A24 190���, ss ���.� ��
�,� �r � � ����
7Ers�����-�-,.-� ����.Il IL—���.Il�I�
,, __t'---.._ (r�,�n YC(1C0
Tax Map: Z Parcel: �Qa
Subdivision �2 �e
Phase/Section/Lot # J 3
Impr �ement Permit
Permit Valid for: Five Years Non-expiring
Type of Facility: `,�i` � I�fS• New 1� Addition _
Number of Bedroom—�L / Oc upants / Em loy es / Seats:
Proposed Wastewater System:
Proposed Repair: S
Permit Conditions: Sor� S)� � S�}�'�n
Water Supply: w� ��
Projected Daily Fiow: �� O gallons/day
Type�
Type: �
Authorized State Agent: � vv�Q✓ Date:
(X) Owner or Legat Re resentative: Date:
_. ._ r,
The issuance of this permit by the Health Uepartment does not guarantee the issuance of other required permits. It is the responsibility of
the applicandproperty 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 owners6ip of the property. This permit was issued in compliance with the provisions of the North Carolina �Laws
a�:d Rules for Sewage Treatment and Disnosa! Svstems'(15A 1�TCAC 18A .1900). Neither Person County nor the Environmental
Healt6 Specialist warrants that the septic system will continue to function satisfactorily in the future, or that the water supply will
remain potable. _
Authorization to Construct Wastewater 5ystem
See site plan and additional attachments (�.
Proposed Wastewater System: U �t. '�S �� �(*)Type �� Design Flow 3� 0 gal./day
New iC Repair _ Expansion _ Soil LTAR: . ag gal./day/ftz
Tyre of Facility: '��J° QS• Basement: � Yes _ No
(*) System Types IIIb, Illbg, IV, and V, require periodic system inspections by the Person County Health Department.
Wastewater System Requirements
Tank Sizz: Septic Tarik � � C7 gaf. "" Pump Tank ��� gal. Grease i rap gal.
Drainfield: Total Area Q� � sq. ft. Total Length 3zO ft. Max. Trench Depth �Z in.
Trench Width 3 ft. Min.Soil Cover � in. Min.Trench Separation � ft.
Distribution: Distribution Box / Serial Distribution . / Pressure Manifold � �
s
i �s,i�Ai
Zi�
Authorized State Agent: ��✓ Issue Date: ('� Z�'' ��
Permit Expiration Date: �-2 'Zo
The system permitted is: Conventional /Accepted �/ Alternative / Innovative . I accept the conditions
and specifications of this permit.
(X) Owner or Legal Representative: r�� L ��� Date:
Person County Environmental Health, 32S S Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12)
S�
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OT 17
PUMP�INE TO DRAINFIELD 13A
SEE PLAT CABINET 16
PAGE 491-496
FOR PUMPLINE DATA.
3•PUMPLINE INSTALLED FROM LOT
70 OFFSITE DRAINFIELD AND
PREVIOUSLY INSPECTED BY THE
PERSON COUN7Y ENVIRONMENTAL
HEALTH DEPARTMENT.
REFERENCE IS MADE TO THE
RESTRICTIVE COVENAN7S RECORDED
AT DEED BOOK 856 PAGE 428.
3" PVC CONNECTIONS SHOWN ON
THE LOT AND ORAINFIELD ARE
APPROXIMATE LOCATION ON�Y.
WELIS MUST BE 50' MININU61 SETBACK
FROM ANY DRAINFIELD AREA OR SEPTIC
PUMPLINE EASEI�ENT.
WEILS MUST BE 10' MINIAIUY SETBACK
FROM PROPERTY LINES AND 25'
MINLMUAI SETBACK FROM tHE
BUILDING FOUNDATION.
CONSTRUC7ION IN THE PROPOSED
BUILDING AREAS AfUST MEET ALL
PERSON COUNTY SETBACK REQUIREMENTS.
. �
t�, � N84'S0' 31'E � � _ _
�,�ry`O p.bo`�na.e2' 10�
��^ 3° PVC
h�ON '�- Q� 3 CONNECTION
�
ry� 1a 0 - qo' -
= a (3-�p� M DRAINFIELD
� vo Pp,� p S
o�� o `
� �e�a��' . �e�
�--- 45.46' C16
�-_N85•44'46•W
n EASEMENT
� LOT 12A
► {�([SSurQ
�a���i,,�
�8' FAVEMEN7 � �
--�--�--_� /
-�--�--��--�����/
INSET DETAIL
DRAINFIELD
LOT 13
SCALE -'
� �,��� � a�se�.�..� l;��s ,�,w��- 1�
C �20.r�`` /KQ�N�C �.Q� I�tS"�l�lQ�Gvf.
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recr�v�
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�--- = �= � � ���� � ,Qcn
IE;aa-���aa�eaa�a.v. 7HL�.s�.�t•E7La Owner: , I�' 1�'�dCY� 1??
Tax Map: Parcel #: �Qv Date: ��Fs'—1 5
�.ine 'I'�p Tap (Sc�a) Tap �'lo� Line �,�ngth �ioe�v / ��ot
# fl�iagneier(va) ( m) �'• (ft)
1 3 � z.s o .►5
2 O I?.S U' . I
3 , � /z.5 �� , 3
� 3 �o o, �o' . r
5
6
7 � V��-*-�_
8
9
].0
�JZD ft of line x 65 gal. per 100 ft= Z° Oa�-'� ; 100 =�a �gal
75% x' o ga1= � 5�o ga1 per dose 5 o ga1 per minute (gpm) _�'low Rate
�'riction �ead r
I.oss: � ft per 100 ft of supply line x N Y�� ft of supply.line = 100 =�•�l ft
S• ft x 1.2 =_� ft of friction head
�
�OU�p J��.�
Q� {,Stt++h GQ
Manifold Size: �� Y " Force Main �ize: 3 " PVC
Total Dynamic �ead = 5� ft of Elevadon head + 2 ft of Pressure head +�ft of
Friction Head = �TDH
�. � �.QU,
Pump Reqtaa�eanent: 7r� GPM @_� ft of Head
IDrawdown: , j��gal per dose �I'ga.l per inch = S•� inch drawdown per dose
��
G�anea� I9esign �for�aiion
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3"
5"
l�Yanifoid Siz ! � Tap�
Max No. Taps off one side
(�irdace b �s ;or ta in �oth ;
xc» ra.,Q 3/." tans 1"
9 �
2i �Z
� �� j.�,v�.
�1ow er Tap
g�e ;1�cuerial Fla:c GPYI
c; �� Scfied 30 �•�
�," Scsied 10 %•�
;, :• �cl:ed 80 1O,1
,, . Sci:ed 40 := '
;� .
���,sf ���.���
- � � ����
IE�ra�ns � �an�n.a��cad�.11 IE3C� m Il �:]La
Tax Map: �`� P rcel: �0
Subdivision: -e -PSPw2
Applicant's Name: �ja b �5.2.
Mailing Address:
Phone Numbers:
WELL PERNIIT
(New� Repair_)
Lot: � �
Location ofProperty: �i �`� 1�/� � C �,. 1�� �I' �il��S�Y�QZ+ �S�'�S ►"�( ` '�
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 permiE does not guarantee a potable water supply
Other Conditions/Comments:
Permit issued by:
�1ew Well:
EHS/Date
Location:
Grouting:
Well Log:
Well Tag:
Pump Tag:
Air Vent:
Hose Bib:
Casing Height:
Concrete Slab:
Well Driller:
Pump Installer:
Approved by:
Additional Comments:
Date Sample Collected:
EHS:
Person County Environmental Health
325 5. Morgan St.,Suite C
Roxboro, NC 27573
w�,,�
Date: �'—z� �lS
Certificate of Completion
OLiner:
EHS/Date
Depth:
Grout:
DAbandonment:
Date:
MethodlMaterials:
License #:
License #:
Date:
Date Results Mailed:
Phone:336-597-1790 Fax:336-597-7808
il/26/13
��� J�� ���� ��
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'"�� �ra�a�-nlroaa�•-++-+• ¢�aa�.m� �'��am.Il.��ia
0
NEMA 4X Simplex Contml Panel
4" X 4" Pressnxe Treated Post�j �
Sloped To Shed Wate: p
b" Covex •�
�
..
Inlet Fmm Septic Tank
4" SC$ +i0 PVC Pipe
12 Separat�oa
Electrical Conduit �
• � ` Access Cover• � •• ' ' � ~ ' .� � ;
, .�
_ ,, . '� ;
� ' � =;� ; .:��. �" , ;
' ; �' . � � . •
,,. Opening Filled With . Anti Siphon Ho1e' \
Portland Cement Crmut �D� ���
Cl,eck
• Valve �
, High Watex Alaxm Level
(!S" Sepazaticn}
. High Level- Runp On ��
;: � �1 '�VaporLock
�j Hole
• . � Drawda�m �IIp Hi11)
• �LowLevel-PumpOfi --��'
� � ' Precast Concrete Tank
,•; (Mate:ialStseagth>3500
.� • . ., .
� •w: . . .' •.
T�x M��� j � F�rcEl # � �
.%. ���'���I�v�s���� , / • •
Ph.�•s•� Sect�ioii Lot #
Ihut Seal Both Cozicrete Riser '
Ends Of The Con�it
-'- 24" Mi�+i»n�*n
" '' ' � • 6n Sepaxation
Threaded Gate Valve •
Unicn . t •
• • ' %r..[1•sf' -
�,,,:,�-PoYt],axid Concrete Gxwt
_ . _: Mastic � • - •
•• • ' . ry� � � '
Zip Cord .� Operung Filled With
• 'pipy Supply � ' pon� Cement Crrout
� ..
Outlet To Distnbuti�on
:ENylan 2" SCH40PVC Pive
4" Conciete
'Sn Block
'.. ;•. : . .'.
1e Float Wi:es � �
.�
i
Floats ; ;
�Removable '.:'
Float Txce '�
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r � ..
. . �•t 1 _. .+.
'� i�6 o GAI.LaN PU.LVIl' TANI�
PUMP EtA?ING � �
Pump Hust ge Rated Yo Deliver
�� aD�M Galloas Pez liinute .
Aga-- i—ns �Feet OE Tota.l
byna�aic �iead (ION) .
T9
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,1�latiie
: f:'�:.�4:.
;5�b' `.s. . � .. Section/Lot � /3
� ZSs-15
Authoxized State Ageat Date
System cor�►'onents r�spverent appnoxinrare�conrours anly.' The cont�clbr �rrut,�lag the system priar tn
begrnning the insAallation ia ntsr!r+e flydepropergrade is maintaired
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OT 11
PUMPLINE TO DRAINFIELD 13A
SEE PLAT CABINET 16
PAGE 491-496
FOR PUMPLINE DATA.
3"PUMPLINE INSTALLED FROM LOT
TO OFFSITE DRAINFIELD AND
PREVIOUSLY INSPECTED BY THE
PERSON COUNTY ENVIRONMENTAL
HEALTH DEPARTMENT.
REFERENCE IS MADE TO THE
RESTRICTIVE COVENANTS RECORDED
AT DEED BOOK 856 PAGE 428.
3" PVC CONNECTIONS SHOWN ON
THE LOT AND DRAINFIELD ARE
APPROXIMATE LOCATION ONLY.
WELLS MUST BE 50' MINIMUM SETBACK
FROM ANY DRAINFIELD AREA OR SEPTIC
PUMPLINE EASEMENT.
YiELLS MUST BE 10' MINIMUM SETBACK
FROM PROPERTY LINES AND 25'
MINIMUM SETBACK FROM THE
BUILDING FOUNDATION.
CONSTRUCTION IN THE PROPOSED
BUILDING AREAS MUST MEET AlL
PERSOM COUNTY SETBA�CK REQUIREMENTS.
�,� N84°50'3l"E
�`�ry`O p � (00� 10.8.82' 1��
��ry' {3- �10
=ry� `� � — 90' -
� f� — �30'
, � ��� � 7
� o
�s�a .
� ��,�- ,,�Qq
— --
45.46' C16
°44'46"W
3" PVC
� CONNECTION
� DRAINFIELD
� EASEMENT
� o ' LOT 12A
� �(eSSGtrQ
� �d , -
� �,(�m � ,
_- �
18' PAVEMENT
_ /
------�___ `'
- - ---__ - - .--- _
_____ ,i
_ _ —_____-- - -
INSET DETAIL
DRAINFIELD
LOT 13
SCALE 1"=50'
� �� �- e�se►�.e�,� l� ��es ,�� Sk 1�.
��
C��2c.1 r t /''cA r- � `22 �v-2 ��t S�ot l l Q�"► a►�l .
� .
c� r�-� �� re— su�-�eY�Q I
� y r
Application Date: � s << p� �� c�.� j� ���� Tax Map:
Amount Paid: OOd , CU �a00. �3 `6 � i � �a � � Parcel #:
Receipt#: ( 4 3 4 I 7 �0 �- e�� 1.�' C�+� � o-�
-13-t� 3co� �� �� � ������ � �2 �d..
� � � ► � r � ���� �r� �
U1ct1 PerM��- ) � f � ` ' �` -{�- � � ����
Gf« 1[52� �.�.�.�-na �as,.�.,..���.�.0 �[.� �.Il�� �liit.-�2 C-�•
�
Application for Services (Septic Systems and Wells)
1) Servic �gques edb�j --- /�
Name��a ��� \�.'c�`�f•'• Jf� Phone # (home):33� �j'Cj''`.L��%.S
Address: � S �>. Z.r- (work/cell): :�3� � r'�
,r- ,' n. . v� �
2)Name and address of current owner (if different than applicant):
.�ld� i�{� �'l �Sou.��n.wc �
Name: `'�' � mr� -
Address: �
3) Property Description:
Lot Size:
Subdivision:
Lot #:
�� 31
4) Proposed Use and Type of Structure:
Residential � Business/Type: Other
Number of bedrooms � / Number of people served (seats/employees):
Basement: Yes � No (with plumbing: Yes No _�
Gazbage disposal: Yes No `�
5) Water Supply:
Private Well � (Proposed � Existing _)
CommuniTy Well: Public Water System: .
Are there wells on the adjoining properties? No _
Yes '� (please show location on site plan)
Note: A comnleted annlication must also include:
➢ A plat/site plan of the property that shows property dimensions and the size and location of al[
proposed structures. �
➢ A signed copy of the `Lot Preparation' form ver�ing that the properry is ready to be evaluatec�
I am submitting this application to request services from the Person County Heatth Department. I understand that
if the information provided is incorrect or if the site is subsequently altered, or if the intended use changes, all
permits and approvals shall become invalid.
Signature (Owner/Legal Representative): �- "��` Date :� j��/
10/08 Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790)