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A24 152�/ �� !Z �Lil1'i��j i�l��s� T� �ILD�n�� /��i�0 • //✓cfiGf� �� ,�o.� w,.` �i� � �r��y �oe�,�✓��y v�<�� . d3�� vb � �.�'� �a� _ � /�,a�L�o.✓.�C �t�� r�J,i.C�. ,�f�L?'�� ., . 1�i��t� c,��i��.v� i��o. �- ��- � ° �' ��' Z`p'/L '�j�j�G �iri"'�l [1��%� ��1.� • %�� li'��'/��'✓'''� � , ��1�� t.►��' ��1 l�sl�js/�i1�ro� . �� ,��us�y or�.✓�e � dx�.y�� ,s� �y�— Gri,�.� l�f��,�+r/�� r.td� � 3 8�0�� 'C �✓� ". %� 1� �'�jt � i�ef� �f�r�' ��-� � ��r�y �1�:�,� - �� a4 o e � I�a �� a ��-�s�� ,. �_ c� `.�' � � 1L71�T°�� j(��,1(��fl ��L��,r,,,Y,,,. ��,.� ��,��. P�L9�J1�Goc`711U� � � Applicar� 'm I KC �-a c,� S o n . � Location: � � ��peration: Permoi System Type (in Acco.rdance With Table Va): �._.,� • THIS SYSTEM HAS BEEN IN�TALLED � IN COMPLIAPICE WITH APPLICABLE NORTH � CAROLINA GENERAL STATUTES, RULE$ .FOt� .SEWAGE �:TREATAAENT AND �DISPOSAL, AND ALL CONDITIONS OF THE IMPROVEMENT � PERMIT . AND CONSTRUCTION ORIZATION. � � . . . .... .. . .I�aia �E�� -....:.: ..�. � .� .: �:. �a�l�� .. . . � Aut . orized State Agenfi � . � � ._ � � � : � Date � - � I nstailed By: �' m m y. L�.�.J i's � . Date: 3- ( o� 09 . . . .. .. / . .. .. �. .. T��KS � s"Pp`�� . L'„` �nsp o�. by 3��+, 3-�0- i • � .� � - � .. ...... ....... _........ ._._.. ..... . ... . .. , '. . ti'', -..�.._: �._ .. .... �: _.�.� .. � $ � �.�,c�-. .. .�� .c. .. _ _ . . _ ._. . . . .. . . .. 3 SwP4�� . �QTb � 000 .1- SZ6 3� 9 I � . . � �— i 3—.03 zo' , �-----� �� , � o1�s�`�P�,� tIl `"`-- S��Ps I8� c �� o!� s�P�y �� I i �.cd;K�e nc� 2" �`n�o aid L�,� c Z/►5�``�`d Z n� 7'anKS� 38's�PP Y L,,, �� cr ,,�,s I�c d o td �-`�� Cs ��' �` �� ion . ��f bu;�di�� PCHD, rev. 07/29/02 SE3�'�C T�N�C [P1S�ECTiON C�lE��CL,1S'C (Type ii -1� Tax Map #.�_ Parce! # ? System Type (Table Va) �� OwnertAppiicant� ir i K� �a WSon . Subdivision ��c,�,sto�c. Address/Location � Ser,lPhase Lot # ID/date 5T6��4 / I f- Tee and Ftter Ba#fle Sealant Riser (if applicable} Tank Outiet�.Sea! Permanerrt Maricer � Pump Tank tate ate 7 R r i I - � �W /Sealant Riser � � Water Tight .. Pump- �hecic Valve/Gate Vaive . t�-sip on o e . . �loats/Switches � � � � Alarm (visable and audible) Rate Approved Pump Model _ Blocic Under Pump Pump Removal Rope/Chain Distribution System Seriai Distribution ' Low Pressure Pipe • Appr. Pipe Material and Grade 5++3-io-oq � ✓ ✓ ✓ ✓ C�.cc Width Trench Grade Trench Spacing Rock Depth and Quali DamslStepdowns etc. Pressure Laterals Hole Soacina ft. ft. ;�i� t�- ��c fd I IVIG �71LG " ' � � � ' Pipe Sieeve . � - � � Tum-upsiProtectors � � �Required Setbac�cs From Wells �. From Property lines � ___: .Structures/Basemer�ts.:: � � t-�na i.. uRcries ivramage vvay; . . . : . .. . Surface` Waters - � - Public Water Su plies Verticai Ct�ts �2 ft. . Water Lines Vehicle Traffic �' Easemerrts/Ri hi of W< �' Other �/ Easements Recorcied . e erator ni Tri-Partaie AQreement Commerats� CtA KS ✓ � ✓ _� Nr� �� dG,� at�-� V�Sh ``� r �c S� ��`� ' ''� Qi� �Ci,^✓ ��- . � vPr�� -�sf- I � (��YM �� S ��"�T . . pchd rev. 3113/01 0 �� 15�� V � ` `� � . �� n -�T T�.T �.IDY`T.1��39••""` @��JL JG��Y'�1� � � s�.��.�� Z . . . � �v � ` La,c,�5on �r (�'� � K� T� �# a4 P� � 1= S 1,��.c�s�,t � • � Se�ion/Irot#_ Q, . �_�a_og : Autho� St�ate .Ageut � . � Date . . 5',�srt r�or�bon�s a�rs�r�E �c�a�r.�saas �. �''vaa , a�st„� � .s�,st�es� �� g�ae #o ��a�'��resg�de ss a��d d i� s . . �K �1 �Y� � � � C.cx�-b"ac,to r � � , l'J �cmo�c Oc-c,K. ,i`n. _t�r.�c,,- 0.S ;� �. ol,� rl . � Cu r�Fi,�.[ ly �.�ca�c�f� �c�nK h�(�s, I<ttf TanKS 5' Fiom ' ho�s� r-oun�l��;an � Cc� �'c �w I (y I �c.a � : � �e, - �C�n n �L�� ° y , EX,s��.�� s�PP�y i,.�� . � P� �. ��- e.r�.s � o� d� -��Ks, � n � �� . �� cK 0 ��i �� TanKS, bk��d c� � o� -�P �cc..K � �ew��y Ic��nciSc�P� pvcr tc��,Ks . � 5c� �.3 u-�c,� sl�c.c(s a t„��y Fr�n, -�u,�. Ks. �Sw,a�+ bc�m P�c�«d ��S IoP�) Scal� ��t� 5y5� wh��c. Y��' -�o• i n S�ktc.c t TanK�. ��nKS W i � 1 r�ttd �� rc.loC.u-tcd a5 S�tiwn � � S 1�. S kc.t�I� � � .� � a� .(� � � (LCi�o� � a l l Sto�r� . c� �� i n �� i c W �� -��, � n I o' o F �� K�s, � �5��1 Ncw r.lC►►-,r'►- 4x Box � � j o�.-��o� A i�r,� . ��, � �9r-�� 0 ' `�� ` j l� Jl �� . � . ' � � �� I�va�ns�TM*,� ��rn�in..11 IHI o s.lL�El�a SITE SKETCH �i N � I K�- .�-� I�SOn .Tax Map # Aa9 Parcel # �s� Su di 'sio �c �.s-tcnt Section/Lot# f� � Z-�F-GZ3 uthorized Sta.te Agent Date Systetn co�nporte�:ts represeht a�iproximate contours only. The contractor must, flag the system prior to beginning the iristallation to insure that propergnade is maintained , Cond c�i��n S � Zn.S�r.,,�i l�cw tJCmA 4 X bax . (.��u�-�doo� a�Iarm -�'Ii�1��, O� ��K -r�s � Sl �-� � I T d�� roc.a�� on � b�.5c oF S�tP Slape. O Pu�nQ � e-X�s�in�,. D- b�x� �� , � ��Wcc(,��u.5, � I I c7 i't5t �or a24 hr �tricd, l.'J m�`t�1t� cn d-T�nKS � F� �! I� Z � O Qum� ou-`t �4- c- r�s'� o � rr,�, ��ernovc. � 5tofn, dra°��► Pipt�-�I� � n For , � on s�dc o� F�ornc c.��►crc. nc� tlinKS bcFor� �i��. Fa�� S � to bc f o cu.t�d, � Q � onc� cc� p�� IGndscup� Ov�r ��tKs So wa� 5�cds ar�d �� KS :, Wf��tt�c bum on ups�o�c . S��c, � �o �c�T � �rad c d,ow n bu.n K� u-L �° S y s.�-r�,, I o�.�'�� . : �dda�ion�� so � � �y R�� h au (c� � S i �c, � r janclSG�l'^'�- %��,[`r'c �'► cnt5, I <<r �� Scale: 0 0 / },��'' v (� ��c� ,,, , . �ctc �%r.-. . � %'� � � �� oPk,'°n (�i Sc� I��`��`d` � �`�� +L� ��S��Ln PCHD, tev. 09/12 f 01 � • ��.)� �� _. � ,�--�' � � � � � � I��aa-�� .11 IE-3L��11¢II� Applicant: � Location:� 1—�►S %n,K.�_ F�'rsf-(p m� K� 4�. � - Cc K Lat n Ta�x N1�a.�� • � Parcel # - S�whclivi�s�ion � Ph�a�se Section Lot u ,''i L K �, Improvement Permit Permit Valid for �Five Years No Expiration Type of Facility: E' S��^^ New _ Addition � Water Supply �KiS h� # of Occupants # of Be rooms Projected Daily Flow 3(.� O g.p.d. Proposed Wastewater System: P�;�.,,� ,� Ctj r�vcn-h"o ��. � . Type: �.6 Proposed Repair: Type: Permit Conditions: FO �� a W C�� i-it.O n 5 � rl �I�-E� S�C �� O /�a7 �'r'uc(r- �Down I�nK d uL "1'b Or"axi� iti tt> �i`:�-E�N Sc.a-tic, l;ncs, a Owner or Legal Represe Authorized State Agent: Date: � � � Date: I2�-9 -Q3 The issuance of this permit by the ealth Department in does not guarantee the issuance of other permits. It is the responsibility of the applicanbproperty owner to in sur that all Person County Planning and Zoning and Building Inspections requirements aze met This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit 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 and Rules�or Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. � Authorization to Construct Wastewater System �Required for Building Permit) * See site plan and additional attachments (� I. Proposed Wastewater System: I� �-+�m � � dcnf�'o�4 I Type�6 Wastewater Flow E g.p.d. New Repair Expansion _ Soil LTAR: E g.p.d./ ft 2 Type of Facility: � Basement _ Yes � No Wastewater System Requirements Tank Size: Septie Tank: �1� gal Pump Tank: �,t7C�D gal Grease Trap: ga1 Drainfield: Total Area: C sq ft Total Length E ft Mazimum Trench Depth � in Trench Width � ft Minimum Soil Cover: � in Distribution: Distribution Box � Serial Distribution Specifications• P�aCt S� ec- S kc tc4 Authorized State Agent: _ Permit Exnv cW � Date: I �-4 �o g Minimum Trench Separation: C ft Pressure Manifold �'1' �7 I 1�W C�n�(1-�'0� 5 0 Date: �o� -4�_ The type of system pernutted is Conventional Innovativ Alternative. I accept the specifications of the pernut. Owner/Legal Representative: _ Date: �� `" C7� PCHD7/30/2002 � �� S ��.� ��T � � , � � � �� -,s:� �..r�. �� 1 1 � � �\ � W I l l. ��.,,/ L,�i+ i` � �� o " ��o o �� ZE��-a.a-�� ¢�,71 IHL��.Il�II� Improvement Permit Permit Valid for �Five Years _ No E�iration • / Type of Facility: �� 5��` ' New _ Addition V Water Supply �i � h� # of Occupants # of Be ooms Projected Daily Flow ti 'l.s p g.p.d. � Proposed Wastewater System: P�,,.,,� ,� C� n v��:,'l�i'� :,t+, j� . Type: �%J'' Proposed Repair: Type: Permit Conditions: �U � � c"�, t,J �C�l i �1; o :1 � � rl �7i -�t. � �.0 �� = i�Q � � % (��«d � -- �C31. % rl � r,i `�b �t�x'rr� j � -. -�r. t, 'C. �'ntS - rs �= " � n ' C.�+1 �t r� ra [.G /i� a �l s.�c;. : Owner or Legal Represen ve i �:t, - Date: L� �� Authorized State Agent: Date: la-9 �L'3 The issuance of this pesmit by the ealth Department in does not guarantee the issuance of other permib. It is the responsibility of the applicant/property owner to in that all Person County Planning and Zoning and Building Inspections requirements are met This Improvement Permit is subject to revocation i� the site plan, plat or the intended use changes. The Improvement Permit 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 and Rules for Sewage Treabnent and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. � Autho.rization to Construct Wastewater. System �Reqnired for Building Permit) * See site plan and additional attachments (�� ). . Proposed Wastewater System: ��;'Y► � dcnb�t�n� I Type/1/�, Wastewater Flow � g.p.d. New Repair Expansion Soil LTAR: � g.p.d./ ft 2 Type of Facility: � Basement _ Yes � No Wastewater System Requirements Tank Size: Septic Tank: 1J� gal Pump Tank: �, i�C�fl gal Grease Trap: gal Drainfield: Total Area: � sq ft Total Length � ft Ma�mum Trench Depth � in Trench Width '� ft Minimum Soil Cover: � in Minimum Trench Sepazation: C ft Distribution: Distribution Box v Serial Distribution Pressure Manifold Specifications: 1" jL�Lt lu i� `Tztr�K.< �'� L2rrk �J�+D�+a1 `�' � 11 � C�nd�t�'�� o`� 0 Authorized State Agent: Pennit Exp: Date: j ,7-'�-p � Date: ) �,� - °� -�� The type of system permitted is Conventional Innovativ Alternative. I accept the specifications of the pernut. OwnerlLegal Representative: �. . %--1�` Date: � � r� `- �� PCHD7/30/2002 ' N "d `� BI� � '�9V'� 1 � ► L1w/"' � • ' � � � er�� County Health Departrnent � VVe![ Permit Z 1-�a � ilate: ��^�'� �"This Pennit Void After 3 Years �� 'b �� Owner: �1i1 r r— l,.o �T.;1. rr: �i SR# /� -� � Locatio� ons: �' � S' S %( Subdivision Name: ' � ' t # Drilling Contractor. �- WELL CONSTRUCi'fON ►ti Distance irom Nearest Propezty Line Distance from Source of �' Pollution � Total Depth: F� Yield: _�GPM Static Water Level F4 � Water Bearing Zones: Depti�„ FG FG� Casing: Depth: From _�_ to Ft Diame� ��'� Inches TYPE: Steel ' Galvanized Steel If Steel, does owner approve� � No WeighC Thiclrness: l Height Above Ground: Inches Drive Shoe: Yes No Were Problems Encoimteted in Setting the Casing? Yes No ff "yes" give reason: ''ti Grout Type: Neat S d,�;ement , Concrete � Annular Space Width �= Inches Water in Armular Space: Yes No -� Method: Pum Pr Poured Depth: From �� to � FG Materials Used: No. Bags Portland Cement Weight of 1 bag Ibs. ff mixture (sand �ve , cuctings) - Ratio: to . ID Plates: Yes No ►� 4 x 4 slab Yes �— No M I HEREBY CER'TIFY THAT THE ABOVE INFORMATION IS C RECT AND THAT THIS WELL WA5 CONSTRUCTED IN,�COgDANCE WITH EGULATIONS SET FORTH BY THE PERSON COUNTY H�IL�'H(Y�EPa,� Date Date Issued Sanitarians Signature Date Completed Sketch well location on reverse side. AQcslication Date: l� 021� 3 Amount Paid• � S�eceipt #• � 27�,��- :'y.�; Tax Map #: �'2� i�arce #: . � .� Z— ��_ � ��.� �� C � �7'1�T �C �Y �Esm.�-s.s�o�s—^--- .o�:�.m.]L Haoa�.IL�� IPPLICA'TION FaR SERVICES 7) Rermit requested b:(f)wnerlager�t/prospective awr�er): p��dmont �c�nstr�ction & Home Phone:� 4-S"� � . Address• ' C-'s�rr�� `d[��'� , nc. Business Phone: �g9- G � , '":.'�__�='�.. w�c �7573� i . 2) Nam� and address of.current ov+mer. 1/ I�l�l� ��s�� Z$� . q��_�Q2 -a . 3) Property Desaription: Lot stze: Directlons to the pcoperty (Inctud F'� Tawnship: �at # 4) Proposed Use and Structure Description: answer each of the foilowing questio a) Proposed ___, Existing . Type of Structure: 16 x ao co VprveQ ��fl'�� ' pepth: � d b) Number of Bedrooms: � . Number of occupants or people�to be served: . c) Basemen�: Yes . No �,G' Will there be plumbing in the basement? d) Garbags Dtsposal: Yes . No IG-.5��'� `-�_�^� � • 5) Watar Supply Type: Prtva#e •(new _ or existing�, Public . Community , Spring � . , " Are any v�reils an adjoining property? Yes No ,_, If yes, please indicate aaproximate lacation an the • site pian. � . .. � 6) 13oes yaur property confiain previczusly identifled jurisdictional wetlands? Yes_ No_ • PLE;ASE PIOTE TH� F�L�OWIAIG: D� A PLAT OF THE PRC7PERTlf OR SiTE PL.AN MUST BE SUBMITTED WITH THIS APPt.lCAT1�N. ➢� PROPERTY LINES ANO CORNERS MUST BE CLFARLY NtARKED. ➢� THE PROPQSEDi LOCATION OF ALL STRUCTURES MLIST BE_ S'�AI¢D OR FLAGGED. A THE SLTE MUST BE READILY ACCESSIBLE EOfi AN EVALUATION Hlf' THE. HEAi.TH� DEPARTMENT STAFF. � � � I hereby maks application to the Person County Health Department for a site evaluation for the or+-sife sewage dlsposal system for.the above-descrlbed property. I agree that the contents'af this apQlication are true and represerrt the maximum faciiiiies to be placed on the property. i understand ifi the site is altered or the iniendeci use changes, tfie perrnit shall Owner or Lega1 Kepresentative �' G��.� Date PCND, rev. 06127/02 ti �` -�" ' � _'r f�erson County Health Department `° ewa e System Improvements Pe�r�it --- te: "� �fiis Pe i Void After 3 Years . �" mer -- _ ` SR# �� `• � „ t ' F �.. Subdivision N,ame: � �� :�''; ��..� I„o� # �._ �,. Lot Size: � � ype of Dwelling: � Water Su 1: vate: �' Public: �� " PP Y pe ✓�,�" = � ssue� - Semi Private: � If not Private Tax Map# e r 0�� r�- Parcel # of Water Supply or Name of Supplier# Bedrooms: Gazbage Disposal � Basement Basement Fixtures . INFORMA T�D B�' �:1�-, � �•r,L� Sanitarian: �-�+/� J„�.T ownu or repies�tative REPAIR: REE�ALUATION: ro , --------r - ----------- � Size of Septic Tank: � gallons �, � Nitri6cation Line: � Depth of Stone: 12 inches ��'ra Max Depth of Trenches: OPERATIONAL P . yes no _�Z f � Remarks: �h , t ! /�7 ,. �► ,"�J a �; \ ----------�--------- ----� -,�- Date Well Approved: Weil should be 100 ft, from any sewer system BY �anitarian Date w ge yst �lpproved: - -� - BY �_ anitarian ,� C TE OF COMPLETION � Contractor. � ---------------------- — � — — ,n Sewage System location, installadon, and protection must meet state and local � regulations. Septic tank 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 tanlc and nitrification line must be inspected and approved tiy a member of the Person Coun[y Health Department before any portion of the installation is covered and put into use. L.ocation of sewage disposal sewage system sketched on back. (OVER) L-'� � � j � � -�r~` � U-�1.•a' =_. � ,�/ F�Y , C�t : ' Person Owner: Subdivision I�arrie: Drilling Contractor. ��I� 1�� C,��. P � County Health Department � Pem�itWell�PeYmst 2-1-91 0� � !p � n_�� 1 so SR# _l33 � � � � S t# C WELL CONSTRUCTION ►� Distance from Nearest Pr�perty Line Distance from Source of P-�' Polludon cn Total Depth: Ft Yield: _�GPM Static Water L.evel F� � Water Bearing Zones: Dept}� FG FG� Casing: Depth: From _.(�� to FG Diamete�: Inches . TYPE: Steel • Galvanized Steel�� If Steel, does owner approvet � No Weight Thiclrness: l Height Above Ground: Inches Drive Shce: Yes No Were Problems Encoimtered in Setting the Casing? Yes No If "yes" give reason: � 'TJ Grou� Type: Neat S�ent"� Concrete � Annular Space Width � Inches Water in Amiular Space: Yes No � Method: Pum Pr Poised Depth: From �� to � FG Materials Used: No. Bags Portland Cement Weight of 1 bag Ibs. If mixmre (sand, grave , cuttings) - Ratio: to _ ID Plates: Yes No .v 4 x 4 slab Yes � No � I HEREBY CER'TIFY THAT THE ABOVE INFORMATION IS C THIS WELL WAS CONSTRUCTED IN CO�t DANCE WITH FORTH BY THE PERSON COUNTY H�HI�PAR7fMEN�', AND THAT ,TIONS SET Date Date Issued Sanitariazis Signature Date Complete� Sketch well locaaon on reverse side. �C� NOTE: ke s1�=�` _�nst'all 'on showing lot size and shape, location of house, septic tanks, privies, water ,,� �� supplies, et Note special p ems existing on lot. Write in measurements in order that installations may be located at later date. ote 1 �on of water supplies on adjacent lots. �� e � � � (1) (2) ��. ' �C�X � r V tv�w� •-- I CPdL � HYCO LAKc � -� 0.PPRCXIM4TE \ � wATER USE � DIVISION r , ��, , `�, \\ • � . \\\ � l0 \ °� \ \ vo�^!o \ \ LOT 7 OF \_ 'MHETSTONE' \� � SECTION C `� \ \ `�\ •\`\ \ `\ _ / � � � �� , , , , � �// cpR7 pF ! CT B OF ~ / - `WHETSTONE" , � � / SECTIC4 C / / � N6f•�B l _ ?�,. �o- . --__ 7�.-M � � / _ � �_ � � ' --- KFN��?t; ryqxCK PROFERTY �' � ��-_ � -- -- PLAT OF SURVEY se=•ao• 15.?S' .E L J ACKSON LAWSON & 3A�A BENTON LAWSON lGHAt1 TWP. , PERSON COUPJTY, N. C. ;q9��, HALL—HA.MLET� 8 ASSOCIATES _ C �32 'p,.-r i s h � � . .. . .. �}})►1t�L� F HYCC ,,/� � ..' ' ..... _4K� 5�� I -. " �.�� ;G� , � , . . . . . _. �,^ ,� � �.' • : ,' n •^ : a` ._ . � _. SITE :: -� ,: '•�Sa..--.. �f= 3�--� � � +316 1396 1��.:.��i►.�i OC�'1e� li��'y�C�� -•"�• � . 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Hs:u,�E?T �-<��:` a�sJ�T nJ ; o_oc Type III (b) System Inspection Checklist Tax Map � Parcel # : �SZ- PIN Owner: Subdivision: Address: Ph/Sec/Lot: Location: YES ` NO 1) �i j: 4) Establishment a) type, size and sewage flow in accordance with permit Tanks a) tank risers accessible and surface water diverted b) tanks and access manholes structurally sound, watertight c) sanitary tee(s) in good working condition d) tanks pumped, cleaned out as needed Effluent Dosing System a) effluent appears clear, free of excess solids b) required pumps present, operating properly c) high water alarm present, operating properly d) floats, pipes, valves, disconnects in good working condition, operating properly e) control panel enclosure and components in good condition, operating properly Ground Asorption Field(s) a) no evidence of effluent reaching surface or surface waters b) surface water being effectively dive�ted away from drainfield c) diversion ditches, swales, tile drains are well maintained d) soil cover, vegetation adequate and maintained as needed e) protected from traffic and destructive uses fl distribution devices in good condition, working properly g) repair area properly reserved,-maintained h) pressure head properly adjusted �� Summary of Improvements and/or Repairs Needed: [� � �� Remarks Authorized Agent�_�Y� � �� Date �j_ �I 1 �jl�� ' � � �.�' ; �� ' ----�----'.. . __—�� ,_ _. J �'f�; �,Q- G��O- Ll II � i �\ +\ . i � ' ` \ � ------, . - \ --- -- - ---...__-__ � _._� _�� :'•, � �. � �Y.a 9G2� i �. �� , � � � �, �. . ' �... n.— _. _. . . �I� .�_r��i�-� w o� I ��!�� ; I � j p ^ —� ----- ,�G 4= � � �: � �+ -^ cl tu S 0� l, 7 i.� ,, I �" j ill \\ '�`; �..�.�%�; � � \ 4 �\ N J.J.;" I�.'i - i_ .._.__. ____.._......._� �.__ _ . ___, ---•- � � __.___ -----_.... -- .�' _. /---1/-% --�— / J' /-- -.____ __.___ _____--_.__. ; ,G}�;,Cil; ��!il--,�3 ��GI��UI': , �_.i� i ' ' ' i I �ivhl3� Ol �hi_S, ,_l - � ❑ � - - -..- .-- L�.� ❑ � -- _-� - I, � ,. ,� � . `�� i °, �� i t> �� --- -- -- — . __ ... ---� � __.._ _ --- /__ ._ __ .____._____ ,� �9 1.'OISNydX � 1�50' __ _ __ ____. ,._ - _ _ : -- �_, _ -�-< - _ - ,__�,�__ _ = - - ��- , . ._. _> � _._ I� . ' � L—J I-1 _ _ U �..� i �,�5-�v F �. , , , i _ _ ; � - .� c rc �_r�; v : � 1' � ?�._/ " I��II'O � F_>''-IO �I D.'��O 2 �I '� � � _ __ ;-- 1 _, „ , _ _ _ . _ _ _ ,'/--,(- --_ _--, �--, _ _ � _ _ _ --. _ _ _ __ _- ---_ __ ___.__. _ _. ---- ---- . -- _ _ _ ._�. . � . _ «__ � \ �, I!.!�I"Y �ry O .L i �> > � -' ,:�. �^.:: ; �`, �h `"a' ��, �� ' � Y �.. � �.. ;x � __ _......_ 6�; ' �� 13' C!.Gc. HT. o O i , _-��`r'}-`=�� ,�; _- _ � , - I � : �,_�„ __- n ��_ �° � _o�� _�,� �� m I I'-10" �--------. �o m � -,"�.`i �. � �AiLi1�G- _ U� �� _;�. I �� 2��m x ?��2 f] Z_ O � :� m c� �: 0 � � C� � ; ; � ? -O' "7'-O" ' ------_- /--- s n � �� i.. Q) c_ L O �� -6 c� �� _ 6 0 � v, � � `; 0 � �.. a� _� •6 �y. � 0 �� Application Date: � � � � 02 �"� � Amount Paid: Rcgeipt #�, ❑ Improvement Permit (Site Evaluation) $200.00/$300.00 (if> 600 end) ❑ Mobile Home Replacement or Building Addition � i SG.00 (if site visit required j 0 '�Vell Permit (1�1ew/Replacement/Repair) $3 00.00/$200.00/$75.00 �� S Tax Map: / � Z� ~.� • � � �� Parcel#c ' '^ � � �� IE:un-s-na-cn.Qamcace�na:,�n.Jl 1C�I�e,s.11d,lln for Services Services Re uested ❑ Construction Authorization ee is de endent on the e of " ❑ Permit Revision $75.00 0 Repair of Existing Septic System Application: No Charge/ CA $ I50.00 or $300.00 1) Applicant Information: Name: � c��c-�t �v�,'�' '�< <-o , Address: �o ;�j � \�33 �� 2) Name and address of urrent owner (if different than applicant): Name: _^. �1�1i � L a� Sa� Address: 3) Property Description: Lot Size: Subdivision: Address and/or directions to Property: Phone (home): (worWcel l): 33� S� 'Z 3 Z.2� pH.nr.e: Lot #: ❑ yes ❑ no Does the site contain any jurisdictional wetiands? ❑ yes ❑ no Does the site contain any existing wastewater systems? ❑ yes ❑ no Is any wastewater going to be generated on the site other than domestic sewage? � yes ❑ no Is the site subject to approval by any other public agency? 0 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: ❑Residential � ❑ New Single Family Residence Maximum number of bedrooms: 3 �% S� � Expznsion of Existing System If expansion: Cu�rant r,unber of bedrooms: � hQ �,� j ❑ Repair t� n?alfun�tioning System Will there be a basement? 0 yes ❑ no With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential A��z� ��^ -C74 ✓4 Type of business: Total Square footage of Building: I 10o SF � Maacimum �umber of employees: I�2ximum numb�; o: seats: Pau.S et�rov� ��ooSF �) Water Supply: ❑ New well ❑ Existing Weli ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this properiy? ❑ yes ❑ no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): ❑ Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any I cert� that the information provided above is complete and correct. I also understand that if the information provided is inaccurate, or if th`sit is s bse a re r the intended use changes, all permits and approvals shall be invalid �� `� �� Signature (Owner/ Legal Representati *) ate * Supporting documentation required. Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat. A completed `Loi Preparation' form rnust accompany any application requiring a site evaluation. (10/11) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) � , , �1�` i �.9� �� .�.��,�-�. ,.,,.,, ��.�.11. IE3L��,Il� I �i�X (41l}J � - ' ��;I'CE�� S'�El� el!i v i�5•i o ra � PI�-a�� SEction Lot ;= i Appiican� �+ KC i.-Q � S o � _ Location: � C�- eration: Perm�t System Type (In Accordance With Table Va): • THlS SYSTEM HAS BEEN INSTALLED IN COMPLIANCE W1TH APPLtCABLE NORTH CAROUNA GENERAL STATIlTES, RULES .FOR SEWAG��:TREATMENT AND� �DISPOSAL, AND ALL CONDITIONS O� THE iMPROVEMENT � PERnlIT . AND CONSTRUCTIQN . �RlZATlON. . �. �-��id ��.r�. .. . .:� - _� ... fa-�`1-�� _� . . .. A orized Sfais �Agenfi � • � Date - • . . . Instailed ay. 3� ^�my C�.�.��s 1anK� � S"��Y . �L�� '`�` '`�`sP � hy ��r+� 3��0 0 , Da#e: 3- f O-' 09 . / � ' � . .. . . ... .... . � . . ..... _ . ._... . .. �-• {�. ��.c..,_�::_." /� 3� 5�`pQ`� . ? �� S��p ^K .p� c�c. o l� s ufp+y �, �, � I'!z �, (Lcd,-ccd ` � ��r" c1�d �i �� A�� ; �' �� QT�J ! 000 S�6 �3a9 I t-13- 03 P7b i ou � P7,85 � z-�,-a3 � 5�! �� d 2 n �+� TanKS� 38� SuPP Y L��`� Cf usl.cd �id -7-4,� �CS �� n . �,��ia �,� � td i �� • t � � ,. ',�..�o � d ;$ _� 4wu.a- Y9. . �.- ' ..� � � �� L1 ��n�n��n�c��n��.� ��.��n November 28, 2012 Michael and Barbara Lawson 2993 Tillinghast Trail Raleigh, NC 27613 Legacy Building Co. P.O. Box 1133 Roxboro, NC 27573 RE: Building Addition/ 265 Bluebill Dr. / Tax Map: A24-152 Dear Mr. and Mrs. Lawson: nsuring a healthy environment An application for a building addition was submitted to Person County Environmental Health on November 21, 2012. The application indicated that the addition (45'x24') would consist of a 1,100 sq. ft. garage and a 1,100 sq. ft. bonus room. The application also indicated that there would be no bedrooms added to the existing three bedroom house. The proposed addition has been approved by Environmental Health. Approval from Environmental Health is required for building additions in order to make sure that: 1) proposed structures do not damage or encroach on the septic system or well, 2) the septic system is functioning properly, and 3) septic systems are modified to accommodate an expected increase in wastewater flow from additional bedrooms. Septic systems have a finite lifespan that is influenced by soil/site conditions and the amount of use. Maintaining a proper functioning septic system is the responsibility of the property owner. In some situations, a septic system that fails cannat be repaired on-site due to soil or space limitations. In the past, the NC Division of Water Quality has issued surface discharge permits for septic systems that could not be repaired. However, neither the State nor Progress Energy is under any obligation to issue permits or approve the construction of these systems. , The system serving your residence is 22 years old and was designed to serve a three bedroom house. Enclosed is a publication that has useful information on septic system maintenance. Proper management of your septic system will help extend system life and ensure that it continues to operate properly. Please feel free to contact our office (336-597-1790) if you have any questions. Sincerely, �� Harold Kelly Environmental Health Supervisor cc: Building Inspections Planning and Zoning EH File phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 � _ � . � � i � v�.� � , . .. :. � � �� n�n�n��n�nn�rnc�m�.��.�. �c��,Il.��n. Building Additions/ Mobile Home Replacements Tax Map #:�7i�f Parcel#:� Address: _ ;�� Approval Requested for: Mobile Home Replacement Building Addition Applicant Name: /"t i�. �� 1.�15o Y) Address: �e ) �� S nP �-o�' g Phone #'s: Pernut Located: � Yes No Installation Date: - � - Design flow: � (gpd) Current Contract with Certified Operator on file (if required): Water Supply: '�Well Public or Community Wastewater system shows no visual evidence of failure on: �(- Z-�e — � Z (date) �Applicant's signature if site visit is not required) � Addition/Replacement Approved 1 w✓�- - Envir ental Healt Specialist �1�21'/Z Date Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 Phone: 336-597-1790/ Fax: 336-597-7808 www.personcount .�net QR;i��a ��e,�� RESID�NTIAL wELL corrs�avcrioN a�coRn RE ?�onh Caroiina Dzparunen: of Environment and Natural Resources- Division of Water Qualiry NELL C01lTRACTOR C£RTIFICATION # .� Sry �� L YYE t CON�i2ACTOR: � ;� � P��- Well Con�acior (Indivfdual) Name �ars�ette Well Drillinv inc. �Ne� Corttractw Comparry Name 611 Bamette Tinaen Rd Stre�et Address Roxboro NC 27574 City or �'own State Zip Code 3�� 599-0015 f.rea a�de Phone number 2 VIIELL INFORMATION: WELL CONSTRUCTION PERMITit OTNER ASSOClATED PERMIT#{dapplicaWe) Sf1E VVELL ID #(i( appiicaWe) 3. WELL USE (Check Applicable Box)� Residential Water Supply C�� DATE DRILLED CI "/ �� S�' TIME COMPLETED 3d 0 AM O PM [lY 4. VYEL3. LOCATION: cin: S e�r�2A cour�rr �',� s rvv 2�'S ,a/Lc.v �� !1 �en�aR.a pdc. z�;�: (S�reet Name. Numbers, Community, Subdivision, Lot No., ?arcel, Zip Code) TOF'OGF2APHiC ! LAND SE7TltJG: {check appropriate box) ' ❑Sk�Qe ❑Valley �Flat pRidge pOther LATfTUOE 36 ° ' " DMS OR 3X.XXXXXXXXX DD LONGITUDE 75 ° ' " DM5 OR 7X.XXXIOCXXXX DD : Latitudellongitude saurce: �PS QT'opographic map (loCa6on of we!! musf be shown on a USGS topo map andatiached to t►us Iorm if not using GPS) , 5. VYEII OWPlER ,� � ,� � L, l+r�� rn •✓ Owner Name z. S? 9 3 i.-//,` � As�+- iR� / Streel Address 12,��,`rl, J�/ c. . 2 7E /3 Gfy� T �� State Zip Code AL � r.�a c�ode Phor�e number 6. 4YEl.L DE?AIi.S: a a. 1�OTAL DEPTH: � V Q 7�r� 3�U b. DOFS WELL REPLACE EXfS71NG WELL? YES p NO � c. YVATER LEVEL Below Top of Casing: 2� FT. (Use'+' if Above Top of Casing) d. TOP OF CASlNG IS � FT. Above Land Surface' 'Top ot casing terminat aUor below land surface may require a variance in accordance with 15A NCAC 2C .0118. e. YIELD (gpm): 'Z O� METHOD OF TEST BIOWtI ZOfTI i. a�siNF�c�oH: -ryRe HTH anounc �2 Cuq g. WATERZONES (depth): Top "2,4�n Bottom Z?f� ��.,jop Bottom 7op 2 � Boriom z qJr�aTop Bottom Top Bottom �op Boflom Thicknessl 7. CASING: Depth Diamater Welght Matarfal 7op Bottom Ft. Top Bottam Ft. Top Boftom Ft. 8. GROUT: Depih Material Msthod Top eottom �t. SandlCement Poured Top Bottam Fi. Top Boriom FL 9. SCREEN: Depth DJameter Slot Size Mater�al Top Bottom Fi. in. in. Top Bottom Ft. in. in. Top Bottom Ft. in. in. 10. SANDIGRAVEL PACK: Depth Size Material Top Bottom Ft. Top 6ottom Ft. Top Bottom Ft. 1!. DRILLING LOG Top Bottom ��/ 3 �c� / / / / / / I / / / I / . 12. REMARKS: Formatfon DescripIIon ! DO HEREBY CEF2TIFY THAi THlS WELL WAS CONSTRUCTED fN ACCORDANCE W1Tii 15A NCAC 2C, WELL CONSTRUCi1QN $TANDARDS, AND iHAT A COPY QF TliIS FZECORD tiAS BEEN PROVIDEO TO TNE WELL OWNER. � �L � �� » SIGNATURE OF CERTI�LL CONTRACTOR DATE YL�/t� !il e P C� / IZ LL �'� RiiIP{TED NAME OF PER50N C4NSTRUCiING YNE WELL Submit within 30 days of compfetion to: Division of Water Qua(ity - Information Processing, Form GW-1a 1697 Matl Service Center, Ralelgh, NC 27699-161, Fhone :(919) 807-6300 Rev.2/09 Application Date: �� $� I 3��d; � ��.5 l"" �� Tax Map: �°2 I Amount Paid: �] . DO N�,Y� V,. , �- � � �.�� Parcel#c � Receipt #: S�`y � 9 I � IE�.un-s nn'axan.v.xaa�an.dm.Il )HI��.)Ii;Ln. ication for Services Services Requested '�mprovement Permit (Site Evaluation) � Construction Authorization $200.00/$300.00 (if> 600 d) (Fee is de endent on the ty e of s stem ermitted) ❑ Mobile Home Replacement or Building Addition ❑ Permit Revision $150.00 (if site visit re uired) $75.00 ell Permit (New/Re f epair) ❑ Repair of Existing Septic System $300.00/$200.00 $75.00 Application: No Charge/ CA $150.00 or $300.00 1) Applicant Infor aYon• ` G� ` Q G�' Name: �� i�h �Cc !i� � Phone (home): s / Address: (work/cell): 2) Name and address o cur ent ow r if different than applicant): �� L� Name: � w$��' Phone: '�j � � "' � �j' � � / Address: / .��r 3) Property Description: Lot Size: Subdivision: Address and/or directions to Property: Lot #: ❑ yes ❑ no Does the site contain any jurisdictional wetlands? 0 yes ❑ no Does the site contain any existing wastewater systems? ❑ yes ❑ no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes 0 no Is the site subject to approval by any other public agency? ❑ 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: �'l�sidential ❑ New Single Family Residence Maximum number of bedrooms: ❑ Expansion of Existing System If expansion: Current number of bedrooms: ❑ Repair to Malfunctioning System Will there be a basement? O yes ❑ no With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential Type of business: Maximum number of employees: Total Square footage of Building: Maximum number of seats: 5) Water Supply: ❑ New well ❑ Existing Well ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes ❑ no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): ❑ Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any I certify that the information provided above is complete and correct. I also understand that if the information provided is inaccurate, or if the .rite is subsequently altered, or the intended use changes, all permits d approvals shall be invalid. �--IS-13 Signature (Owner/ Legal Representative*) Date * Supporting documentation required. • Permits are valid for either 60 months or are non-ezpiring when accompanied by an approved plat. • A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (10/11) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) PERSON COUNTY HEALTH DEPARTMENT SUBSURFACE WASTEWATER SYSTEM MONITORING REPORT 1, 3 i'{ 3I�o��4 �SCi A�y lS�.... Date of Inspection System Installarion Date Type Tax Map Pazcel # ab5 QwEO�� 2.. , S�rtiowa , �c. ��343 Property Address Instructio�s: Cl;eck yes or no for appropriate items and explain in space �ravided for remazks 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 SYS'T�M: Evidence of leaks ? Tank risers accessible, free of infiltration and surface water diverted ? Septic tank needs pumping ? Inches of solids: Septic tank filter cleaned ? EFFLUENT DOSING SYSTEM: Required aumps 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 tanlc): Elapsed time readings ? � Counter readings 7 Drawdown rate• YES / NO ❑ � ❑ ❑ � ❑ ❑ � ❑ ❑ � ❑ ■ ■ ■ ■ ■ ■ ■ ■ ■ DISPOSAL FIELD: Evidence of efflue�t surfacing ? ❑ Evidence of effluent ponding in trenches ?❑ Surface water effectively diverted ? $j Diversiaas/sv�a:es properly maintained ? � �egetstive cever n2inta�ned ? � Protected from tr�c/unauthorized uses ? � Di�tributiou uevices in good condition ?� Field free of settled or low areas 7 [� / / / / / / / / � �� ■ ■ ■ ■ ■ ■ PRESSURE DIST�IBUTION SYSTEM: � f A Turnups/cleanouts/valves/taps intact & accessible ? ❑ / ❑ Pressure head properly adjusted 7 ❑/❑ COMPLIANCE: Compliant Non-compliant Needs Maintenance �� ■ ►': REMARKS 5�c. —�a�� r�sc a cc.�,ss, A�. P,�r.Q � �.��L s�.�c �0.c�E,sS,a� ; NEdav��,� C.Rn�9ScRQEQ c,..l SHCt.�.1(1S � �SN�c1 f�iW'�`�tJ Qi�+P '�R.J�I � CoaTtw�. ��fl. • Pi�a�+P "�a�\�. A�e�sS R��. S�+,PqoSz'c, 'c� k�E �o'� �v� ��-�� ' . (.oa.c.c�� 2�►sN (i�x v��a.�C. �sz s��. �F 6;u,a�c� � AP4�S o��i- AI'ii,iTiviv:w Cvi��i�ir.i1'i S: RE �-.�►�n�h 'r�T �+�r�p T��\` ci S6P�C 'T�a�l I�E 1`�ME A c,cc ss �[1� ��L f�+�'t,� t�P��rtic�-,�t� Atii c� . �t�, --'�R�\�S 4�� 9�w11 5 EHS �� - ��