsrex �c�aaEss n��uL _ f� g (a fy iL ic. . �G ft R � [OIA=..' : - it � ft [t cc S E� � � Q n r ��FiL�G'`e7L% � ��� Counq+ Psul Ideari6catioaNa [Pli�I) Sb.Iatitode �nd LoBei�de in degreeslmmatesfsecondsar deeimal degrea: 2Z Ce�ti�intioa: � (iF�vellfirld,nneladieagasa&eieet} ` - ^��Cc'� 3� : L� � �� �- �r 7 `/'' � C; � �` �� w �i►-rr��c r ,..� �� % _ 3 G ^r % ! ��f�_ �� � SigaanceofCutiBdSl*dCCocm�adcr �� 6_ [i (ate) t4e8eII(S)_ �eTF�uent ar Q%mP'a�rY Dyslgnivg rhisfornt !lxre6y aengy dra rhe��cell(aI �* %+TI �crrd In aecorrtartu ,�;rh rsa xr�rc azc.arwr or Ts� xr�cax.ozao rr�r� c�u�� g� � r� a' 7_ is this a rel+air to aa �a� neL: 17YCS ar Cii'� �.FJ'al�reton/ Lm�bwrPtmldcd !o rha xelt aeAer. (jd�isirarcpalr,fr!larularorav�slleoraum�loxlnJ6rp�mloaamdezptaint/snmwcofObe Zi.SitCdis�e'WOTSddiGOnzLWdLdGt9lifi tcpairvndsrs',21 remar�Cz'roc[tonoroatGcBockqfrhf.tfotra. , 1 You mry tsse the bsdc af this page W ptovidc �3diaoaal v��El site details ar wcll S. Kum6crofwciEs roastructcd� eanstru�ion demiLs Yaumay�ls° auach eddinonal pae�s-ifnccassary. Forwufiiplelr�ctrioaornmo-aarrrsrqgi7y.relLcONLYuirbthesm+rerans�caraaY�+� $�1tiCl'iA.LIN37UCfIONS submrtorrcjorrrc 9_ Tocalndf �eptb 6daw Iaad sntfacc �"' a � ((L) T�ta. Far Au we1l� Submit Lfiis fnrm v�n`t�9n 30 days of camp3etiaa of v.'Ell 1%arrxuluplerelfsLsraBdrytla+fdTffer�rt(a�mP'�r'3Q7��mrd2eJ00'} eoIl5hL7�dn�the'f011owiO� 14 Srauc rvater Irnai bdaw cop oFnsin� �"Z s (ft) Divis+aa of WscttrQuatit�, 7aformaSoa Prua�siogilnic, I�i{c�crfsvelis ebm�eeaste� �r'�*" i6I7A4aa Servica Ceater, Rslefgb, l`C Z7699-1d77 IL Sorehole diam�ter_ � �iaj 246. For [aieetiou Welts_ Tu add�oato sutdm8 the fona t+a tfoe addr�t mz4a abor� aLso submit a aopy af this form wid+in 30 days of omup7aioa af vaelt 12 W dl eouahvction method: /�` I� � O f.f-� 1e `� c�strne2ian to the fallo�viog. (i� su�eqmr.np, �shi�, d�sct past� eu-? pn.'st�a vfR'atu- (�uality, Oadcrgeoand Injeetion Conls+o! Pm�. itOR R'ATER 5UPi'LYii'ELIS ONLY IA6MaIt Sc�vice Cwtu', Rateiok. NC 23699�-16i6 � ) Mathodoftes� SiOwnZOriliA Z4¢.�+orS�'aterSaonlv�IrReeUon�Ydts inadditiontosendingthetomsto 13a Yicld (�m� t4ee addrers(es} aba+rq � submit ane copy of t4us fosm wilhia 30 da_rs of eompkeion of wet! eautrnetiaa m tbe muutS* hr.atth dq�artma�t of tlu eourity I3b.Diainftc�ottcygc HTN ��z 'ii� Cf,ip ��� Form QW-1 'Naed� Cmolcn Depammn ofEaviroa�e aad NamolItes��s—Di�aion ofWmsr Qrttey � R�a1.Azou- ���.sf ���.��� �- � � ���� IC�ca�n�r�aa.�am�rnd�.11 7F7C� �.Il �1Ea WE � PERNIIT (New Repair _ ) Tax Map: �d -3 arcel: � t � Subdivision: ���v✓� Lot: �� Appticant's Name: �'tr'C�, Qe r (�(i4� Mailing Address: Phone Numbers: Location ofProperty: ���� 4Qn-� 1�� —}' � D,.� ��;r, �Qq.Q. ---� C��trul4d-{,� (�, . e Permit Conditions: 1.) See attached site plan for proposed well location. 2.) All applicable State and County regulations governing construction and setbacks apply. 3.) Permits expire S years from the date of issue. 4.) Issuance of a permit does not guarantee a potable water supply Other Conditions/Comments: Permit issued by: � , �.,�,"'�. �Tew Well: � � HS/Date Location: Y-7`� � Grouting: cc 2-t-�'j Well Log: 5 • Well Tag: �'{�'-l'7 Pump Tag: Air Vent: Hose Bib: Casing Height: Concrete Slab: Date: 1— 31—C Certificate of Completion Di.iner: EHS/Date Well Driller: frt . Pump Installer: Approved by: M Additional Comments: Date Sample Collected: EHS: Person County Environmental Nealth 325 S. Morgan St.,Suite C Roxboro, NC 27573 Depth: Grout: DAbandonment: Date: Method/Materials: License #: License #: Date: �l Date Results Mailed: Phone:336-597-1790 Fax:336-597-7808 11/26/13 Jimmy Lewis Contracting, Inc. 1024 Henry Street Roxboro, NC 27573 (336) 599-9890 Office (336) 599-1806 Fax INVOICE DATE INVOICE NO. _4/7/2017. 18321 P.O. # TERMS REP DATE DESCRIPTION QTY RATE AMOUNT THIS LETTER IS STATING THAT JIMMY LEWIS 0.00 0.00 CONTRACTING IS A CER'TIFIED NORWECO AND AMERICAN PERC R1TE INSTALLER. THIS SYSTEM WAS INSTALLED PER PLAN DESIGN FOR LOT # 13 ENGINEER LYNN MANN ��Z �� `� ��� �� � �� o�� ���� -- � � ��� l WE ARE NOT RESPONSIBLE FOR ANY DIRT SETTLEMENT Total $0.00 If you have questions regarding this invoice, please contact our office within 30 days of receipt. Otherwise, we will expect payment promptly. _ U� ,Qy��.�i ��'l� cl-2�r-e� d- i�s}�ifl�¢� � f ��� ��/U/ � ` tf � ('1 (�t'•-� �0`Ck ' �1d� — 1 'n��W ' Wl �`� 1 \ l LEGEND: R/W = RIGHT OF WAY C/L = CENTER UNE EIP = EXISTiNG IRON PIPE ( ) = FlELO MEASUREMENTS � , , / . , / /, . . � . �� � P�AT CABlNET �5� / N� �R/O N�TM 632 /, : I i i I S� � I � � , CURVE TABLE CURVE LENGTH RADIUS CHORD BEARING CHORD Cl 408.17 825.00 N25'S1'49'W 404.02 e��",k �° �J,,�.i `�? / a- ; cn 0�1 /., F �'�g • LOT 1 4.56 f � LOT14 f ^�� i ^ : � � �: � -� :�' ' +l � � I � I I � � ,_ I LOT � 4 - . +�' � 15 � I ' �1 I I �� , ._� 14.33 ui "'."'" 14.67 o DECK � 24.00 PROPOSED • PLAN (NOT TO SCALE) cov. s� � „ HYCO I,<S3o�a�,' E LAKE 1 �5 �2 ��; � (SO4'43'S2"E r�v/ ' 104,q.p�� -- � ��� �1 � I ��� WATER USE UNE �L/ ; .�^\ I —i M � 435'S7"E o i .00' � N � I o `� i. M ` I 1 1 30 18g6 �I � N� � � �� i � rn �i �� � � nl � � �= J !/ ' � � ��'� � _ cn . /� S°�� � '� ,; �a,��fP � � ! Ih� , sl�e-e� p , ,� �j�O i�.00 o � � �c�. scR� o � � PORCH � n ro N � 2.s� � ' yP � ADDRESS: 441 i— � _--- �� ��— , �� � � �� ! �� ' � / C1 50� R/W -- I ' NE -- � ���� P-�ER �'P` ,,�� �_'___-- Ip,R`� �- , — 0 � M LOT 12 � 0 � �� ---- ----- � i��P GLE _�'" � � do�s: / Q j-' /�,�t �� NOT FOR RECORDATION, CONVEYANCES, OR SALE. i / Qj ,,��p,5� � PROPERTY SUBJECT TO ANY EASEMENTS OF RECORD. � ��'� �vj i T1TLE SEARCH NOT PERFORMED BY THIS OFFICE. � / �-' � � P� FIELD CLOSURE > t /10000. ''�`:- P'�i OFF-SITE SEP11C SYSIEM-SEF CABINET 15, PG 632. j� ,/y v�Pj�� PIN 9080-01-07-2219.000 / RECORD #:27071 THIS PROPERN SIGNATED A RDS ACCORDING TO �.��.s� ���.��� ' c����T�i`� IE �,.��. a- � �.� � �-� �.Il IE� � �.Il � Tax l�Iap �3 Par�el #�2 l O Snbdivision C�-�t�wa.� Phase/Section/Lot # 3 # of Bedrooms 3 Applicant: l"l� l.✓Q� � Location: ,.2_9u-,,vq H . �►uerat�on Permit System Type (From Table Va): q Product (IIIg): �O�w� cA !�-� ��}'P Type V& VI Expiration Date: Type V& VI Renewal Date: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions af the Improvement Permit and Construction Authorization. �-C. ��� ( uthorized Agent) ,� �► � (Licettsed Contr�actor) 3—co� �? � n� �!� r��1 I� n E�S �� �K�/ �9����C c �; S�a�-- ,�� �1e�-��� � p �P c,�— � �.�� w( �✓�Y � �''`� ���;� � �✓l�ti 0�-� s' S �+ � Scale ,%�`�j PCfiD, rev. 12/14/12 C� �^� � (Date) �{—�— t (Date) / 1��� ��i �i�� � ! %� � ' ; ��� � i� i � / � � �,��'�'r , ' / i /i � i� � , I ��� / � l� r�Q� _� / �P°"e� � �� �'X.L'l�✓OrKs / n ` � � s�Pj�, RZ� `� �. 1�o � /kah� �t ZS. ♦ �. l S �� �a,��ys l� S�t �l..e� �� G�sJ�► ����� � Mu���� Tax Map: Parcel #: Septic Tank System Checkiist (Type II li� ; .e.� State � Tee a Baffl� Vent �Riser Outlei Perm. D-box Serial Pressw r pp 1�lotes: 5 c� o � . - . �S�S' System Type: = State ID & Date: . Ca acity:' ,`� Ris�r (6" min.) NEll�IA 4I� B z Model: �,.� 12� Piggy back plug '�.. Hard wired `� � Alarm functioning . Mounted on post Above grade (12") Conduit sealed Pressure Mani%Id Number of taps: Size and sch: ____ Pump System Checklist , -�.., � i InitiaUDate �'ank Cam oaents 3��0 �� Pum model: as 3, v' Block (4") \ " � N.ylon retrieval rope Float �e� arid attachments On/Off float swing: Alazm float (6" separation) ' —� Anti-si hon hole � - �` Check valve Threaded union Gate valve t/' Conduit sealed ✓' Ouflet sealed A proved and secured riser S�pply Line Size and material: �n. Length: /�e, o' in. ft. ✓ _3_� � � � Contracted Certified Operator (Type IV System ): IV�tes: � � S _ ��t.,�� �-5�� _pRc� � SYSTEM OWNER: �t .. �. ADDRESS SYSTEM OPERATOR: DAVID BRANTLEY WASTEWATER TREATMENT I� OPERATOR: � �>, CERTIFICATION: PIN# � , �;� TAX REC• ±��^:+w*.�?` REPORT IIT1Ifl�Af�f7liEt t ��M � �...�..._ � a .,. .. _ . . . Y N REMARKS FACILITY: Type, size and sewage flow in accordance with permit �.: � � '�,� �� TANKAGE: Risers accessible, surface water diverted? L~ -::;� � d Risers structurall sound, waterti ht? ° '�� � . �f,�n . � ���_, , _" z; Sanita tee in ood condition? Effluent filters cleaned? `�`i .��,�:� - Slud e de th/a earance , level acce table? ' � , � ��`� � w�� ���` . � �` Grease Tra r �� � ��� EFFLUENT DOSING SYSTEM: Slud e de th/a earance , effluent a ears clear? '� a � Re uired um s resent, o eratin , and c clin ro erl ? � p�-- ?_� _"`�- `:�.- .�r Hi h-water alarm resent and o eratin ro erl ? ��� � �`��E �"� �- VenUfloats/ i e/valves/disconnects in ood workin condition? "`��; �" °���� �� Y� Control anel/electrical com onents in ood condition? -` t;:, , .-� ,.;-_ ,i;-� : GROUND ABSORPTION FIELDS: No evidence of effluent surfacin /reachin surface waters? �`� ��� `^ '� -"' Minimal ondin in subsurface trenches? °° > � ° � � �` "� Surface water dive�ted around fields, no de ressions? t� >.� .' �. Line cover/ve etation ade uate/maintained as needed? x �>�n =�-%��� ��, ,<<� '- Protected from traffic, destructive uses? ��;��� �`��'�- ��` Distribution devices accessible? �'sx� �� �'- � :: -� - � Distribution devices in ood condition, workin ro erl ? a� � �� �n�-� � <'� � � ,,,.;� �, �. .,.� . >; Re air area ro erl reserved, maintained? � � �''� r. ;, � �� . �= s�'"" � ::'- z �� '��'_ Turn-u s/cleanouts/valves intact and accessible? �: , `' �� � �� '� � � �'. :�: � No effluent standin in lower laterals? �_ {�_ >� �� ` � ,,, Laterals free of excess solids, flushed as needed? �f ��- ��R `" Diversion Ditch/Berm in qood condition? ;� �:�. ��<�� COMMENTS: MALFUNCTIONING NEEDS MAINTENANCE STRUCTURELY NON COM ^�'""" '."y'" r�+r".'�'la��-�� _ iF�': 'BK �'. '� . '� � . a. �. ; �� -� .� �� aceAnalyticai� wwxtpacefabsrom ANAI,YTICAl. RESULTS Pace Anatytical Services, LLC s7o, cor,rerence orive Rsfelgh, NC 27607 (919)634-4984 Project: Michael Ward Clearvvater Lane Pace Project No.: 92354934 Sample: Eff(uent Lab ID: 82354934001 Collected; 09l1211710:00 Received: 09/12/17 11:40 Matnx: Water Parameters Results Units Report Limit DF Prepared Analyzed CAS No. QuaE 2640D Total Suspended So11ds Total Suspended Solids b2106 c80D, S day EDN Carbonaceous BOD, 5 day Colilert-18 Fecal Coliform EDN Fecal Collforms Totai Nitrogen Calculation Total Nitrogen 35U.1 Ammonia NfUagen, Ammonia 351.2 Total Kjeldahl Nitrogen Nttrogen, Kjeldahl, Totai 353.2 Nitrogen, NO2lNO3 pres. Nitrogen, NO2 plus NO3 Analytical Method: SM 2540D 4.6 mglL 2.5 Analyllcai MeUwd: SM 5210B 19.2 mglL 2.6 Analytiql Method: Colllert-18 Z420 MPN1100mL 1.0 Analyticai Method: TKN+NO3+NO2 Calcufallon 6b.6 mglL 0.12 Mafytical Method: EPA 354.1 1893 Rev 2.0 45.3 mg1L 1.0 Analytical Method: EPA 3512 b2.9 mg/l. 2.5 Analytical Melhod: EPA353.2 2.8 mg/L 0.020 1 09l13/1715:12 1 09/13/17 17:58 09l18/97 74:20 82 1 1 10 5 1 09/12l17 t5:27 1g as�z�t� ��:sa 09/15J17 06:41 7664-41-7 09/20/1711:54 7727-37-9 09l20117 22:46 Samp[e: (nflttent Lab !D: 92354934002 Collected: 09/12l17 08:45 Received: 09/12/1711:40 Mafrfx: Water Parameters Results Unils Report Limit DF Prepared Analyzed CAS No. �ual 5210B BQD, 5 day EDN Artalytical Method: SM 5210B BOD, 5 day = 242 mglL 2.0 t U9/13117 58:12 09I18/17 12:50 361.2 Total KJeldahl Nitrogen Anatytical Method: EPA351.2 Nitrogen, KJeidahl, Tofat 32.5 mglL 2.5 5 D9/20117 11:21 7727-37-9 REPORT OF LABORATORY ANALYSIS Thls raport shall not be reproduced, except in fulE, Date: 09/25/2Q1711:39 AM wilhout the written consent of Pace Analytical Services, �LC, Page 4 of 17 � 3 2�a � � �;�� 2 -�c. ��. tFr.cNn• CURVE TABLE R/W = RIGHT OF WAY CURVE LENGTH RADIUS CH�RD BEARING CHORD �� � C�L = CENTER LINE CI 108.17 825.00 N25'S1'49'V 404.02 EIP = EXISTING IRON PIPE ( ) = FIELD MEASUREMENTS � �_�� HYCO �� PUT CqBINET % � N� �RIO ry�� 63� � �' � / /� � � 22 I S �,�� I � � � � LOT 14 I I ^ ^ �� I � 0 � � � ' I � � LOT � � � 15 , I , w 0 � � I� � Z LOT 13 4.56 AC. ��•) FW NDATION (N0T TO SCALE) ADDRESS: 441 � � � / �,`53o�Z, E LAKE 1 45 I � � (SO4'43'S2"E ' �-� \ I 104.40') --1 � f 1 �� , wn�R use ur+e �t/ � I I I i� � i ,.E �P �' I DIST.) N � ' I I �g96 �� I � N Nj I . � o� ^ i � �=l 6�\ (p' \ •� � n I � � NI �c v� ``� I `�\ � � �\ � C�, _� . � �--� 0 (T J � /V�� �O O = � t7 � � ^Uj� �p � LOT 12 � 0 � � � � � c� 50° R �W j � NE ----------------------_ � -- � � —� ----------- ; � `�,1 P�ER _�--� _ _ — — — � N� vv ,/__ i � � — i J�,� �, �LEPR �� i� NOT�FOR RECORDATION, CONVEYANCES, OR SALE. �J� j'� S7nKE /��� � PROPERTY SUBJECT TO ANY EASEMENTS OF RECORD. ' ,,� R j ��� i T1TLE SEARCH NOT PERFORMED BY THIS OFFlCE. I /Stf,'Nj" ��Vi FlELD CLOSURE > 1/10000. /,NP -' p �g / / OFF-SITE SEPTIC SYSTEM-SEE CABINET 15, PG 632. / � , �gt�j � PIN 9080-Ot-07-2219.000 / RECORD $:27071 i/-" ,/�5j � DRIVE NOT LOCATED AT TIME OF SURVEY. THIS PROPERN S NOT LOCATED IN AN AREA DESIGNATED AS HAVING SPECIAL FLOOD HAZARDS ACCORDING TO FLOOD INSURANCE RA MAP #3711908000 J . EfFECTNE DATE:JUNE 4, 2007. LOT 13 BLOCK SECTION FO U N DAT I 0 N SUBDIVISION CLEARWATER saw RECORDED IN PLAT CABINET 15 PAGE 632 PERSON COUNTY REGISTRY 2o�s�sa :� � �vr AMWARD HOMES, INC. � iQ111LDi�5 CUNNINGHAM TOWNSHIP PERSON COUNTY NC ;_SHOgt+ �: ��=ioo' WARD SURVEYING SERVICES, PLLC �a,h: 11/11/16 LAND SURVEYING & PLANNING ..� AooK e: 297p56 APEX, N.C. (919) 367-7858 / � ; � � t � . ./� f ��,� � ♦ � Illl � ' , � �. � �� (�� t \rl��� I�;«�. ����.,���������� :,I I- I��.�I f� CLEARWATER S/D PERMIT CONDITIONS Information for the Installer: nsuring a healthy environment 1. System shall be installed per approved engineered plans. 2. Contractor must be certified by the drip and pretreatment manufacturer in order ic> install system. 3. Contractor shall have a set of approved engineer's plans on the job site tlirougliout installation. 4. Pre-installation meeting mandatary (Design engineer and drip/pretreatment manufacturer rep. must be present). 5. Contractor must re-flag drip lines on contour after clearing and have layout approved by health dept. 6. When clearing drainfield area disturb soil as little as possible. 7. No site work should be done under wet conditions. 8. Contractor, design engineer, drip and pretreatment manufacturer rep., and certified operator must be present at system start-up. 9. Before operation permit can be released a registered professional en�ineer or certified designer and drip/pretreatment manufacturer rep. must certify in writing that the system was installed in accordance with the approved plans and specifications. 10. All tanks must be accessible from grade. phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro; NC 27573 �-.* ''^..„� ,` f . :'""- ` .,,.... _w : � � ���� ���a�^�n���n���.� ���.���n CLEARWATER S/D PERMIT CONDITIONS Information for the owner: nsuring a healthy environment Before the operation permit can be released a copy of the signed certified operator (ORC)contract must be given to the health dept. (a contract for operation �il�d maintenance with an American Certified ORC shall remain in effect for as long a:: the system is to remain in use.) The ORC must be both a Grade II licensed wastewater treatment facility operator and a licensed subsurface operator. 2. Grass inust be established over the drainfield area and cut when needecl. 3. Caution must be used concerning volume of water entering system and what is put down the drain(ex. Grease, personal hygiene products, cigarette butts) phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 Application Date: � Amount Paid: a�-�-�'� Receipt #: 1�1�115a C.1f2,� C�c1 Improvement Permit (Site Evaluation) $200.00/$300.00 (if> 600 gpd) Mobile Home Replacement or Building Addition $150.00 (if site visit required) Well Permit (New/Replacement/Repair) $300.00/$200.00/$75.00 ��,�, f ��1L0.��� Taz Map: _1�� � � � ���� Parcel#: a (� ICennwn u-m�rnuxa�und.mll IE��,m.11�Iln tion for Services Services Construction Authorization �Fee is dependent on the type of Permit Revision $75.00 Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information• Name: :� �czr- -� � � � C r/) �� e�'� I,^�c�.�c.� Address: ' ,- � 2) Name and address o current owner (if different than applicant): Name: Address: Phone (home): (work/cell): � � �1 - (, 6 `1 - � U � � Phone: 3) Property Description: Lot Size: .�� 5 Subdivision: �� ec��.�a't'e f Lot #: �� Address and/or directions to Property: �� j CI P c3„� ���-P..� L n �,-�� ❑ yes no Does the site contain any jurisdictional wetlands7 ❑ yes �o Does the site contain any existing wastewater systems7 ❑ yes C� n� Is any wastewater going to be generated on the site other than domestic sewage7 ❑ �es C�'no Is the site subject to approval by any other public agency? E3"yes ❑ no Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Use and Type of Structure: OResidential eC�1 w Single Family Residence Maximum number of bedrooms: �_/ Occupants: �_ ❑ Expansion of Existing System If expansion: Current number of bedrooms: ❑ Repair to Malfunctioning System Will there be a basement? ❑ yes �o With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential Type of business: Maximum number of employees: Total Square footage of Building: MaYimum number of seats: S�Water Supply: C'I New well ❑ Existing Well � Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes ❑ no Please note any known ground water restrictions or sources of contamination: 6) If applying for `Authorization _t�oj�onstruct', please indicate preferred system type(s): O Conventional ❑ Accepted C�"Innovative ❑ Alternative ❑ Other ❑ Any y3 I cert� that the information provided above is complete and correct. I also understand that if the information provided is inaccurate, the site is subsequently altered, or the intended use changes, all permits and approvals shall be irrvalid. �""1��----� L���' Signature (Owner/ Legal Representative*) * Supporting documentation required. I � j Date • Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat. • A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (t 0/15) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) .` ,\ •\ � \ ,\ � .\ \, � . ,...� �' _+ `�� /� �-���� i"/ �` f —' "_.- "..._� �-...... �: � �� `� \ �v��� � . .\ �� ,\`\ . .... . ✓�JO JJl y , � ✓ v � \ � ✓� v ✓J ', � I �� \ \ > `'� ✓ ` ` ,,�`'' ', � y �J '� � efl ✓ y' � ' �i �J \ � � , �' �y �� � ��� � � � � ,� :," ,,� . � �� ��+ J l � O � ,� ' ' 'f�9. �d� � . � sy'� ti �'°/ > / / .,1� � �, °' �. r � �' . � �\ � .� � � , j•% ✓ 6'• ! V � ,\ � � �� �s� � ' % d� /./�o � f�� I ��� � � �d o. ;✓� :� 1 .`�" ,/ .,+'` °"� . / a+''� �,a) p r� �-�' � .i `� . '>��� �� , �� �, ,,�. �, � �'''� ��'°���'�� ,.�. �. ��, 6� �' �� ` �✓�,��Y��y �� � . i �� 0 � ��'�"` ��'' ���'�"� I _ , ��.���-�o � � � d � ��W�o � � _. ��. , \� 9��.o���wjG �o� I ' .�. � ,� /�' � i �� `9 , � S ' . ( i ,e. �' .��W �r , ,, , i ,/ .�y� . , � . � . ' . ,� � -- ����Wi ''� � '1 � � -� ��W„�—'� ''""' � � � I � v� . ,\ � ----� ,1 ' i � ; - �� , '\ '� �,�- .� ' ,` � � --- ------------�,' '� �` �� \,\ \,` '\ '\ �,\ �\ \ 1 •� \,\ / �.,-----� \ '� _-__ _ ______�- � �. � � � ; � .� � , , i .�o '� � I j � �� o. I j ,,.,--�---- . ; � � \ ,� �------��� . �' '� – ���� I ,.'/ � � , , r���\ / _ �� ��, i � I�'� �� I �` � � � � '� �' � ��� - i ��'�v� � ( ��� i � � � ( ' � � -_______-- , i i i � �-�_.�.:...--��� -� i � ��� � � . i � � �� �� . i �� -� � ,� '� ,� ��,\ ,� i /� �� � � '� �� � \ ��.��, � � � i� j '� � � �� ---,------------- - --_ J � '��', �� - , � � � 1 ���, / ��a • � % � �^ 5 '�1, �•� � p '� �" '�, ` �� / � , �, � � � � � ---_ __ ,� ,\ � _ ;' �i �� -c�\p \ i- � ` � ��,0. i-�- �\ �-?t J�O � % `� � \ ��� �' ,---_--'� _-- i 1� `� ���,\s�, ',� \ �\ � � . �---- �� �� -- ��� _�.- _- ,, , _ �� ,_ � �, �.� ,_.—. u_.._.�,� ,\ � '� ��, �� \ �_�-i" ,- �� `� ,� o '� �- � � � �'� `� `�`''��. �� `'�,. �\ '�' � ,- � .� � � �, '' '� � j o� �, � �'�... �\ � � ,�------�., � 1 � 1 \ �� , ! � �. �' ` j3,� � �" .\ � �� 1 1 �� i '��5� �� � �� I1 � �' .s, ' ,�a� ` ' � ' � ��; 1 � �s, ; I � �� � � , i `'� \ ,�_� .``�.- ��-�'� � ' � �� .�.,' o I i � o�y� '..��� �]��i�r�+�' CD �4 � � � °'l;1 f� ' ; ``� j , /�a � �� % % � % � �-_