Loading...
A24 490 . , e.Y� .��� . �,,� �� �� �� �� �� � � �� PERSON COUNTY ENVIRONMENTAL HEALTH PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT T� �p � Parcel i� /'1 � Zoning Township l'.lAV1 Yl �V1 Q��Q '� ApplkanC �1n d�%'Qiil% W \�YS _ LocaUon: �S l�� i�A ��/ c7Vlv Subdivision• �1 • �AylS Sedbn: � 1 � Tvpe of Water Suppiv: Reauirements: Well Permit �s .�ndividual Communiiy Public Site Approved by RS u o Grouting A roved y �� R� �y����- Well Log u q oo �� _ 1,�-�g tD upir- a �.qv'` Well Tag � �� ���A�''^ Air Vent � �( � 'I;�� n_,,-, Hose Bib _ � �' 3 ' � ��,��'r�'� - ° � �v 1�'"��,,�j , Concrete Slab �1+� 5-01.�1 � ?`m � � �"' � � c� Well Driller Weil Appro � �,,.,,.� �. � �o Date: �� � � � **See Attached Site Sketch** Wells must be 10 feet from property lines. � � n_ �^ G Wells must be 100 feet from septic systems. �0 �-�ro� �� Wells must be at least 25 feet from any building foundation. Other conditions: PCHD, rev. 11/29I99 PERSON COUNTY ENVIRONMENTAL HEALTH PLEASE SEE ATTACHED PLAN FOR WELL SITE tAYOUT , Tax Map #: Parcel � /1 � Zoning Townahlp l:�Ll V1 ir� � N���Q� ApQllcanC��l���%`e�,l% �\�iS Locatlon' �, �� ' S�t �� � L�v'f2 I�U • o rQ. �G125 t� � � . ► I�slco�l �a �er �s'� � �. (°Tc�e,�t. Z �v�N �t�1,�5'2 Subdhrlsion: �;1 . '�%VQlhS SeGlon: � 1 � Tvpe of Water Supp1Y: Reauirements: Site Approved by Grouting Approved by Well Log Wel! Tag � � Air Vent � Hose Bib Concrete Slab Well Driller: Well Approved By: . Well Permit Individuat Community � Public Date: � **See Attached Site Sketch*'` Welis must be 10 feet from property lines. /� � .�.�� G Welis must be 100 feet from septic systems. �(� �--�'o�`^ �. Wells must be at least 25 feet from any building foundat�on. Other conditions: PCHD, rev. 11/29/99 __ _ _._ �_ __ _ __ _. _ _._. _.__ _ _ ___ _ _ __ s AppUcation #: ,_ Tax Map �: Parr.�l �: • Person County Health Department Environmentat Health Section - SiTE SKETCH � � l�- av�� 5.�. 1�€�`r �g 1-�v�dV`etrtl "" � II �,P, � � - Ap ii s ame Subd'nrision/SectionlLot# . � ^ �,p l6 Qb Authorized ta e Agetrt Date System cornponer�ts represent approximute conmurs only. The contractor murt flag the system �rior to beQinnin� the installation to insure that proper grade is maintained jLe�.� ' t�J tll 5 �� ��� -�r„ �ro�2�� �w.er a�,,,.o� � o � �vw �ep� � oE,v�e.a_ � G�I S�� 1�'�G�I�e�l r I,, � \�......�� iFJ'1�,Q -�� �r . J � �►- �`�a.� I�oa.d� . , Scale: /11'f � T� .�r�le ___ ..�o�,s� � PCHD, rev.1 Q112199 Person County Heaith Department Sewage System improvements Permit Date: � Thi Permit Void Af er 5 Years � 3,�� OWne* tr � (a ,) G'� i '� � �' � R# _ Location/Directions: -+' �►.in I s f n A f�IP i'� �� _ ` . ,F Subdivision Name: � � �� � � -� f Lot #.�_�— , �, . .., � ; Lot Size: � ' �' • 'I'yPe of Dwelling: .�\ Y '���, ,," a., ` Water Supply: Private: �--�,'l Public: Communit 1 � B�.�ms; Garbage Disposal , , � Basement __--=���.BasementFixtures " `,.�! •� �°.u�-�� �+�� INFORMA iv R BY ._ _ P.. . r, '� ' � � �nei or tes� tve $fli11t2I1f111: • � : � . /' �pp�; • • - REEVALUATION: — — — — — — ° f , �: °� �� ize of Pu Tank: � ' ��. Size of Septic Tank: f;' �gajlortsJ S� �p ,, -. � � A Nitriiication Line: � � : �� ,( .C::� � �^ � : ,�.1,,,..([�: !. Depth of Stone: 12 inches .�� S�' ��}� n� Max Depth of Trenches: , •� pltemative System: Conv. Pump _�''�— LPP �mP c� ((►;� Remazks: � Date Well Approved: Well should be 100 f� from any sewer system BY Sanitarian _ cl o Date S�w e S te roved: — gy Sanitarian . .RTIFT ATE OF COMPLETION , Contractor. _ � -------------------- � Sewage System location, installation, and protection must meet state and local ''� regulations. Septic tank should be pumped out every 3 to 5 yeazs and shall be maintained � by owner in such manner as not to creaze a public health hazard. Septic tanlc and � nitrif'ication line must be inspected and approved by a member of the Person Counry Health Department before any portion of the installation is covered and put into use. If the site plans or intended use change this pennit is subject to revocation. (G.S. 130 A-335F) •. L.ocation of sewage disposal sewage system sketched on back. (OVER) 0 , , :�j % (-�" � ._�: � ��i•:i,:;ur�, c��ii,�ri•�� i:Nvi.�cuNr,::N'i�i�i. ����n�,�'t� , lJlil.l. I.Ut� Da te: _� �-.� �.� Ownei: � __..�S1�.fh � ►�. . I.ocation%Dircctiol�s: _�-�t- C�- v. �,,,� �s f� t�s- _.._----- SR#� .. .. . . . ......_--- ----- ��.1�:' � visio,�� Nan-,�:---. ...-D T Cd�-� s ' Dril]ir� ConCr _ _ . . --.----- o[ � accor: — ...... L . v . .�. .. ..... .... ..----._____ # ._ . ..�t-- s.... l•c.).�._/1.....,d r,_1_l.:_�.__ �... �� -- Dista��cc .from Nc�u-cst � 1'� l:: l . t .(::'(7N�_1:t� t1CC1_'I( TN'�.----�- 1 l�o���r�y t_.;,i�:....�S.�i�u-� lli:,c;l►-icu Pollution /.o a ---- lro,n Source of ' Total_Dep.th:--���-- Ft. . �'icicl: __ /�._.. ___ C�a'M .Static Waterl,evel Water $e ' - aring .Cones: Uc �1i . Casin . .. � . . �: ;Deptli: From A�_L�._ _.d..... �'�• -��.__�'i.�_ I�t. �t. .•F TYPE: Stcel , `.�c'_`... .� �.f- I��. lli.11l]CI(:I'; 6� G;�lv;in ,�;c1 S[ccl � Inches Z.f Stccl, docs �..—.._.. _.__�... . . owncr a����rov�;: �'c:; Nc� � �Cl�.�l[�.�` '.�'111C�JICSJ. � ' ' Drive Shoc: .� -,1��.�Zc'ght�A(�ovc Ground. y � ' Xcs ____ Na .:.�_.Znche's � Werc Problcros ��,countcrc:c! iri ,�c:�tint; �Iic C:11lJ1!'? Xcs . „ •. ---`_ �: .,ycs �;ive; rc.is�ii: .� —.—_-___ No Grout: `�ypc: Ncat --�---._.__._._...__.... _.__._._------- ��� .�:lI1C��C,'C:IIICII[ � '':"•. Aiulular: Spacc Wi�ltl� .�.. — .. --_.Coricrete • . . �•�:; Watcr in A,nntil �--`-; . - __.._I�iclic1 .;% ar Sp:�cc: 1 ��:: Mct�iod: I'tu�i�x;c���__ , - .. . .�.__._. fV� �-- _ � Dc; ..... ._ ._ 1 rc:;::ur�:.__._... � ._._l�,c,urccl �-- .. , pc}i: From ._.�. . ��, '-_. __.—_ . .. � . :.,• Matei-ials Uscd: _. _. . `��----I�1• . • ' No. .�3aLs ,�'c�ttl:uid Cc�ncnt_ . Zf mi::ture sznd � , • —... . � Wci�;ht o.f .l � ba ' ti: ID �'l:itc i , r;i� c:l, cut.�ii��;ti) - lZatio:�__ t ..�_ ��:.,,1 bs y s: Ycs l/ ` o �... � -- ----- N��- . . . .. • . � x �� ::lab X��----�._ Nc� - ..._ . . : � . ... _.. .__... .._ . �------. I)l� I 1.I .l NC� 1.(X; _.. __...___ ._.__.. . ._ . _ D- �L l . _.__..._.__._ _.. From � "�.'o - ----.---- - _... _.... ....__--._..._...---__ ---------- -------- ._... lA��r,-nat;on llcacr� t n �_ � .. _ , io , -, ---�.�.�.y � ; �__ .-- __ _...._i�_r�.,� n ---�--�. �rv�,.i ..,` . � -o—_. __L.z:r�t /. . ..�.;�� f� Z HEREBX CERT�ira' T'f-I�1'�..1.1��L ��13t)V1; T�S WELL W!1S CONS'1'1� UC"1'k;l) [� ,�C:C;pU llM�1'l'10N !S CO.RRECT AND �'�RT�-I �X•T�-I;; P�IZSOTI (':nU.N'1'1' I�11:AT..TI-I p : A.NCL W�TI-I REGULAT'�Or .. .. LPAI:TM,�N-1-. . ... - - `�`-�_ =_ 1�.1_.� 4�� ,Si1;rt:�lurc c�f C.�on��.��:t�,r ;`; �:� �:�� . :� :�:; . •. ~�3 :.:i :`' - . ���: Datc