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A23 223�� 1 C�' Z i p..23--1�1 Z� Q� � •� � �� .:,,�� J . �� w � � � �� n.�*n�•+ta�a�sa<c.u�tL-.r1.� �a�:.c�.�d:�a Date: �/ I 1 / 1 S� Name: 12�'�c GG� (�,�.OSvJE1.1._. Address�5 ��^��f �.� ��_ '�E�1. � � C- �?7 �`f`�' Re: Bacteriological Test Results Dear Well Owner: Tax Map:� Parcel: Z?� Your well water was sampled on j�/�/�, and tested for both total and fecal coliform bacteria. Your water sample test results are noted below: � No coliform bacteria were detected in the sample. Your well water is safe to use for drinking, cooking, washing dishes, bathing and showering, based on the bacteriological results only. Total coliform bacteria were detected in the sample. Fecal coliform bacteria were detected in the sample. Total coliform bacteria are naturally found in the soil. Fecal coliform bacteria are associated with animnal and/or human waste. The presence of either total or fecal coliform bacteria in well water may indicate that a new or repaired wel( was not properly disinfected prior to use, or that contaminated groundwater may be entering the well. If coliform bacteria are present in your water sample, the water ntay not be saje for use. Young children, the elderly, and the individuals with compromised immune systems are especially vulnerable and their physicians should be notified of the test results. A well that tests op sitive for total or ecal coliform bacteria should be properlv disinfected and retested prior to resuming norrnal use. The well may be disinfected using the enclosed disinfection procedure. A well contractor or plumber can assist you if needed. Once the chlorinated water has been thoroughly flushed out of the system, please contact the Health Department to request a re-sample. For additional information, please feel free to contact Environmental health at 336-597-1790. Our office hours are 8:30 to 5:00, Monday through Friday. Sincerely, �" � �� Environmental Health Specialist Person County Health Department (rev. 4/20/16) Person County Environmentai Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573, Phone: 336-579-1790, Fax 336-597-7808 North Carolina State Laboratory Public Health 43012 D�st?ct Drve Environmental Sciences Raleigh, NC 27611-8047 http://slph.ncaublichealth.com � 1 C i0 b( O � O Phone: 919-733-7308 g y Fax: 919-715-8611 Certificate of Analysis Report To: Name of System: PERSON CO ENVIRONMENTAL HEALTH REBECCA CARSWELL 325 S MORGAN STREET ROXBORO, NC 27573 EIN:566000331 EH COURIER #: 02-33-15 StarLiMS Sample ID: ES121917-0072001 � �� ) �� ES Microbiology ID: GPS Number: Sample Description: Comment: Environmental Microbiology - Colilert Profile Test Name: Colilert Analyte Test Result Total Coliform, Colilert Absent E. coli, Colilert Report Date: 12/21/2017 Absent REAVES LN. SEMORA, NC 27343 Col lected: 12/18/2017 14:00 Received: 12/19/2017 08:26 Sample Source: New Well Sampling Point: well head H. Kelly Susan Beasiey Well Permit Number: A23-223 Method: SM 9223B Date 12/20/2017 1 v2o/2o17 Reported By: Susan Beaslev � Explanations of Coliform Analysis: If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliform bacteria are Present, the water is considered unsafe for drinking purpose. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. �� -�5 nc department of health and human services ��r�� County: - � � Sainple ID #: ��- -� For Inorganic Chemical Contaminants Name: �2Sv�/� � Reviewer. ��, TEST RESULTS AND USE RECOMMENDATIONS !. � Your well water meets federal drinking water standards for inorganic cltemicals. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inor�anic chemica[results onlv. You may liave other water sampling results that are not taken into account in this report. 2. ( f The following substance(s) exceeded federal drinking water standards or the North Carolina 2L calculated health leveis. The North Carolina Division of Public Health recommends that your well water not be used for drinking and cooking, uniess you install a water treatment system to remove the circled substance(s). However, it may be used for washing, cleaning, badiing and showering based on the inorganic chemica! resu.lts onlv. Barium � Cadmium � Chromium � Copper Fluoride Lead Iron Mercury � NitrateMitrite Selenium Silver Ma�nesium Zinc nH 3. 0 a. Sodium levels exceed the U.S. Environmenta! Protection Agency's (USEPA) Health Advisory level for sodium of 20 mg/I. The North Carolina Division of Public Health recommends that only individuals on no or low sodium restricted diets not use this water for drinking or cooking. It may be used for washing, cleaning, bathing, and showering based on the innr�anic cl:emical results onlv. . ❑ b. Levels over 30 mg/1 may pose aesthetic problems such as bad taste, odor, staining of porcelain, etc. 4. ❑ Re-sampling is recommended in months. 5. ❑ Re-sample for lead and /or copper. Take a first draw, 5 minute, and 15 minute sample inside the house (preferably the kitchen) and if possible a first draw, 5 minute and a 15 minute sample at the well head to determine the source of the lead and/or copper. 6. �he following substance(s) exceeded federal drinking water standards. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inorpanic che�nica! resu[ts onlv, but aesthetic problems such as bad taste, odor, staining of porcelain, etc. may occur. You may want to install a household water treatment system to address aesthetic problems. For n:ore informatioii regnrding your well waler results, please cal! tlre Nortle Carolinn Division of Public Herrlth at 919-707-5900. Report To: H. KELLY . � North Carolina State Laboratory of Public Health Environmental Sciences Inorganic Chemistry Certificate of Analysis PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET Name of System: P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htto://sloh.ncoublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 REBECCA CARSWELL REAVES LN ROXBORO, NC 27573 Courier # 02-33-15 SEMORA, NC 27343 EIN: 566000331 EH StarLiMS ID: ES121917-0021001 Date Collected: 12/18/17 Time Collected: 2:00 PM Date Received: 12/19/17 Collected By: H Kelly Sample Type: Raw Sampling Point: Well head Well Permit #: A23-223 Sample Source: New Well Temp. at Receipt: 3.0 GPS #: Sample Description: Comment: New Well I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 m /L Barium < 0.1 2.00 m /L Cadmium < 0.001 0.005 m /L Calcium 35 m /L Chloride < 5.00 250 m /L Chromium < 0.01 0.10 m /L Copper < 0.05 1.3 m /L Fluoride �$�0 4.00 ma/L Iron Lead 0.30 0.015 0.05 mercury < U.UVUb U.UU"L m /L Nitrate < 1.00 10.00 m /L Nitrite < 0.1 1.00 m /L pH 7.8 N/A Selenium < 0.005 0.05 m /L Silver < 0.05 0.10 mg/L Sodium 8.90 m /L Sulfate 7.60 250 mg/L Total Alkalinity 120 mq/L Total Hardness 110 mg/L Zinc < 0.05 5.00 mq/L Report Date: 01/10/2018 Page 1 of 1 Reported By: Deddie.r�loncn! WELL C�NSTRIICTIOI�I coxn L�is i�rm qin bc ma3 forsinglc x m+ilapfe meIIs 1_ Net[ Coatrndnr IaEormatioa: �--� ,�} r {/� fii�i �-� Ps2. t' � -�1'�� r Well CamccactcrNamc 3 3 ? � �--� VC CVc][ ConLeffel0r Certifiratioa IfwIIbLT Barnette Welt DrillEng, inc. Conramy Name � � Z ZUNI Constrverion P�mic�: — Lrsr all eap4mifs srdf cnnstrceerort permus �t Cma+�y. SYa[� 3'o+i�c� ueJ 3. iVdl Use{checl:sr•cU usa): � yVa[er&oppiplYelL• �AgricuEnural OhlunidpaUPulslic- ❑Geothcrmalif3cxiIIS/CaoliagSuPP�Y) ��drntialW�erSuPPiYC�� QIndusaiallCom�aachl f3ResidusdaF WaterSuppiy {shac�) DAq�if�orRcchu-oa �{�aundt.�ruItcmediapor+ flAquiferStorzgeand Rccavar OSatiniri'Barriv �AqniFa Tesc ❑Ssormwatcr.Drainage flExpaima�taLTcr3molagy Ohihsida�ccCantmt pGeoti3er�aS (t3osed L�p) �'['iacec 4.Date'�►'e1i(s)Compieted:%•7f? ��dilD� 4� � _ Sa. tirtR Loc�tiont . � ��._��; � . OC � E��'C'tt � ��+ " Fnci:i6l0�urrxrl�sw� Faz�'litylD�(�applioble) a�� LifJ,. Forinteenai Uu ONLY_ 10.'WA7Ts&7ANE5• � DESa[�110N �� °' � � r� �' / � t�.� f` 1C�� rt is_ouracc�.�� m��o-�a.,.a�.o�r:u�a��r � r�u FROH APSN£[F�[ TW�d�SS MA7ERL�I. w !G �('Z R 6 i°' �G7 �J �/�'..' t�.�rtt�c,�caoxros�� n��aa � • �ea� ro nun�rfa �er.'rae:s ntRi�Ftar" . {� fi m- � � ia Physica! Addres:. CicY. endZiP t/ c..qGrV �'� �C3.� � �� ,�, Pu�11da4ificsionNo. {P3N) Sb_ latiinde aad Lond bude in degreetlmiantesfsecon+iscir decimal degTee, ��.�n s�a�«,c��,n�s�s„��) _ � �� . S�'L- � I f rr � `i t'1 ��.. w � Is tsrc) tfic tacll(sj: ff�Yi�sn�ncut or Lli'rmpnrarf 7_ Is thiss repairto ao e:isuag�cvdL Dlres or �}Lfb� lJ�hit is a rxpai .I+ft aat 6mxa �n!! aorarivction 1nJorviaJiaa mrdetplaier rl�r ttaane ofdte rrpuirander �2! rrmarlssaxfan arvrs d�e8ackojdrts/6rm 8. L�amber of�cUs eausttacfr�:, / Por mr.tt:ple FnJeerlan ornanarareraiq{pfy reOsOfVLY�iilr rLcsmae coasO�meKant i� aovt rubrnu onefarnL R tG � ra � � ic. f4 �- {t ia. sw�u4 �r+ � Gn`' � o� fc � [tAVSL PA.CIC ai . �iaiEle : .. : TO ilih'i'Fnur- � 2 ZZ G�tii'uatio� �.,,,,, � �J � ��'Y�?�G�-t� •� � l � ti -�l �'�! Si�mazoEC.atifrr�l Wcll'Coalndnr � gy slgting rhtsfarnr, ! frerebp c�rr�i� rhm Jae xe11(sJ war (wc+51 �cd .R oaoordenu _ x�ltfi JSANGIC OZG.(11Q0 ar ISA NCAC OIC AN1Q IPdlCaaxmmtorr Stc+rd�+ds aad lhot c cnpyojiLts.reoorzilwrbeen prwlded m�u qrl! awnec 23. Sits di�gnm oradditioaal wcl[ det9tl,: � Yon a+aY use tiee bsck af 9�'ix paga tD providc a3ditional vrcil sita daas4s or wei[ cdnsWdian de�ls. Yau Qiay also auach addiiional pa�cs ifncctssaiy. SUBMI7TAL iNS�UCTlONS 9 TotaltcrIl dept� beIm►[sadsm-I'acG,,,,_ �� (ft) �a- For Alt WdLs: 5ubsuit this fom► w+Uun 30 dsys °f °°i°pl�ian ofxslE I'ortmittlpfau�effslttfa(f6rpth�rfdfJfe+antComnPk`3Q2P��a"d�C��7 �narOn��eYo2lawi� L� {�} DivisiouoiWat�rQa�iity.IaformationProa�ssic&Uni� 7 il. 5iatic �vatar Jevd bdow top of rasing: IQ7Ma0 Serv,ioe C1�ctu, Rgidgh,i�iCZ7�9-lb�� Jfxoterfeo-efisa600ecarie� ase "�^ 11_ SorehOEe divtneter: � C�.) 24h For Inieetian Wellr. Ia addition io seu�uig ihe f61R1 to the addre55 in 711,a abovc. aL.o submit a capy of this form wilE�in 30 days af camplrti� of wcll iZ Well coasiraclion metbod: � � � � � � �� '� CO�� C;�� ti.a au�c, m�uy, oh Iq dinct pustr, ea.} Dir�ioa afNater QaaG�F, Undergranad 7ajeetion Coatrol P�ug�xrn, a 63sDiaa Sc�vioe Cwtv, Ra�g�, tve a7�9-�sss FOic 1YA'CSR SUP'?LS' i1'EF.LS ONi.1`: � MetLodoires� �oWq2Q utill 24eFor�'aterS� IniecdonNell�nadditiantosa�diagthefamto ]3i �eld (gpm) � -- the addt�s(a) above, also svbm�t ono oopy of this fo�ia wilhm 30 da}5 of � eoumpleti� ��dl eonsttnetios oo the eoturty htatth dcparu�►c� of th� eatmn* z3b.Aisinf�ctionrygG HTH �o�t_ 412 Cup wiuseconstnscrrd. Form GVf-t Nvnh Gvoiiaa D� ofEavimnmencaadNz�iRwom�es—D'crainn ot'ZR�erRus►uY �'d 9LZ6-869-9£E �ulsu!II!aa IIeM a}}auae8 1tw:cedlm.?AI3 �Z9�90LL 861�0 Tax Map: �3 Subdivision: ��` ; , �,� �� ' (� � IC.T�T°�`� �° �rn�a�ramaa�rnn��ca.�am.Il ��ce�.��a Parcel: �� WE L PERMIT (New Repair_) Applicant's Name: __ �-�2 � � c °+ �CYsure-( ( Mailing Address: Phone Numbers: Lot: �.2'�( ✓'�k S�;- � � � (I}ti �1'jr'�/1 � uWt ��,`r S7S �M � Location of Property: � G �--�� C ( �. -� j�.v�s � , -� �. �- oc 5 �. o � Permit Conditions: 1.) See attached site plan for proposed well location. 2.) All applicable State arrd County regulations governing construction and setbacks apply. 3.) Permits expire S years from the date of issue. 4.J Issuance of a permit does not guarantee a potable water supply Other Conditions/Camments: Permit issued by: t� � Certificate of Completion ew Well: - EHS/Date Se'� G Location: lG � 7 c2Y}; f� e�1 Grouting: � �,�d Well Log: Well Tag: ✓3� Pump Tag: Air Vent: �6 -1�i -1 � Hose Bib: Casing Height: Concrete Slab: Well Driller: �GYr1 r,f�P Pump Installer: � t `� Approved by: Additional Comments: Date: �( OL,iner: EHS/Date Depth: Grout: DAbandonment: Date: Method/Materials: License #: License #: Date: �_ Date Sample Collected: Date Results Mailed: �/�� EHS: '1� Person County Environme�tal Health 325 S. Morgan St.,Suite C Phone: 336-597-1790 Fax: 336-597-7808 Roxboro, NC 27573 11/26/13 ��,sf �� lEaa�aso��a�ffi�mIl lE�emIl�fln � System Type: � ./�C Septic Tank: � gallons Pump Tank: — gallons Total Linear Feet: 3� � Max.Trench Depth: 33 " Name: �E Subdivison: Site Plan sw�el Lot: EHS: , � Date: I�I � 7° t!.!1' � &" tAf 5�� s�s� � � D� `�� S�G� l�ss �� 1�� ( �►-�e.�c �� ..�� ,s,a.�.Q �o,� ( �f � �� au ( � s ��'� ht-e �/4��,�( �►-�2�C��5 w�'��. � ?� �d/.� � ✓�'�u, $�- '�'c � ��' ✓� i � ,�c,yv� S.�' ��C 5 �j S i2�-� . c I T�V n�a"� � 7 I Parcel: 0`�2-3 � �i 1 '; n `33 � �'�P• c,+.�� `-�—� �i� c(ar, 5 0 � � �� Scale: � =�Q C� R��te: 1; Drain l�nes re�reser,t a��roYimate contours. Orain line locat�ons must be flagged prior to inst�lia!;C i . �.. 2) Contact Persa�� Cou�ty Er�vironme�ita� Hea�ih with any Guest�ors (335) 597-1790. Additional Comments: ,;� �.��'?;�f Ji ll �� 1.1��\� ' �-�- C� � ��T � � I��a��.-�.-r ��►.Il IF��.]L�I� Tax Map � Parcel # 223 Subdivision Phase/Section/Lot N # of Bedrooms 3 Operation Permit System Type (From Table Va): Product (IIIg): i r-F Type V& VI Expiration Date: Type V& VI Renewal Date: �,cl/,� 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. � Authorized Agent) ��%ra � Lew �� (Licensed Contractor) lo -tR-�7 (Date) la—i�-I? (Date) Scale � PCHD, rev. 2/14/12 Tax Map: f�23 Parcel #: 223 Septic Tank System Checklist (Type II-I� System Type: � Se tic Tank InitiaUDate State ID & Date: S-rg _� �-i _ -f - Ca acity: 5 _ d Tee and filter Baffle ,/ Vent ,/ Riser Outlet boot ,/ Perm. Marker �/ Distribution D-box (levels set) Serial j _ Pressure Manifold LPP Notes: Nitrification Lines InitiaUDate Trench Width: 3 ft. �--s _� Trench De th: in. M��• Total Length: 3 ft. ,/ Minimum s acing: ft. o,c, Rock de tl�/ uality � � Dams/ste downs ,/� Grade (< .25" in 10') ,� Cover (6" minimum) Setbacks From wells � Pro erty lines ,/ Foundations/basements � SurfaceWater ✓ Other: Pump System Checklist Pum Tank InitiaUDate Sta ID & Date: Ca aci : Riser (6" in.) NEMA 4X Bo Model: Piggy back plug Hard wired Alarm functioning Mounted on post Above grade (12") Conduit sealed Pressure Manifold Number of ta s: Size and sch: Contracted Certified Operator (Type IV Systems): Notes: Taz Map: ��3 Parcel• 223 ��f �� Subdivisior �—' = � � ��'� �' Phase/Section/Lot # ]:E�s��.a-��„-,Y„ ��.�1 IE–IL��.Il�7�. Permit Valid for: Five Years /� Type of Facility: '��2 �'!� S Number of: Bedrooms �/ Oc u� Proposed Wastewat System: Proposed Repair: Improvement Permit Non-expiring New � Addition �Employees / Seats: Permit Conditions: �Q� St `v�c ,�-e-'%C �-. Water Supp;y: � �( Projected Daily Flow: 3 e� allons/day Type: Type: Authorized State Agenc: _ i� � U`-t"""'�� Date: '—a 6� t (X) Owner or Legal Re esentative: �oa7��.Q0_ Date: �7_ a6_ The issuance of this permit by the Health Department does not guarantee the issuance of other required permits. It is th;, responsibility of the applicant/property owner ±o insure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject tu revocation if the site pian, 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 ruid Rules for Sewage Treatment and Disposa! Svstems'(15A NCAC 18A .1900). Ne`rtl�er Persoo County nor the Eavironmental Health S�Cecialist warrants that t�e septic system wiil cantinue to function satisfacto::iy in thc future, or that the water s��p1y �il! remain potable. Authorization to Construct Wastewater System ��'ee site plan and additional attachments (�. A Propos d Wastewater System: � c�-S'`,.� (*)Type��, Design F(ow ��O b gal./day New Repair _ EYpansion _ Soil LTAk: •�-.S^ gal./day/ft2 Type of acility: 31�f2 � 12.QS • Basement: _ Yes _ No (``) System Types Illh, Ilibg, Ii�, r�nd V, require periodic systena inspections by the Person County Health De�artment. Wastewater System Requirements Tank Size: Septic Tank 1 �'�c�gal. Pump Tank � gal. Grease irap � ga� ,Sc�P,zJ�, �� Drainfield: 'Total Area d� sq. ft. Totat Lengtl� 3� d ft. Max. 'french Depth �3 in. Srs'�,,,,� Trench Width � ft. Min.S�il Cover � in. Min.TYench Separation � ft. Distribution: Distribution Box / Serial Distribution� / Pressure Manifold ____ __ �pecific ions: C�i12 „�^`3 3 � � .Q�-c - S . ti � �� S{-lr ��q � �-2 S o � ` ( � �k ��t ?�e t� o �to�l- aCEe �C U��* � -21CCmvQ.. �,� (. Authorized State Agent: tssueDate: 'l zG-�7 Permit Expiration Date: `j �2-�a � Z Z The system permitted is: ronventional /Accepted �i Alternati�e / Innovative . I accept the conditions and specifications of this permit. n n r� (k) Owner or Legal Representative: ��/ Date: 1'o� ��, ( Person County Environmental Healdh, 325 S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5l12) �/2��t 7` Apptication Date: � 7 J% p d � �p o. oo �{�'a . �� 11�� Amount Paid: !,L�_ ,_,.; .�� Receipt #: � �f 3 � 7 Z�� . , � � . �-� lU ��t ---- i,, w 1��m�au-,m�a�a�a.��A 7HC��.I.L�,. � � �� Aanlication for Services Services Improvement Permit (Site Evs $200.00/$300.U0 (if> 600 Mobile Home Reptaceinent or $150.00 (if site visit require Well Permit (New/Replacemen $300.00/$200.00/$75.00 Construction Pluthorization (Fee is dependent on the e of Permit Revision Tax M�p: � 3 Parcel#: •� `� Repair af Eristing Septic System Applicatioa: No Charge/ CA $150.00 or $300.00 1) Applicant I, n .formation: �. Name: '� i . Address: m `� � . 2) Name and address of curren owner (if different than applicant): Name: � Address: � Phone (home): �� `s�'?� �'�3 � � (work/cell): 4� �— �Sa 3�t3'� 3 3(� - 51 y� 1�38 ��r�sa) Phone: 3) Property Description: Lot Size: a�O � Subdivision: . Lot #: Address and/or directions to Property: O yes 0'no oes the site contain any jurisdictional wetlands7 . ❑ yes �oes the site contain any existing wastewater systems7 !7 yes no y wastewater going to be generated on the site other than domesric sewage? p yes o the site subjeat to approval by any other public agency? Q yes �Are there any easements or right of ways on this property'? (if `yes' is checked, please provide supporting documentation) 4) Propo Use and Type of Structure: � Z 2� 6^ 2�^� � �R ' ential ' n ew Single Family Residence Maximum number of bedrooms: �l Occupants: �� ❑ Expansion of Existing System If expansion: Current number of bedrooms• ❑ Repaic to Malfunctioning System Will there be a basement7 ❑ yes n� o With plumbing fixtures? ❑ yes 0. no ONon-Residential Type of business: Total Square footage of Building: Maximum number of employees: Maximum number of seats: 5) Water Supply: ew well ❑ Existing Well ❑ Community Well ❑ Public Water ❑ Spring . Are there any existing wells, springs, or existing waterlines on this properiy? ❑ yes O no Please note any known ground water restrictions or sources of contamination: 6) If a�}pfying for `Authorization to Construct', please indicate preferred systern type(s): �B�Conventional ❑ Accepted ❑ Innovadve ❑ Altemative ❑ Other ❑ Any I certify 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, ald permits and approvals shall be invalid. Signature (Owner/ Legal Representative*) '� Supporting documentation required. � 7 7 ate • Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat. e A�.o��ieted `LatPr?a�ratinr' f�rm rnust accnmpany a�y zpgl�ca:LOlt CC�lllrEng z site eF�aluatic:�. _ . . �� f.1 nnr n 1 l na Cl__'�_ /� r . . �.r ....�.... .�� ' �..� ' _' _. ��,�f i! lle�l�,�� Name: ., �- ��.�� Subdivison: JEad�esm�aaa�ua�mfl I�]femIl�a � Site Plan sw�e( � i(:�' �t "� � �' � i"r- n r ; � • '� . -, f� r '�{ � . =`: �� '.' � h � .. 1. .- �S � %, � f' . ; 53`�% �17 . E; r �: �' = � _ : .t r•s' -. _ ••L :. - ' Lot: EHS: � Date: Ai �7°/l�1�7'Cn tAl 3' � T3X ��3�: � � ��.re�_ � � � �� ~ w �J � `J 5ystem Type: �l�� /nC Septic Tank: � gallons Pump i"ank: " gallons Total E.inear Feet: 3� 0 Max.Trench Depth: 33 " S'��C,G �e S�s� : ��fl�,.! �,,t S�G• j(, p s S �.� n'�3 3`� p�Q.P+'`�, t� � � f� ./t� Ul0.G�t�'{ � '7`rfKC Lt�S (�trt �-�-� �-2?� �"a� � or' i o�c� � �i� c(ar. �� V� �iu l I� 5�-( c�t-�t h t'e 5 p r� � T'�o ��C��`�� +'�Q�C�CQS 1��'f��. • „ �,t/� � �. g�- � ��` d � /� 'r � jj ,,` 5'.e��`C 5 � ! Scale: '�� 1 � I `�Y �j s � �_ i , � • -- Rrote: 1; Dtafn lines re�reser.k a��roK�matP contours. Dr�in fine iocat�ans m�ist be flaggpQ pri�. to �rstalra':�+ t zj Contact Persan Cou�ity Environme,�ta� Hea�ih v;�th a�y que�t�or; (335) 59i-17��. �� 4 � 1 � ,. 1 � `� ` � a° � ,� � � \� � !\N �� a � � � �� `� ��' ��