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A24 111
� ���'�b� — � �u �vj�G %�(,� l��.15��/ #�}i �4�r�� � � � �7 -/�� '��SJ S�` :� ��S `�� . ��y y c�d.�'i�� `�..�� ��,�,1�,�� r.�e �..`�.1 d� ,_ �v�� �� 2�` � �iCC G�/�� ���'=� ������ �%jL�o�L � i�,�✓il..�i�� � � /� 11`� Z�i � ��.lJotic.� �� �c-c� -� ��r�,a.���r- v � � � . �� � � ��� ��i ������ �� �. . ��..�. o A � � '�.. -�� � � ���� 1��.-�-II.��-�-n -�-� ���.�.]1 7�3L�.�,.]1.,EI1�. . - Applicant T�x Nla�� : ' �rcel » Su;bd�ivisian �. r Pha:s�e,S�ci,ia;n.'Lo.t +� i 11oG{5� s!-� 7 Z, 1d� � o� Suhse� u�'n � � ' �prave�ent �'ermit P�rmit `�alad �or �'ive 'Y� o �piration �� Type of Faciliiy. r� v P� � i � New tian � �Vater S�pp�y � f� # of Oc�upants ' # of B oms Projected Daily Flow �_ g.p,d. Proposed Wastewa System•7 c c �� � � Type: � Proposed Repair: � d • Type: � . _ .. . ' . A _ . _ - . . .. n Permit Conditions: Ownes or Legal Represe Authorized State Agen� �.r' •.:'. .' . � The issuance of this pexmit by the Health Departmeut in does not guarantee the issuance of other permits. If is the responsibility of #he aPPl�can�proPertY owner m in sure that all Persan. Coimtq Plaiming and Zomng and Bu�ding Inspections requsements are met �['his %mpcovement Parmit is snbject to revocation if the site plan; �p��'o'r� ti�e intended use changes. 'ii�e Innpravement Permit is not a�ected by a c.h.wge 9n owner"ship oi the property, This permit was issued in compliance with the prnvisiuns of the North Carolina, � `Zaws and Idules for S'ewa�e Trerrdnent and lDisvosal Sestems' {�.SA NCAC 18A .1900). Neither Person �ounty: por':`#lie-`. '�� Environmeatal Health Sper.ialist warrants th�t th+e septic tank �ystem w�l continue to fnnction satisfactor�y in the futnre�or�tliaf. the-water supply will remain potable. • � � • • � Authorization to Constrnct �astewater System (Requirexl for Bnilriing Yermait) � * Ses site plan cmd additional attachmentr (_). � � -. Propos astewa#ez System:�c'C � � u.. � Tj�-pe Wastewater Flow f 1 .p.d. New � Repair Exp •� � .� SQiI L�'T�� ��s g.p.dJ ft 2 Type of Facility: �i ✓u�2 tr�r? C,t'_- � � Basement _ es _ No �Vast�wa�er Systeara Reqc�ireme�� Tank Size: Segtic Tank:� OG� gal Pnmp Tank: /�Ob gai Gre�se Trap: � I�rainfieid: Total Area: � sq i� Total Length �r�0 ft '�mwna Trench Depih � in 0��• Trenclt Widtfi � fiE tl�Ya�u' 'uaum Soi1 Cover: � in I1Tini�um'I�enc3� Separation: � ft Disfa�bnt�on: Distn'bntion �oz � Serial �istr��ntion /�'ressnre l�Yanifold . Spe�ifications: . � , � � . ". '' - ' ' d � ,� S S-�e _ � �.��' t��`�� � . - Pernut Expirat�,6n Date: � = — 2 The type of system permitted is Conventional � Ac��#ed ��A�lternative. I a�c�pt the specifications of the P�• . G C�a�ee�/���1 �8a�r�s�iatflye: � V• Date: 0 D � ` PCffi� rev. l li 10lU5-.- ,. . : � � .. � ,�1��J�� ������ ti �^ ' q � � ��� �7m'�'717C�T'f1lY1t'�.0��g ���� , � � ; , SITE SI�T��-I : � . . _ � , � � ti �� � Name �_ Taz Ma.p #�_.Parcel # � r ( , Subclivi n o Section/Lot# 2 , �`�� c i �' . —� a �. ��,1 0 f> Autho�ized State Agent Date '`' ��'�� System camponents slep�esent ap�iroximate�contours or�ly: The contnzctor must, flag the rystem prior to ct � r� � begin�sng the i�stallatian to i�sure thatpro�ergm'de is maintained t�� ';����� ��' � ' ' � � �� ti� 1-! ' � �� � ,i � � S �. �., � �� '� � � S,� �1 l�ne easemenf n�►us-I' be � P Y � � Su y ,:� I ` � Q��a��, �v' ma�K� b��e ,,,�all� � , . �, � �' `f� � �� , ",,��- 11 m ��r leve � �i�e : , � " S ` , ( '4! ' ��"'��i .l � , � �' ', t ) t' � OW1 �2 a�, ��� IJ�,�, ��; � � � ��� `` � ��` �'� ,� �11����;'4�� pr (p � �- � l Ir•ne riusf i,e 3 �° t l S L ' , � ti' � ,� � � } ��'� , ; �!. �">s�a�;� �� �` ... � /`7 yr 2'a�� �t ` �� t E 5(,' E} [,,� : � = S� � 't y�° , � , : ;� L� / , , �. uPl°Y �i �;'�'': `�� �cr� w'� �I� S�ee�ea( ,� d�r�� iroh -�anK A�PN� � • and art�P.S �J�i,en �ressr�G �oac� �J � r r� SyS�°l�! --3(eo .�l .�3 bed 1 oav � se�h� �ahK _ g � � (SDD � Puwt f�nK � , 3(�0` ���' ��,,��`' �'�;,:� � ��.�i �.,.� .,.�,.-�� ��. ��;;;��:.,.� �ioi�An� �'. — 1z" �►-er'C� „ �e�er �ver s s,�eivt '��lace l� ad�l ha�a� s�� �� Y .,Q a�„t�s Q, �--� _ � •� �,25un5 °-�' {i rf� ; , , � � ,;::� � :� .,...::,:� :.:. ....... ... ,.:,.,.. ._.E.�i��r .... . „ , .,.....�� ��..,, ,., ... ,........-... „ .. �..,. ,._ ..�,.. �...,.�; .....�� � ., . . . .. .. . t ,� .. .... , . . . �. . . . . ,...,, � ; yP � �� I I �' 1, � ) i ) ( r.� 1 1 �'' f 1 �, � � �. . �, � � ,� 1 f�, 1 + .71 , ;1 � � . ,� 1 � ;, r� � �tit ,� � ( q1 � .� l � � i ' ( ��,. ( i' ) I i „r? ( / ) � _ ... ':t' ,. '1 ���A'�, � � 0 �' ; i � �i ( , lii Y' � ��"''�q _ , � � , � � �� � �{�..:� � .l�i.,. ..�.. , ..'.� �'�� .,�i9�. . I ! P� ! �.i) '.;(►;' "��1i " ! ��'� 1�l ,� � , �� PVC C�e Velw ��� ���.s f� 1I�'I�I�..���T �---= � �� ���� 1[� :nn-vnn-Kaana�en�an�E�a1l ]HI�cmJ1�E1L�a Owner: Tak Map: Q � Parcel #: � 1�( Date: Line Tap Tap (Sch) Tap Flow Line Length�� Flow / foot # Diameter(in) ( m) (ft) 1 � �p D . (o 2 . 3 � • � 4 � 5 6 - 7 8 � 9° 10 ,�O ft of line x 65 gal. per 100 ft = ;' l00 =� gal 75% x gal = !�L gal per dose 2� gal per minute (gpm) = Flow Rate Friction Head - ; � � Loss: .19 ft per 100 ft of supply line x^' .300 ft of supply line = 100 = L. Z7 ft ft x 1.2 ="� � ft of friction head . � NIanifold Size: 3—� " Force Main Size: 3 "PVC � Total Dynamic Head =�ft of Elevation head + Z� ft of Pressure head + g ft of Friction Head = '� 0 TDH Pump Requirement: �� GPM @�� . ft of Head. Drawdown: J�e gal per dose ,—` 2l gal per inch = g inch drawdown per dose scheddedorvaTm+ S1na-�.d�p 1�1SFPW 2" min - SChedIIle 40 � ��� �� �� � � ��:��� � � � — •• i : � �. , ■�;�»�oo�ao ::: ...::.:..:::::...:.:...::::°::: ..:...:...........:..........:......:. :, :� : �. ����rs . � , , N ��► ql , : , _ � ''' -. ,,... 9m� � ' s 3" uiold S'rze / # Taps lY[ax No. Taps off one side luce b�/: for ta in both ta s '/." ta s 1" 4 Z y g 3 16 9 '` 40+ 21 lZ � ' " F1osv er Ta -- Si�.e iLlcuerial Flow GP�%1 ;." Sched 30 .i.s • ;: " Sched �U i.l �/, " Sched 80 1Q.1 3�, •• Sched 40 1�•� � ��� ��i ���� �� �. ' � ' }11� `�J ����� 1�'..�wi�.�9^3��„—„,rn-n���.ffi.L. ��a��.1i.'i�.lt'�. . . - . Applican� Location: I�QGS� S[�- � �,� 1 df- �,+v� PEr�nit �alid �or ✓ �"ave Y Type of Faci7ity: r-� u � e # of Ocrupants , # of Be�rc Proposed Waste S �� Prc�osed Re�air: � P�t c�a�: G�,�� O�vner or Legal Represe Autiiorized State Ageat . � :r_ — Ta�x Nl a� '� r c�e.l * SUibC�iIVI�SiQII P� � a.s�e S ect,i a;n.'La�t +: an � _ .. 'J�� S4irSl�L ��•�� • ' �anprave�en�t_�?ermit . �pir�laon � (�i� �New �.�ddition � �ater Saag�piy j,2�G �I ��_ Proje�e3 Daily Flow � g.p,d � � Type: � Type: w �e�o��;�.s �re sGbm, ���c� �o ��;ze Ac� Date: �.p•- '"''..' Tbe issu�ca of this peumt by ti�e Health Deparm�eut m does not guar�tee the issuanca of othcr peumts. It is the resp�ility of the . aPPli�P�Y owner to in snre t]�at aIl Pezson Caimty Pla�ming aad Zomng and Btu7ding Iuspections re� aze me� This Tmprovement Permit is snbje�t to revocation if the site plan; �pl�''ur� the intended use changes. TLe Ympravement Permit is not affected by a c�iange in owner'ship oi ti�e property. This permit �vas is�ued in cnmpliance with the prnvisiuns of the North Carolima, . 'Laws and �ules for 5ewa�e Treutrnent and 1Disnosal Svstems' (X5A NCAC 18A .1900). Neither Person �onnty.:por�;tlfe-'`'� � Environmeatal �ealth Speeialist warrants that the septic tank �ystem wiIl cantinne to fnnttian satisfactQnly in the fnture�or:-Fliaf. th�water snPP�Y � ��n Patable. � . . . � A�rthorization to Constrnc�t �astewater 5pstem (�tequ�ed for Bnilding Permit) � � * Ses site plan mld additional attachments (_�. � . � � . -. Propos astewa#er System: hlCCG��erl � r:J�� p�rrtio 'I`�+-pe� ��z- W� Flow i p.d. . New � Repair Exp �- � � .� Sai1 L"1Ai� t i� g.p.d1$ 2 � Type of Faci7ity: ri ✓- ,�r c�?ni:E': � � Basement _ es _ No . . ' .. . � � " � .� � �.- ..� � ��V�e�va�r Sysiean �uireme�ts � . '�ank Size: Septic Tanl�' l�G'i? g„� pnmp Tank: /�Ob g� Grease Ta a�: -----gal � . Draiafield: Total Area:� sq �iE Total Lengtt� , R��� ft ' l�ta�mnm �'rench Dep�t � in ��� �. p. C. '�rr�nac,�t �Vidti� -� fi �Yiinimnm Soil Cover: � m 11�nimum Trenc3i Separatioa: G ft Dist�ibutson: Dis�b�iom �oz Ser3a1 �istrib�ion /�ressare 19?anifold . � � Speeafieations• . ' . � . � . - . •�'� /tt�r' Iv '' C,� i�.�f�L S+� r'�o,�r�r rjvei- �(>'S-�n� . U�*. f�IItiH019ZC���tC1�CIl � � D�: �-.5���/�-- --- Pennit Date: - �l2'� The type of system permitteri is Conventionai � Ac��ted �N �ve. I a.���t the spe�ifications of the � f��i �.88�a�s�taia�e: � 1./• L�� Date: � G 07 ' . . ` PCffi� r�y.11110/Q.5_ : . � .. : . � _. � �'�...�`�� j � �iiL ��1/ �./ �. V �.r—.. � � � ��� � �'.aca.w-a�c-a��n�� a»rca�e�.� ����.�.¢�. Slopad To Shed Watar 6° Cov�r • i .' Ix►lat Fxom Soptic Tank 4" SCH 40 PVC Pipa ' NEMA 4% Simplex Contml Panel 4" X 4" Presstua Treated Post 1'Z' Sepuation Electrical Corduit ; T,��x M����� ; P�irc•c�l # S��i,laclivi-5ion �.� � Pli���sc Sr�rt,i�n Lc��t a � DuctS�alHoth i End� Of Tlw Co�ubait 24" Mininnim —� f . T--�^��r � Thteadad Gate Yalve � .r , . —. ... , Zlnion �• � ` Accvi Corer• • , ' : ; � •1 . � • . - r l ., ' ' r . . � . � r '-- ='. . •:� � .: �• �. ' . , • � • - - - .' � � Zip Cv:d �,, Openin= F'illed With ' , pnti Siphon Hok' Tie� 1 Portland Camettt Gicat �� g� ' Check •�.,,Ny1on Concrete Riser S" Sapsntion . . . :r ;,rhl.�` . '• t ;�,:,,..�..-Portlazid Concrata G:aut � ��ff].0 • ' � .:� � �: . : � ' �y� _ : . � Op�nixig Fillad With Supply ' ' portland Cament Gront � I.in.o • • ' . Outkt To D'utnbutiox 2'.' SCH40PVC Pipa Valw �P� F1oat 1�V'ua� ' � • High Water Alurn L�vel • :• • ' (6' Sepasation) � � ., ' iii�h Lewl- Aunp Ox • i. ::.., ' ,: rVaporLock P1oab .�: • '. H Hole ♦ . . • �Drawdcwn �Up H�11). rrRnmovabk '. •' • •� ,� Float Tsae �. , Law Lavel-Pump OfF � �_ • . . Pump .' . .•• t . :.. ' P:ecatt Concznte Taak . ' 4" Corctate ,. Material St:e h p3500 P H1o�k � � •�� . ;,; _ .�, � ,'4'... • ' •• '� � - �. . �: . , , 't � . • \ ;` � • . � OD GAtL�l�i' PUIVIP TANK �u � � � 2�! GPM � �a'o�,��,� ��ller (SS 9 ,::�.`:..: . .. . ..�`� �j '��•:: ..y:• ��� . .'';�'15.11'.� . . '•'1:... J:: . . ... . ,�'.•�.'.. .......�_:.:•.' ;..,;' . . .....�: .. � � r< L':�:':�:•.,_ �::•�... � ��^'�,p�'��-� . �3jC'va�.'.'19'.31:1C!Y:9��'�^'�9C73i:A5. ''.'��L' 'y�'��.'11:'y,]JL:�.+•��L7L.�'. � WYS�' n .b , �y:�8t19'8S1 . ���� ��� �311''y�� �u •r+�l �OSC V1'L'lL9J 1��. e'� �1�tlJ 3 Tax Map �i Applicanf: _ Subdivision: LoSc � on:� aro Parcel # To�wnship: Lot # . � �ype of �a#er Saappiy: �/Individual _ Comm.uni Public 1Y I�e�uire�ents: Site Approved By: c�C�' �Z�*� � Grouting Approved By: � Well Log. � � Pump Tag: . Well Tag: � ' Air Vent: ' � Hose Bib: ✓� � Casing Height: � . . Concrete Slab: � : � . Well Driller. � Well Approved by: � �� �***9ee Afitac�ed �ite Sl�e#ch***� Liner. 'Installed by: _ Depth set: _ Grouted• Date: Water Sample: 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 founda.tion. Other, conditions: Date: �( PCHC rev 01!?7/04 0 - - - �� - _ <:: - . - .�_:->- _ : �:� _ _ ;.; ' . . �> " 0 Q �� � � � � • YC'.:` � -::��� �. : ��:i���-...�-��...: . ..�._.....�_ :_,:_: - � � �e. �te l�z( � . =:�::�::��:� �=:. . =�:- --::� - . i. :. ::= ::::� . � � .. . . �: ...:.:. ... .. . ������:�.�,.¢:�:�: � ����� . D� O�c�csl y— l r —� � _ . .. � Ovvner: Locafion: Subdivision: , Gront Log � e� d � Tax Map �` Parcel #� Lot # � - Weli Constradion Distance Fromn� Property L'me (Minimuni 10 fcet) I i' �' Distance fc�am Septic System (M"mimum 60 feet) ��� � Tota113epth: ���D ft Yeld: � GPM • Static Water I.eveL- Water Bearing Zanes: Depth `b. �, ft ft ft ft E� Casing: ' . n�: F��� � 6 �. , n,�: _ {�' �� m . 7.�e: Galvani�ed Steel � Weigh� Tlucl�ess: . �iii Height above Ground: �2 in . Drive Shce: _�Yes No Any problecns encountered wh�e setting casing� If `�res" gtve rc�son � Xes ��No GSrout: _ . , - Neat SandlCe�ent �Concrete GraveUCe�eat _ -•. Annular Space WidHi • inch�s Watrx in Annular Spac� Yes ✓No Method of Grout Punaped Pressure � Poured � Depth (� - to ,�,_ Ft MateriaLs IIsetL � - Liner: No. Bags Portland �t ' Weight o� 1 Bag Pounds If mixbme (saad, gravel, cuttings} — Ratio to ;,� - ID plates: � Yes _, No 4 x 4 sIab ✓ Yes _ No - -<,. Date Installed: Grou� DriIling Log Installed by - Locafion Drsiwiug �om To Ror�ation �/. • � 2`' - �`J ,�1� �c .� � h ` � - r� , . 7 -/� • 3 � Cl... � I �t� a � . I hereby ce�tify that the atwve� infa�nation is coaect and tirat this well was consEructed 'm accardance wi$� regulations set forth by the Person CounfyHeallh Depart�t ' - SigaAtare of Coairitcbar ID # u6� Date _ � ` ,� Pamp Instaifinent ,p � Pim� Installation Conhactor V� e- G I State Regis�Uration Number: L,� ��� �P �P� ' I�� � ft Shati w� LeveL• Z ft r Pump Mak�e & Mode1: �' P� �` J c�c�f. {' Pamp Size and Ratin� � 7 hP -1 z� gpm I hereby certify that t�is pwmp was instalied and ti�e well head completed acco�+d'mg to the Persan Cotmiy Well Rules in effect on this date and tbat a copy of tiris record bee� �vided to-ti�e well owner. . pnmp Installer ggnature - �- Y - 13ate. �I ✓ ( � � �� � PCHD rev OI/27/04 � ���� �� ���� ��r ` v b 1 � �� `�J' �� 1i � 1Ls�.w:1�r-�o,rn ,*-,rn-��.��n.� ����.��� A�plicant: Location: e -� � "� ;:i. :� - � �:. ,( / ax M�p 'arc Subdlivision � �l ' Ph,as - Section, ut # � " af BeeJroom. % . Syst�m Type (in Accordance Wiih Table Va)� � THiS SYSTE� f-lAS �EEi�i iNST�4LL�i� If�! COMPLI�►NC� 1dUliH APPLlCA�LE . NORTH GAROLINA GEi�E�L STATUTES, RtJ�ES FdR SEINAGE TREAiMENT ,�ND DlSPOSAL, AtdD • ALL CONDITiONS OF � THE IIViPROVEiVlENT PERIVIIT APlD C�i�STRUCTION AllTH R TiC�N. - . r., (� �v-'� ,:3 /s � g'. - Authorized State Ager�t Date ` 1�se � lns#allet�. By. 5 G��'�i Date:.CO le� ►i� r% � ��Ks .� �' a"'tP ��:/ �`_ "'"' �`. �� �� N q�' . ���-e � � � :la-F �'^ �Y �' � �� rd�� ���Lew� s� � n S�� ��.� �- �''�� ��11����� �� � S.�.a,,,�e. �— DPct abw�' ��uM�,� � ��� h�.c�� � . D Q-Q� 0-0-D � �� s y� r7 ���� ti �6` `: �� �� �� o�r�e � {� j s IkS'�t�t� ��� 1'�`. PCHD; r2v. 0 i /29/Q'� a ����� � �{ �������3�� �u��'���..�� 9 ���� �� - �� Tax IViap #,�� Rarc�! #)� Sysi�e� Type (Tabie Va) OwrierlA�plicani Subdivision Address/Location SecfPhas� Lot # � Se���. Tank lni�"sa9l�ate Na�� o��oea an� In��a at� � State�lD/date -l3-0 � Trenct� Wdth � ft. Ca aci S ao-� al. �� � � Trenct� De th in. Tee and ilter - . � Trenci� Len ft. � Baffle � � Trenct� Gtade � . Sealant � � `� Trencf� S acin �..� � Riser ifi a lica6le � � Rock De tii and Quai' • ��'ank Outlef Seal Dams/Ste down� etc. � Permanent Ma�cer Pressure Laterals � � � . Pu�ro�a Tank - Hole Spacing . State Idate 2-( -e - �2 z o e ize � .- � Ca ac' n5- ai. ✓' Pi e. S(eeve � � Wate roofi ISealant � �/' Turn- slProte�tors � � Riser . �ttequired' Se�a�9ts Water� Ti ht � -� � �'rom� Weils � ��rn� From Prope lines � . Checic Valve/Gate Vaive StructuresBaseinents ✓� �� Ant�-si on o e � c es 1 caina e.a � � Fioats/Switches � � �Surface Waters ,l � Alarm visable and audible Public V�later Su iies � � � Electrical Com onents � Verticai Cuts >Z ft � � Rate m . . Water Lines � �' A roved Pum 11�ode! VeFiicle�Traific .�� f' Bloc�c Under Pum � Ad'ar.ent tems � r/� - � Pum Removal Ro elCnain � • ,�EasementslRi hf o# V1/a . � Dis�bu�ion: Sys�m , Ot9�eee� . � Serial Distribution . Easements Recorded . � ressure I�an o e e erator ntract Low Pressure Pi � � �ri-Partate A reement A r. Pi e l�fateriai and Grad� -" � � � Valves - � - Comanen� . . . pc:�d rev. 3l13/01 ��� �� ���� ��r �..e s1� ������ ��n.w�ia-�����s�.��.1i ���.�.}�.��n. Applicant: Location: ax M�p � �rc Su,bdlivision ;. � � Phase Se t.ion ot # " of Bedroom. �0�45C. SITZ Z.C�' �o-�' o� � oh SuhS�{" �oin�' , . ��' �� � �� �� Syst�m Type (in Accardance With Tabie Va): �L� � Z) THIS SYSTE�ii t-1�►S �E�N i1VSi'ALL�i? 1�! CO[�IPLIANC� Wti'H APPLlCABLE . NORTH C'�4ROLINA GEiVER.a►L STATUTES, RLJ�.ES FOR SE1fVAGE TRE,RTME3�T AND DISPOSAL, AND - ALL COND[TiONS OF � T}-iE 9iViPROVEiVtE�T PER1Vll7 �►ND CQi�(STRUCTIO(� AUT T10 . � . � . 1�1�� ,: � �s o�i. . Authorized S te Agerrt aie � lnstalled Bf � Date:� 2�2/-O$ . . \�I� . . � � P .�. \ \ �;���.�( J �� ��a�tn� �-7 �� . � �. " 51,ore �cre5 Or, 0 3'` Sc�i�o � � VG ` �in Q . � �� Y � PCHD, rev. 0712Q/Q4 ����� '�'�K �NSP���'30� ��E��lS d �'�Pe �@ a 9� Tax Ma� #,�� Parce! #�_ Sysitesra Type (Tabie Va) Ow�er>A�p{icant Si��division Address/Loca�ion SeclPhas� Lot # � Se��a�. Tan� ini�sa�/D�� No�a �c��on an� tn��� �te � State-ID/date Capacity Tee and Fil�er � Baffle Sealant Riser (ifi applicabie) T'ank Outlei Seaf Permanent IViarker Puma T�nk Waterproof 1Sealant Riser Water Tight � � � Paarre}� Che�fc VaIvelGate Vaive and aurlible Elecirical Com onenis � Raie m A roved Pum il�odel Blocic Under Pum � Pum Removal �Ro e/Cnain . �Dis�rabu�ion:Sy�s�m � Serial Distribution €'ressure an o Low Pressure Pi e A r. Pi e I�aterial and Grad� „.__ . Trencfi �dih� � 3 ft. � Trenct� De th 2 in. T,renci� Len ft. Trencf� G�ade � Trencf� S acin Roc�c De th and Qual" Dams/Ste downs etc. Pressure Laterais � Pipe. Sleeve Turn-upslProte�tors �quireci� Se�a�� From� Weils From Property lines /� � . . _ � _ _ - _ _ _ T _ _ - ` _ _1_ . . Surface Waters Public 1lUater SupQiies Verticai Ctits (>2 ft) Water Lines Ve�iicle�Traffic � � �/Righf of V� O�es� � Recorded L Comsnera� . . . � 0 pc:�d rev. 3/13/01 � PERSON COUNTY HEALTH DEPARTMENT SUBSURFACE WASTEWATER SYSTEM MONITORING REPORT _ -Z1�,(� 2-2(-O£C �`_ �.— Date of Inspection System Installation Date Typ Tax Map Parcel # �� SuhS��' io�n-� �(: Properiy Address Instructions: Che:,k yes or no for appropriate iter.is 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 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 pumpi ng ? Inches of solids:�_ Septic tank filter cleaned ? YES / N ❑ � EFFLUENT DOSING SYSTEM: �/ Required pumps p:esen: & functiona! ? p—d/ / High water alarm operating properly ? Q/ Floats, valves, etc. in good condition ? �/ Control panel & components in good condition ? � Effluent free of excess solids ? �/ Inches of solids(pump/dose t ):�_ Elapsed time readings ? Counter readings ? Drawdown rate: 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 tr�c/unauthorized uses ? � / Distribution devices in good condition ? �/ Field free of settled or low areas ? � / e REMARKS 0 � P��� �p� ovt rY�eE'Q� r�n�j �Sa�C�l�u ��ssu�C,� ❑ K�e'`,�s ��ae,�ed i�l ele�h-4�ct( �X �Nc��� ❑ p❑�; �c�� �uc{� Sea( }, �.e(� ((eeA Se5 -trati✓t (�'6Yfa�i�'1 ��e(�"T(CQl �,`Or Q11�11� g � ❑hl —7 a�1e }v o�� rowr► v� .e��Fiov► W�e �oul� nc�' ❑�.I obser��, �Ft,� d ra� nGi�l d. ❑ � ' 1/e t�a�ioh N�la�vl7"Ct'n�Cl o��� � � �e��me+►d Ke�'n �e I'a� {rom ��1� ❑ �,��►�'i'e(d -� ,re�n-� � � k . �o , e� Sul�f�(� J n s s w1 to ❑ sys�em Ptace � Y ❑►� PRESSURE DISTRIBUTION SYSTEi1�1: Turnups/cleanouts/valves/taps intact & . � accessible 7 � � ❑ +_ � �„ y r�� ( �� ,l 1 2 Pressure head properly adjusted ? /❑��feSSU(� �Q� � ue.}�a�ra ���°� CN Tn'� �eSE fQG COMPLIANCE: Compliant Non-compliant Needs Maintenance AiiDiTi�ivriL i:.vi�iivic'iv'T�: , EHS � ■ e c����n��