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A23 218m �' �' ��.�!� �' ��� �-- ���=� . �� �...� �� �/23�`� �'°� ,�a� . �'v.�•,� -r�� -t- -Tp..J� �3�t ,�I�-r�{-� � �a-��-t o� G�w10 �t- '� �ss V sA uKn �. �2.0� . V�.�s ..�Q.,; lti�,�� s-�� -ra �►�o a.�o e.e.-� ��+��.e ��P�e c' ��-�-' - �%P.Q�.� U O.P� d�� C• �.v�� �-e� v� -�--� � � �� � � � Tax Map: � � Parcel:�_ ��, � � � � ���� �� Subdivision �--� — �--{� � � � �'� � Phase/Section/Lot # lF�a��a����.-„-„ ����.Il IC���.11�I� Improvement Permit Permit Valid for: ive Y ars Non-expiring Type of Facility: � Si New �Addition Number of• Bedrooms y� / Occupants / Employees / Seats: Proposed Wastewater System: Proposed Repair: o � Permit Conditions: � Authorized State Agent: (X) Owner or Legal Re Water Supply: � g �� �4 f i� �E'd ,Z Projected Daily Flow: 3L� o gallons/day Type: �q Type: �_ Date: -� 3! /� Date: � - � I - The issuance of this permit by the Heaith Department does not guarantee the issuance of other required permits. It is the responsibility of the applicandproperiy owner to insure 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 Improvement 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 mrrl Rules for Sewage Treatment and Disnosal Svstems'(15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic system will continue to function satisfactorily in the future, or that the water supply will remain potable. Authorization to Construet Wastewater System See site plan and additional attaehments (�. Proposed astewater System: �� v t:�� . �vv� (*)Type � Design Flow J�Cd gal./day New �Repair Expansi n� Soil LTAR: • gal./day/ft2 Type of Facility: ���� �r`dpi1C.� Basement: _ Yes _ o (*) System Types Illb, Illbg, IY, and V, r�guire periodic system inspections by the Person C�unry Health Department. Wastewater System Requirements Tank Size: Septic Tank �•� ODa gal. Pump Tank ` —gal. Drainfield: Totai Area �d sq. ft. Total Length 30o ft. Trench Width � ft. Min.Soil Cover �Si. in. Distribution: Distribution Box J f Seria( Distribution / Pressure Manifolc Grease Trap gal. Max. Trench Depth � in. Min.Trench Separation "1 ft. Authorized Statz Agent: Issue 17ate: � - 3 ( - (� r Permit Expiration Date: I' 3(-� Tlle system permitted is: Conventional /Accepted / Alternative / Innovative . I accept the conditions and specifications of this permit. � ,\��:'3 (X) Owner or Legal Representative: Date: �� Person County Environmental Health, 32S S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12) 0 -- �---- --- --- ----. . -- --- __ _._ - _._ _._ . : . __ _ � . . .. � :���,�� ���.��� � � . , � . � ``�' �'`'^ � � �°IC� � �i �]C3Y1LY'�'�'"TM* �833� �iCl�1G7[L. � . � I . . .. ; : SiTE�:9�T�-I. . . J � � ' . � ` ' : . . 23 Zl� � Nairie � S�.� S �� � 2 0.�� � Taz Map # A � P�tcel # : �ub' - � - � sectiafl/Lot# . . . . Z_�_(3 _ : , : uthorized State Agent . � Date . � , . '� sy�, �mp� �res� �pro���contours only: The coniractnr must, fTag the system�rior to ,: . , ._-- ------ beginning ihe installa�'ion to i�sure�that pr�npergrade is maintrri�red � _ - -- - - - - - -_ _ _�__ _ t �Of+`99 L M .,E0,95.08 N ___,_ `� S � ° �%I � � M 1 ` � � , � � ���`.�,�""�` J � t� �� O; ` `� C± � l O N .8�,:� 3 ,, �o� 1�-�ti5'�'� N � „£0����6L , S�I'L�� I���� �OV� s . �L'66Z M .,[tr FF,�t N .L�'�6� w l£'� �gZ. 9 S e�insfall � o� �ee�r� � a� '"`..__ �c,ha�e � t,w�-1 l 1�'�' ����` ` a� a3r+N�� G� � ���n Z1 'IQtl1 � � ,� 6l � F� � W£5�,�— l��l-N`` ��� ,££���� �. S� M ��04,f � - �•£g � � � �j /�� . 0 �1� �£ 1.'£6£ � ,,0£ �r �8 S �ap'05 �''�� 3id��s3��3�d ad��d� '6 �� ;jd� 3 r� d'131� �►ld3S � ry `A ` no� � J•v`�� 4����� S N` .�o�a o� .aF•61Z - •�y S � �� � `� _� _ _ _.. . . _ . --------.-=-�----------- . ReJ__. ._ __ ���.s� ���.��� ' �-�- C� � tC�.�T'�I� � I�������,�,Y„ ��n��.Il IF-���.I1�1�n. Applicant: ��.SS�� �eave5 � Location: �.,I�,a I„ L� K.� P_,l . � Tax Map 2� Parcel # 2�� Subdivision � �}- Phase/Section/Lot # ��J # of Bedrooms � K��xv�5 �t� , --=7 Lot ov� lj� Operation Permit S System Type (From Table Va): 1�1 � _ Product (IIIg): �� Type V& VI Expiration Date: 1 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 of the Improvement Permit and Construction Authorization. , .� (Au or' ed nt) � I I'�{'._ �-�,1h1' i S (Licensed Conh-actor) �i�� i l.� � (Date) _ - F.E�-E� — "' �l�C - 2'a (Date) � {4 _ _ .��„�� �,.:. _ - + ������ ���, _�,�., -- _ ,. � � �_ _ . ` { < , ° � �- - „ < ,� 1i �� fl� - , �r � � , t I 1 �, _ _. , .. _ _. : _ �; _i _ .._ . - - ,--. - 1� � � .; _ . _,,�'—t.._ � — , r� S. `' ; �,�t: �` ` - _ _ — - _ :, _ , . . �' .;' �. �l , . i -. �2 � � gg' � _ _ �� - 5 . , ' . �> - � � � T-� � i L �; "�'� _ _ . . �l f/ ��� . ,r-, : � � , " I -ci&r,.!' . . � a- r.� �•�f .� a_ `: 4�` � r7 �. � �� l k - ' i, �� I �'(/ �}�� 41 �i �' F f .�� . 1 �`° I;yi N_.:f � �� � rb r':. - � �'. r� S -. � �1 d ". r.. �.ti � i ' � .' �^'��`�" '� {�.► i--�il�Fv� FMr �''" ��, r I'�'� � f �� } �r'`' -a �'d; 11 i�,,�� � � �Cl � i"= r 1' � i _: i i, L� i> i'_`' "_a ,. - � =i:; , �- � .. .� � '_ _ .. I _ ".._ . r. �•: Scale Nl � Cohcrl{� d'�OaX PCHD, rev. 12/14/12 �s �!AS�rn��rl�'��i�%(���` �j� �vl vVec� (� f v��iu�e. 5 - ��n�.l���vrf, UP rs SeSrie I ��r�eS �,cw; l� i�+���t '�'� �L f an�� % s�'�'�y v�F Taz Map: 23 Parcel #: ZI $ Septic Tank System Checklist (Type II-I� System Type: �_ Se tic Tank InitiaUDate State ID& Date: - 32c( T,$ g- Z- �2 -(�{ Ca acity: 5— pp p r/ Tee and filter ✓ Baffle f Vent ,.,/ Riser ,/ Outlet boot ;/ Perm. Marker Distribution D-box levels set) - Serial Pressure Manifold LPP Pump System Checklist Pum Tank InitiaUDate State ID & Date: Ca acity� Riser 6" min.) NEMA 4X Box � . Model: Piggy back lug Hard wired i Alarm functioning � Mounted on ost j' Above grade (12") � � Conduit sealed Pressure Manifold Number of ta s: Size and sch: Contracted Certified Operator (Type IV Systems): Notes • ' Tank Com onents InitiaUDate Pum model: Block 4") Nylon retrieval ro e Float tree and attachments On/Off float swing: in. Alarm float (6" se azation) Anti-siphon hole Check valve ( Threaded union ; ' Gate valve Conduit sealed Outlet sealed A roved and secured riser Su 1 Line � Size and material: in. sch. 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