A24 206���.s.� ���.� ��
�___..ti � � � ����
1���-a�-��,.-�„ ���.�.71 IHI � �.Il�7�.
NEMA 4X Simplex Contml Panel
x I1
4" X 4" Pressure Treated Post '
i
Sloped To Shed Water 12" Separation
\ � E��t�� co�t — l
6" Cowr • ' � Acce s Cover. � .• • : ;. ' 1 �
� . � - i . J
• • • I �; , i '_ ; • • `• , • . i
�,, Opening Filled With Anti Siplwn Hole' ,�
Inlet Fmm Septic Taxlc Fortland Cement Gzaut (Drnm Hill)
4" SCH 40 PVC Pipe � '
Check
Valve
� High Water Alazm Level
' (6" SeparatiAn�
H' - Puznp Ox -�-���
�� fiVaporLock
' �• � Cf- Hole _
. � rawd � �Up Hi11)
'. Low Lav+al-Pump Ofi --^-^"-'
' � � '. .
�•
/
T�x M�� - P�:rcQ,l # ' '
s��ncli�is�o�, ; • • •
Ph���se SQction`Lot # �
Duct SealBoth
Ends Of The Cozubiit
� 24" Mininnim
,. .,
Threaded Gate Valve •
Zip Co
Ties
R,ope
' Precast Concrete Tank 4" Concsete
� � ;.; (Material Strength >3500 PSI) Block
� ,•`.•.... . •, . • . . -' . . ':•.' ; . . '. ' .
Concrete Riser
b" Separation
• •. - . :� „J•y+• -
;r:rrPoztlazul Concrete Crzrnit
Mastu • - '
� Opening Filled With
Supply � ' portland Cemant Crrout
Lina • •
Outlet To Distnbntion
2" SCH40PVC Pipe
F14at Wires �� �
�r
i
F7cate .:
�Removabie '• •'
F7oat Tree �
�
r
r � . �.
�. � � �.•.�.' .
� � �1�aLLa�v � T�.vx
��� �� IPI��.���
�--- � � �-r= � � ���� �e �I�/% 9
IE�-�� ��¢�.11 IHL�.�.11,�. Ownei� "�� r\-P �(�. '2 l
Tax Map: Z Pazcel #: Z� rp Date: 8�-1 ni "�
I.ine Tap Tap (Sch) TaQ k'!o� Line �ength �odv /�oot
# i)iameter(in) ( m) �:. ft)
1 3 0 2-S oo� , i25
2 3 �fo�� !Z•5 ��b � !z
.
3
4 �
5
6
7 Z v�P�..�- o �2
8 �
9
10 �
20 � ft of line x 65 gal. per 100 ft= ; 100 = gal
75% x'Lo �ga1= SD gal per dose �_ gal per minute (gpm) = k'low i�ate
�riction �ead � �
I.oss: � 23 ft per 100 ft of supply line x N�$� � ft of supply. line =100 = Y. S ft
�ft x 1.2 = _� ft of friction head � � ��� �,� ��� � �n,.�X,
��
Manifold Siae: 3 " Force Main 5ize: �_" PVC
Total Dynamic k�ead = s� ft of Elevadon head + 2 ft of Pressure head +�ft of
Friction Head = �TDH
� e �ev. In-� Qn,� x.
Pump Requirement: � GPM @ 5 g• ft of Head
Drawdown: 5 � al per dose :.2'!' gal per inch = S�� inch dra.wdown per dose
3a
Genea�l I9esi� �f'oranation .
�_.:.. .., ..
�
.,.�y , —
=�i�����t0 � • . �
. . ,,.,. _.. �
� ,. .,
, . . . • ■I(�)1���00
,_..
1�1 �l 1�1 (�1 ���+*�iiiiiiii�ii+iiiiiii��iiii
I � .... .... ..... ��a��������:+������������+��►��.�
� � � i '. ' : � .. _ : . :, : : : �:
r�a�
�aim�
2" mtin
Sche�ale � "w
3p/C �,,�
� 9mm� � S
. . . - . = I`low er TaP
Sue �Llcuarial FTow GPyl
t.� " Sclied 80 �•�
f, �� Sched 1p i.=
;, " 5c1:ed 80 10,1
j4 ' �cileri ?0 I= '
.�: � l `� = � � � ��.s� 1��1����T . r � � ` o �
S'c�.� �:��:��� S � �� � � �
/_ ����Q;�;���t ��mn�
'�-- . � � ..:�I�'E`:•��IF� �
,�Naiiic: 1 � oSr2 . '� " . Ta$ Map #�Parcel #�
�:��.•.
"�it "�- ' � e Sevv�_: • • Section/Lot#
� .
, 1�luthoxi�edStateAgent Date . ��J� C 3g�
' (dddq ST
s,ystemcoi�►oaeais�ivereneappnozimate�cnnrorr►sonly.' Thecant»rclbrmrist,flogtherystempriortu � `7ovJ• `�
begr{rnieg�hs au�rllydian sb iasWr,ethdep►npergrade rsmaietairred p P
.J
c, ���e. � �� �►�s � c �.e�.P '�m '°v�rp� , � zoo�-�f-• PP�PS
� P� 7 ¢2 ��� � .
�o�- � o�a;��e(� ��ea• , \, '� � /�,�.� �-r�,�e�
. �:1.
b�eKS ` Gi`� S��i�cN r v Lt
� �,�1 �a � '�e�- � �l `
. 1
l S' �o�Q�w� . s
� �. �- 42�v' ��� 3�` c' C56 .
l 0 P f 5-fn� �' \
5a` �a�C� o°
n �
� ,.
��rQivt�'e�� (�lv�eot /bu,c�i- I�-� C(r-eAr�Y Ma✓'l��C `r J CS js�
�1 I � S GJQc
�.Q�iO�� j vts�-R � �� �f-i0v�. C
. � v
�: � u�� �- �►�,; � �P o�s;y,,, sl,�� C `� .
P _.
� �,f ocK �a�z( -�+re��s � �b� 3-� = W�� m .
C.ep�C�-�rA S 4�c� vt�2�eci�� Z�,
Q
'�" 1 J 1 J ` J � I
��, �, . Z �,
IS �Z� �r � W �
PUMPL I NE �� 1 � � � ��
� EASEMENT E IS 8 A I� • � o �
ac, � I � —'
� CP
IS N _
i E l D I S ��6 � ^ �rESSuw^e- C+� •
A � lKp'1i f0 �� � �
� I `17 � O �
146 � 1S 3
s
28a � , � rs � �s°�, 5�' '9. `9i
J IS �� � IS �8 �,..�' M�✓1� " �, Mrn. `
cn 2 ' �
6A IS � � � �
� ''�'.P �� f ��
�*w �0 1� ,�• �y .�, g0 , .
� � � �
� 149 51 0 ��
� �
7 A �r31e ,
IS IS �67 � I �� '
IS l. �
2 A �,� I S �, � t5� '�
� � ._
�Q�1� N ^
S zz4 22z ...: �o�'��Jaw -� � 1 1i� s
IS IS IS ls /. ��*�riO����� �? 2� �
N88"25' 41 "W 233. 96 � . ��2o dJ� fn. S.r(� . �
��
�
nc department
of health and
human seroices
��� ��� ������ � �� ��:����r�
��� • �..���� :' ���•�.������� • ���.� ��
For lnorganic Chemical Con�amirrants
County: V -✓1 Name: 2
Sample ID #: � �� Reviewer: W�f
� TEST RESULTS AND USE RECOMMENDATIONS
1. ❑ Your well water meets federal drinking water standards for inorganic chemicals. Your water can be used for
drinking, cooking, washing, cleaning, bathing, and showering based on the inoreanic chemical results onlv. You may
have other water sampling results that are not taken into account in this report.
2. ❑ The following substance(s) exceeded federal drinking water standards or the North Carolina 2L calculated health
levels. The North Carolina Division of Public Health recommends that your well water not be used for drinking and
cooking, unless you install a water treatment system to remove the circled substance(s). However, it may be used for
washing, cleaning, bathing and showering based on the inoreanic chemical results onlv.
Arsenic Barium Cadmium Chromium � Copper � Fluoride � Lead � Iron
Man�anese Mercurv � Nitrate/Nitrite � Selenium � Silver � Magnes�um � Zmc � pH
3. �. Sodium levels exceed the U.S. Environmental Protection Agency's (USEPA) Health Advisory level for sodium of
20 mg/1. 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 inorQanic chemical 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. ❑ The following substance(s) exceeded federal drinking water standards. Your water can be used for drinking,
cooking, washing, cleaning, bathing, and showering based on the inorQanic chemical results 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.
Barium Cadmium Chromium Fluoride Iron
Man�anese Selenium Silver pH _ Zinc
For more information regarding your well water results, please ca[! the North Carolina Division of Public Hea[th at 919-707-5900.
North Carolina State Laboratory of Public Health
Environmental Sciences
Inorganic Chemistry
Certificate of Analysis
Report To: ADAM C. SARVER
PERSON CO ENVIRONMENTAL HEALTH
325 S MORGAN STREET
Name of System:
P.O. Box 28047
4312 District Drive
Raleigh, NC 27611-8047
http://slph. nc�ublichealth.com
Phone: 919-733-7308
Fax: 919-715-8611
THE RESERVE LOT 29
END OF ESTATE RD
ROXBORO, NC 27573 Courier # 02-33-15 SEMORA, NC 27343
EIN: 566000331 EH
StarLiMS ID: ES061115-0041001 Date Collected: 06/10/15
Date Received: 06/11/15
Sample Type: Raw Sampling Point: Well head
Sample Source: New Well Temp. at Receipt: 7.5
Sample Description:
Comment:
Time Collected: 2:00 PM
Collected By: A Sarver
Well Permit #: A24-206
GPS #:
New Well I (Profile)
Analyte Result Allowable Limit Unit Qualifier(s)
Arsenic < 0.005 0.010 mg/L
Barium < 0.1 2.00 mg/L
Cadmium < 0.001 0.005 mg/L
Calcium 40 mg/L
Chloride 7.80 250 mg/L
Chromium < 0.01 0.10 mg/L
Copper < 0.05 1.3 mg/L
Fluoride 0.29 4.00 mg/L
Iron 0.13 0.30 mg/L
Lead < 0.005 0.015 mg/L
Magnesium 17 mg/L
Manganese 0.04 0.05 mg/L
Mercury < 0.0005 0.002 mg/L
Nitrate < 1.00 10.00 mg/L
Nitrite , < 0.10 1.00 mg/L
pH 7.9 � N/A
Selenium < 0.005 0.05 mg/L
Silver < 0.05 0.10 mg/L
Sodium 30.00 � mg/L
Sulfate 26.00 250 mg/L
Total Alkalinity 164 mg/L
Total Hardness 170 mg/L
Zinc 0.46 5.00 mg/L
Report Date: 06/18/2015
Page 1 of 1
Reported By: Arnold Hall
�
North Carolina State Laboratory Public Health
Environmental Sciences
I�icrobiolog�
Certificate of Analysis
Report To:
PERSON CO ENVIRONMENTAL HEALTH
325 S MORGAN STREET
ROXBORO, NC 27573
EIN:566000331 EH COURIER #: 02-33-15
StarLiMS Sample ID: ES061115-0108001
� ����u� u���� ��� ����� ����� ����� (���� ����� ���� (����� ����� ����� ����� ����� ����� ����� ���� ����
ES Microbiology ID:
GPS Number:
Sample Description:
Comment:
Name of System:
THE RESERVE LOT 29
END OF ESTATE RD
SEMORA, NC 27343
Col lected: 06/10/2015 14:00
Received: 06/11/2015 08:29
Sample Source: New Well
Sampling Point: Well head
P.O. Box 28047
4312 Distrid Drive
Raleigh, NC 27611-8047
htto://slqh. ncoublichealth. com
Phone: 919-733-7308
Fax: 919-715-8611
A Sarver
Angela Heybroek
Well Permit Number:
A24-206
Environmental Microbiology - Colilert Profile Method: SM 92236
Test Name: Colilert
Analyte Test Result Analyst Date
Total Coliform, Colilert Absent Denise Richardson 06/12/2015
E. coli, Colilert Absent Denise Richardson 06/12/2015
Report Date: 06/12/2015
Explanations of Coliform Analysis:
Reported By: Susan Beaslev
� ,�
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.
���.sf ���..���
�_ � � ����
)[�s��a���-„-.�-n ���.�.11 IL—���.Il�I�
Applicant: ��
Address/Location:
Permit Vatid for: Five Y
Type of Facility: 3��C'
Number of: Bedrooms �
Proposed Wastewater Sys
Proposed Repair: �'�
Improvement Permit
i� Non-expiring
S • New � Addition _
)ccupants / Fmployees / Seats:
Permit Conditions: SP.� 5��� �� �
Tax Map: Par el:�
Subdivision S v-2.
Phase/Section/Lot #
Water Supply: �i✓e��
Projected Daily Flow: 360 gallons/day
Type: � , 2
Type: ��
Authorized State Agent: � � Date:
(X) Owner or Legal Rep esentative: Date:
The issuance of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibility of
tl�e applicandproperty owner to insure that all Person County Planning and Zoning and Building Inspections requirements are met. This
fmprovement 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
nirrl Rules for SewaQe Treatment and Disposal 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 Construct Wastewater System
See site plan and additional attachments (�.
Proposed Wastewater System: ��PS v�// ,�umA (*)Type��6/ b• �2.Design Flow 3�OD gal./day
New %� Repair _ Expans�on _ � � �— Soil LT�R: `. 3 O gal./day/ftz
Type of Facility: 3�31e S• Basement: k Yes _ No
(*) System Types IIIb, Illbg, IV, and V, require periodic system inspections by the Person County Hea[th Depa�tment.
Wastewater System Requirements
Tank Size: Septic Tank ��d0 gal.
Drainfield: Total Area � 0�O sq. ft.
Trench Width 3 ft.
Distribution: Distribution Box / Serial Di
Specifications: � (�, �1'! a-a
Pump Tank � S 0 fl gal. Grease Trap gal.
��� -
Total Length Z�� ft. .A4�tx Trench Depth � � in.
Min.Soil Cover � in. Min.Trench Separation � ft.
ribution / Pressure Manifold i�
�.to S�r4�le�,re�
tr
0
Authorized State Agent: h� �"'�� Issue Date: �' � Q'' �`�
��/� n Permit Expiration Date:
��
The system permitted is: Conventional �/Accepted lternative / Innovative . I accept t e conditions
and specifications of this permit. ��� `/
(X) Owner or Legal Representative: Date:
Person County Environmental Health, 325 S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12)
WELL CONSTRUCTION RECORD
This form tan be uud for sv�le a multiple welis
i. Wdl Contractor Information: ��
�D�h.�.c— �� �..�1_'/�
Well Connactor Name
���6 i�
NC Wcll Contiacwr Catification Numba
Barnette Well Drilling, Inc.
co�y N�
2. Well Conshuction Permit il: // Z�" 2 0�t'
Lis! a!lappJicable well courrricrion permits (i.e. Cmmry, Sm�t, Vorionce, etc.J
3. R'dl Use (c6eck weli use):
❑Agriculdual ❑�M/unicipaVPubiic •
OGeothamal (EIeating/Coo(i�g Supply) QiCesidential WaterSupply (single)
QIndushiallCommercial QResidential Water SupP�Y ���)
NOo-WBfGrSUppIV Wtll:
QAquifer Recharge OG�oundwater R�ediatian
❑Aquifa' Storage and Rxov�y OSaliniry Bartier
❑AquifaTat �Stomtwatcr Drainage
��erimental Technology �Subsidence Control
❑Geat4eimal (Clased L.00p) �Tracer
�Geothe�mal (fiea[ing/Cooling ILetum) ❑Othu (e�Iain undes #2I IiemarYs)
i n f�
4. Date R'ell(s) Completed: 3 � �l.�7'We11 ID# !! ' 7/T '- z0�
Sa Well Locatiun:
�.�� � ose Y"'%� �J2,�'s�Rve L��- 2`�
�—
FaciGty(�wner Name Facility ID# (if applicable)
:�P� b�c�� er!► X s���- 6�i� ,
Phyucal Address, City, and Zip
�i�Y 50 y1 �� 6
c� r . r�� ra�;s�tio4 N�. (pn�
d ' � il
Fa m�i uu oxcv:
I4. WATER ZONFS
FROM TO UF,SCR[PTIOIV
Z:�
� 2 D �`' /Z J r� • 2 2 9'�.- 2 1
(�S" /$8 « � �a / 2 �S �e ZSd ^ D �' 1
15: Oi1TER CASING for Imulli-�sed ndlt OR I,INER if n inble
FROM 1'O DC�INETFR TH(C7QYES5 MA L�L
O h /�3 r� �S. `°- fvR Zl G
f��
REEIV
TO
ft ft
(t ft
:OUT '
TQ
fL �.j �-1
GG.�
ft
k.
1+(DlGRAVEL P
ro
tc
ic
ft �a
ft ��- -
� ��
M1fA'CERIAL �... EI
ft �aRdent
�.e
fc
ft
�CIC �t' IieaWe '.
Mwreau[.
fc
rr.
t'� �o �t oc�e R
ic � R s' �2
ft Z� it �. �
f4 (t
ft f4
it ft
ft ft
Sb. latitude and Lond fadc �n degrces/nuuates/sesoods.or euma egrees. ���ficstiou:
(ifweU Sald. one lat/long is safficient)
j 6 � �o - z,.� N �Q ' 0 `�` -o� w ��r�-...�����- 3 /S -/�
�_� SigaaturaofCatttified Well f.ona�auor Daze
6. IS (g1'e) thc wtll(sj; C7Ytt'mantnt. ot ❑Temporary Qy si�r,v,g rh;S far„f, � hertby certrfy rhm ihe well(sJ wax (x•ere) construUed in accordance
witir fSA NGiC 02G.0100 w ISA NCAC OZC .OZ00 Well Consuxcdon Staadards tvid thrr( a
7. [s this a repsir to an existing:weU: OXts or f�� copyoftKfs reconihar beenpr+ortded ea rhe well nwner
!f �i+is ir a repatr, fi!/ orv brewn we(! aonsuverion ir�ormatiar qad:erplain tlre aature oflhe
rcpairnRde� �21 rcmarks section or on ihe. bcc$ oflhiSjomc i3. Jr1tG d'u�r9At 01' 9lddltioelal Wl11 dtttils:
You may asc the back of. this paoc to provide additional well. site ddaits or well
& Number of wells constructed: � cdnstrucfion dctaiLs. You may stSo aUach. additional pages: if necessary.
For multiple injection or non-waru supply we!!s ONLY with tlre samt eartSUnc(wet; you am
aubmironejorm. SUSMI71'ALINSTUCTIONS
9.Totalwe(Ideptfi belowl3ndsnrfaer. 2 v� (ft) 24a For All Wdl� Submii this.fiorm within 30 days of completion of well
FormtJtiplewe!/slista/Ideprhsrjd�erent(etmn�e-3Q200'andZQIW� c�stluctiontothCf011owitlg:
10. Static water level belove top of casing: 2� (ft� Division of Watcr Qn�lity, Information Processic�g Uuiy
IjHntet leve[ ts above casing, use "+ ^ 1617 Mail Serviee Centur, Raleig4,1�C 27699-1617
11. Borehole diameCer: v �n,) 246. For Iniection Wells: in addition to sending the foim to the address in 24a
,�% p above, also subtnit a copy of this form withia 30 days of cocnpletion of well
12 WeR construcfion metbod: �[�!"� b�/ !�� eanstruchon to the follotvin�
(�i.a auger. rofary, cabtq dirxt putt5 dc.) .
Division of Water Quality, Undergroand.Injcetion ControCProgram,
FOR WATER Si1PPLY FVELIS ONLY• 1636 Mail Service Center, Rale�h, NC 27699-1636
13�. Yidd (gpm) �CJ Method of tssk B�own20 minute 24c �or �Yater SuooW & Iniation �Yells: In addition to sending the fam to
the address(a) above; also submit one copy of this fomi within 30 days of
i3�. �c�r�tioe e��: HTH Amoun� '�%2 CiU�i compldion of wdl constcuction to the county healtfi dcpartment of the coucity
where coiistructad.
Fam GW-1
Nortfi Carntina DepaztmcatafEnvimnment and Natual Reso�coes-Division of WalaQuaGty
Rcviscd Jau. 2013
���, sf ���.� ��
�--�- � � ����
IE��nu-�������.Il IE3C��.11�]]�
WELL PERMIT
(New � Repair_ )
Tax Map: �� P el: 0�0 �O
Subdivision: ( � PS2r�
Applicant's Name: �� �C�S2
Mailing Address:
Phone Numbers:
Location of Propertv: 2i �� �� � C� r
Lot: �
�S �-a�iPs !Cn(� ''�
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 permit does not guarantee a potable water supply
Permit issued by:
Certificate of Completion
�Tew Well:
E S/Date
Location: .�'�Q—J �
Grouting: ��"L�i�l �j
Well Log:
Well Tag: ,�� 3-31-i�
Pump Tag:
Air Vent:
Hose Bib:
Casing Height:
Concrete Slab:
Well Driller: Yyb�
Pump Installer:
Approved by: TJ2'�ikc� a 5�+�,
Additional Comments:
Date: ��'�—� y
Ol.iner:
EHS/Date
Depth:
Grout:
DAbandonment:
Date:
Method/Materials:
License #:
License #:
Date: 3-3�-45
Date Sample Collected: 1(�`' �� Date Results Mailed: ��'�� S
EHS: �j
Person County Environmental Health
325 S. Morgan St.,Suite C
Roxboro, NC 27573
Phone:336-597-1790 Fax:336-597-7808
il/26/13
��.,`, ; , �f ���� ��
— � � ����
IE��a-��� ��.��.Il 1�33I � �.Il�I�n.
Applicant: �'aid ��
Location: E�E 'P..O =
�
��1��°a�10�1 �� flt
Taz Map �1 Parcel # �►b
Subdivision �'� ��c-�E.
Phase/Sectian/Lot # 2 '
# of Bedrooms 3
System Type (From Table Va): � 3�.. Product (IIIg): �'a'� Q�`�-
Type V& VI Expiration Date: �� Type V&,VI Renewal Date: �_
This system has heen installed in compliance with applicable North �arolina General Statutes, Rules for
Sewage Treatment and IDisp�sal, and all conditi�ns of the Impravement Pea�mit and Construction
Authorization.
� �^�����
(.Authorized Agent) (Date)
�'a.A�, �-�tS l[/-v�-5~ l S
(Licensed Coniractor) (Date)
� ��a
-r���cs a� s�c�..y ��a,E
� ��o �aa-���a
.�,Js�Fec�O 3-3�-1�
y��
��
�
�� �a"� �
�,�.��c�
�
Scale �S � EtQ
PCFiD, rev. 12/14/12 (,t}�p �c1�cl
� ►.a�x � �
Line Length
/ �'J �
Z /v� �
2ov'
Tax Map: �'� Parcel #: a4�
Septic Tank System Checklist (Type II-I�
Se tic Tank IniiiaUDa#e
State ID & Date; �-��- pqs �-3�-�
_�_�
Capacity: t'�S- ���
Tee and filter
Baffle
Vent
�Riser
Outlet boot
Perm. Mazker
DishibutiQn
D-box levels set)
Serial
Pressure Manifold
LPP
Notes:
System Type: �"�
Pump �ystem Checklist
Tank Components
Purnp modeL• �e ll�Pr- 1 �
Block (4")
Nylon retrie�al rope
Float ixee an� attacl_unents
On/Off float swing: in.
Alarm float (6" separat�on} �
Anti-siphon no�e
C�eck valve
Threaded ur.ion
Gate valv� �
Conciuit sealed
Outlet seale�
Approved a�d secured riser
Su I - Line (
Size and matzrial: `3 in. �{osch. ' � _
Length: �- Z ft.
/�'t RJo�-, �'�y /Z1 i� Y /��.
Contracted Certified Operator (Type IV Systems): < <
Notes: �Itlrm� �S G� dl0 ���-`�' S2Q �.
:i�-1�-��
�.�ww t,�� 5�E 3U' nC-G }�,�+1 �- �3' c%i' ��Z- �` su�'�r z�t�lG �—; �stltcs Ariff'
��t'?t-D t-p.�c., So�cG �Q� , t�� �� R�t� �r+�s�tc� a' rrtR�Y` '���1crr�`�. o� s s�
"'�v c'�t SWF,s G�r+�x'es r5�- Sv.'�t's�cs 'i1ActJVws � ti..�, W�+'t�'�v+�� ��Ow s�q "T�� -i�.
`�c���o
6��-T Cu�-wc� `R,�..Su�.-'�' :,a� i.�.. � S`_'Ps1� ��to�5 h'r� �T
���� +�S � w�."�t� S'�3t-� �� S�e `i�S ' .�, c�`�.,� .
�