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A24 72
�1/2007 11:3a 3365977808 PERSON COUNTY ENVIRO PAGE 01 � 0• '�tion 0 te• 3' � � % � �O ,Q� Ma • fT�`f � Amc Id: ' 1 � �.. a.� � R�$�� �� P_arcel #: �� ��� •—� � '--,�-��. S�^ ���� �� ���`.�'� C�-�� 3 �f --, _ � ' � --- c � v��°��' .-�,r- (�� � ��-•�.�.o�.�,.�:�¢�.n zF-a�.�.n� �l.C�" �i � -��'�� APP_LICATION FOR SERI/ICES �, .. .....:....... ������ � 0 Improvements P9m�R- 5750.00 (AAobNe Home RaplaosmarMlAdditlon) ��3 consavclwn Autl�rtsatlon Ta SepUc 3ystems- � 150.001320U.00 PennR itevislon Fee - 575.00 _ �. IF THE INF013MATlON IN TH� APPL1CATiON �OR AN IMPR�VEMENT PERMIT IS INCORRECT. FAL8IFIED cHANG�o. OR THE SIT� IS AL��REQ, THEN THE IMPRON�MENT AERMII' AND AUTWORIZATION 70 CON3TR SHALL BECOM� INVALID. . 1) Pennit requ�st�d by: er e spective owne�: lJ �� ``d �� �/l"�T Home Phone: - � � �0� Address; � �.• Buslness Phone: -' �� r-�. . _ . � _ 2) Name and address of current 3) Pmperty Desc�ipdon: Lot size: Olr�tfons to the prop�t (I�clud • $ l . �Tovunsh�P! �g road nam�s �d I t,d,ci" 7)in C� / � � � � � � �.� � • �. � ti� � 4) Proposed Use aryd Shucture Dascriptlo�: answer each f the follc�ing uestlons: a) Proposed ✓ Existing Type of Sfn,cture: �'i� 1�, }}- ���Width: �� Depth: � b) Number of 8edrooms: ,�.�� Numb� of accupants or people to be served: �, � c) Basement: Yes^, No ,�,�Will tFle�e be p�umbing in the basement7�� � d) 6arbage Disposal: Yes ��, No ✓ S) Water 9upply. Type: Priwate �' (new �r e�cisttn �� ubiic� Communily`, Spring _ ' Are any wells on adjolning roperty? Yes�✓No _ If yes, please indicate approximate location on the 'site plan. � 1�1.��.•, n i_ ,��.6W�- �1'1 r► �r WT � .Q-Q-� 6y Does your pmperty contaln previously Identtfiad u�ladlctPonal wetlands? Yes No� , j � — PLEASE N4'TE THE FOLI,OWING: D A PLAT OF THE PROP�RTY OR SITE PI.AN MUST BE SUBMITTED WITH TH1S APPLICATION. . D PROP�I'tTY LINE8 AND CORNER3 AAUST BE CLEARLY MARK�D.. , � THB�PROP09ED 60CATION Of ALL STRUCTURES MUST BE 3TAKED OR FLAGGED. D THE SITE MUST 9E READILY ACCE3$IBLE FOR AN EVALUATION BY TH@ HEALTH DEPARTMENT STA�F: � I hereby make applicatlon to the Person County Health Deparlment for a site evaluation for the on-site sewage dispasal system for the above-described property. I agree that the contents of thts applicatlon are irue and represent the maximum facllities to be placed on the pr rty. l understand if the site is altered or the intended use changes, the permlt shall become invalid. �� , r ��� " I l.i. 3 V e or Legal Representative � Da PCHu, ��. os+z�roz � , . � �� � � �� b.J �� : s . � � �. �� o � ��� � � ���� ��-�.��� � ���.�.11 IL�L�.�.11�1�. . Applicant: �Z«� RAi�7�?� T�x Ma,� � � �rcel » / SUIbf{�IVISIOfI ,l Phas�e Sect,ian.'Lot � —�i . ][anpravement.�ernrit P�r�t �alid for �+ive �e� IYo �iration / , Type of Facility: +e 5� � New Additian � Water Suppdy � e l � # of Occupants •�_ # of Besirooms �_�; Proje �� "d Daily Flow 3 t� a g.p.d. Proposed Wastewa System: (= Z r � Type: � � Proposed Repair: � . 'Ij�Pe. , � ,/ Pezmi.t Conditions: .•'+ � r�i¢s3trn S+P.-1���� � �S � _ - . Owner or Legal lteprese Authorized State Agent: Date• 3 /3 d,� The issuance of tlYis permit by the Healti� Departmeut in does nat guar�tee ti�e issuanca of other permits. It is the �esponsi3ility of the . aPpli�proPertY owner to in sure that all Person Coimiy Planniag and Zoniag and Bui�lding Inspections req�ements are met. This Tmprovement Permii is snbjesf to revocation if the site plan; �pla#''oi� the intended use changes. The Improvement Permit is not a�ected by a change in owner"ship of the pruperty. T7iis permit was issued in compliance with the provisions of the North Carolina, .. 'Laws and Rules for Sewac,�e Treatrne�t and Disnosal Svstems' (�5A NCAC 18A .1900). Neither Person �onnty�:mor`�t}ie.`'� � Environmental Health Specialist warrants that the septic tank �ystem w�7i cantinue to fnnction satisfactorily in the futare or�t�t. the-water snpply w�71 remain potable. • • • Anthorization to Constrnct Wastewater System (Required fur Bnilding Permit) - * Ses site plan and additional attachments (_). . j ;� � -• � � , �2.�(C41 c<�lta�►tGt� I � ProposecjiVfTastewater System: ; � "I��pe � Wastewater Flow ��.p.d. - New ✓ Repair Exp _ � .� Soil LT ."�S g.p.dJ ft 2 Type of Facility: ..P�p . Si'�P v�GP- ' � Basement _ Yes No � �'�Vastewate�c Systein k�eq�rements � . � � 'Tank Si�e: Septic Tan.k:� �G�� gal Pnmp Tank: �DE,� gal Grease Trap:�----gai - . Dr.�infeld: Total Area: �Q,,� sq ft Total Length 3�o ft ' 1Vla�innm Trench Dept9� � 2 in � � � . d, C, �renci� Width -� ft 1VYinnnum Soi.l Cover. � in � Trench Sep�ration: � ft IDistYibution: iDistri'bution �oz Serial DisiYibnlion ��� Pressnre Manifold . Specifications• l'����%�,� S f'i�c�G�S � � � _ -= -_ . �uthorized St�ate AgenL• S Date- � —%3— O� 7 Permit Expiration 13ate: — —/ Z The type of systesn perinittes3 is Conventional Acc d w� Al�ternative. I acc�t the speci_ficatians of the P�- i�aes�/�,agal �apa��s�utative: Date: 7 Zo 0 ' PC� rev. l l/10/O5.- ,� .. . .. . � 0 vF �ip ..nA�?Y.. �v.?'^^i'� �... r. � . . ... . ' :� h t.••.r�, •' 'r• r .�t�� . } ±:�,...,'.' "Sr•. t +4. ��y•w�:��'t•j;• � �:�������;++:r •Y .. v�c," •.;... t:�.• •...�. ...� ••, • . .. ny.,M..... 4 i' n .;• :; . .., ...^?' :..ci;,'.'J:........t...�� k` c t. ' • 24' 4:h'^cY�:`.'•',�`..:;�^.`i"�si::`�; Z�f�::�'.�.�'� . . �'.y.a�,�:'�.?�':,-:.�".,.�,�:,�a.u,p,�z�,�,�,�:�1;,:�;�C.,�.;�.�;.�;. �'1'LLL �•��■L1YYli . , �J�Y:�t9�lt! ��A� 1i1 l�� .C�-�talY Y�VB� YYL� n'o ,�1��:7.�,.ti�l.J1 Tax Map _� Parcel # � � „ Tb�vnehip: � Subdivieion: _� t s Q � � Location: � �, ......_.::.-� . ; � j � ;� � . T� of �Vat�� Su �; t� Iudividual Yp PP Y _ . . . . I�eqnirements: � Lot # Commwuty Pubhc Sita Approved By: SS �eT; . � ' �Grouting Approved BY� ' - � o � ' 'installed by: ' Well Log. . ' Depth eat: Pump Tag: � � Grouted: � Well Tag: ' ' Date: Air Vent: � ` . . Aose Bib: � • Wate� Sample: . Caeing FIeigh� . Concrete S1ab: � � : �: ` � ' : Well Driller: 1� carn c?�-f�e. . �. Well Approved by: . Date:, *�**51ee.At#ached Site Sketc�***� Wells muet be 10 feet from prape�iy lines. Wells must be 100 feet from s�ptic systems. �Tells must ba at least 2S feet �from any buiiding foundatian. Other conditions: � � PCZ3D rev 01.�2710�� � .. . c�am���. 3<<�/ � - : � G'� -%a+ y�e {� i,� � � l � . 0� f��l _ � I - 7 _ v-7_ ., � . r craut I.og - �wner: .�n v� lJ�� s°" " Tax M,a� ���/ Parcel #'7 Z Locatian: � _ Subdivisi�: �--.-----_ _ � - Lot # �--- - WeII Constntdion Disiance From nearest Prbperly Line (].1�'inimum 10 fcet) % c � t Distance fi�am Septic Sysbran (11Tminum� 60 feet) (� e7 Tota! Dept�: 2 0 o ft Yeld ��, GPM - Static Water I.eveL- $ Water Bearing Zflne� Depth� J_$ L 2�ft ft $ Depffi: From . c� to ,� � tk Diam�et�er_ �/`� in � 1`yp� Galvani�ed Steel � w�� ����: �� $�� �o� c�,ma: 1. � m- � ` Drive Shoe: %—Ye_s No Any problems encotmte� wh�1e s�tmg casingi Yes ✓ No If "yes" give reason: _ � (�oat: / � � . - - Nea� SandlC�t ✓ Concrete GrraveUC.ement - '• Aimulaz' Space Wi�h ' inches Water m Aimular Spac� Yes � No Mei�+od of Ga+� Pum�ed. Pres.sure � Pwued ,/ Depth r�_ to � Ft Matp.�:aic jjg�: - . No. Bags Pordand cem�t " Weight o� 1 Bag Poimds . If mn�rc (sand, gravel, c�s) — Ratio bo - ID P]ates�.,� Yes _, No 4 a 4 slab �Yes No Liaer. - . — — - .... �Pt�: Date instaIled: Grou� InstaIIed by: — Drilliag Log Location Drawin� F�om To Rorma�uon ` � : • . 3 a( e/ • ` P,k. y � . - � � � ✓a /( �V�' , - _ � S . ��� C�y ��1C a�IOP�' I[�U� 1S COACC� 8� �18t �I1S tiYCu �fla.S � tII � W1�1 I� SP.� fOi� by the Person CountyHeatBiDe�art �--. / , _ . �tare of C.oa�tc.�or ID#� Y(� Daie � �' 7�� . .� . - Psiup In�meat Pump Installation Contractor: r� ,�� C/U� i� State R,e�ration Number. � �� � h o $ sc�� w� r��: ��— $ 'ttmp Make & ModeL• _ �_� ea �._�e �'� Pump Size and Ratin�- ���P �1L 8P� !�Y �Y �� p�P was mstalled a�d ti�e well head com�►leLed ac�ding �n fhe Persan Camty Well Rnles in effe�t xi t�is date and ffiat a copy of ti�is record has p�+ovided t�e well owner. . � � � - . �-- . ��� D� .1 _ � -�Jr P� �v ovz�ro4 ���� J � � 1.iCS � C� �.J' �T � — � b J / � � � ���� ��a�a-�-�-++ ,:-n-n-��.��s.�. ���.�..��a I �x M� � � �rc � Subdlivi ion �� • ' Ph.ase Sect.ionr of # �# of Bedrooms Applicant: �r�2P�o,i1 � _ . � � Locafion: l�il ,; , r. �, Q , r � �❑ . ,� �. ' ' , _� �., .- .� System Type (In Accordance Wi�h Table Va): b�J THtS SYSTE3UI H.�S BEEA! INSTAiL�D IN COt�IPL1ANC� lnlli'H ,a►PPLICABLE . NORTH CAROLINA GEi�E#�,L STATUTES, �RU�ES FOR SEUItAGE TR�A7ME3VT AND DISPOSAL, Af�D • ALL COI�lD[T10NS OF � T}-iE lli�PR�VEiVIE1VT P�RIVfIT AND CONSTRUCTION AUTHORlZAZ10N. - � Authoriz� State Agerrt Date l nstalled. By: �J `�~S Date: � f� t,�l ( � � R� . �S'c� �. D,�-t pin �� �, ! � � �, s,?,� 0 ' �(� {� �` � . � ��u 70� ?�6�r J1Sf . � , �� �-�-- MA�,,��; q , o l� « - Z��„ g�� � r ° �/o'' n�o � P � rz �u�, R ' "' 7�►,-P^2 a� � _ � . � � ,�y .. ��� � t � � .�� . ��� �z �.. s► �f � �� p�� 36t� P�� PCHD, re�. 0 i /29/Q1 ���"�C �'��K �Rl����'�30� ��lE��..lS � ��Pe 9� � � Tax n/la� #�� Parce! #� Sysi�esn Type (Tabie Va} Ovve�erlA�piicant Subdivision Address/LQcation Ser,lPhase Lot # � State�(D/daie � Capacity �p� Tee and Filter Baffle Sealant Riser (ifi apQlicable; T'ank Ot�tlef Seaf Permanerrt iVlarker t/' Waterproof /Sealant Riser Checic Valve/Gate Vafve � Antt-s�p on �o e F�oats/Switches �41arm visable and audible Electrical Com onents � Rate m .. A roved Pum ii�odel � Blocic Unde� Pum - Pum Removal �Ro elC�ai . �•Dis�ra�a.tfiaon:Sy��� � Serial Distribution Pressure an o Low Pressure Pi e A r. Pi e ll�iateriai and Gr , ,-.--_- .. Trenct� UVidih� ��� ft- Trench Depth 12- in. Trenci� Length '�6a ft. Trenciz Grade � Trenct� Spacing Rocic Depfih and Qualiiy Dams/Stepdown� etc. Pressure Leterais � Slesve Requered' Seib��� �rom- Welis From Propertv lines Surface Waters Pubiic V�later Suppi Verticai Cuts (>2 ft Water Lines VeFiicle�Traffic � Easemeni�s/Righf of V' Othee' Easements Re�orded � Co�ae�ten� . . . � � — � i i pc�d rev. 3(13/Q1 � �����.sf ���.� �� �-.. �" �'�'1� � � � � � � ��� I�na-s�-a.�-�„-„ ,�-,Y,. ��rn�rn.71 IL��.ffi.71�7�. NEMA 4X Simplex Contml Panel . � � �� 4" X 4" Pru�uza Treated Po�t j � . Sloped To Shed Water 12' Sep�ration Electrieal Corduit — :I . , •. .r . • ' •' . .� 6° Cowr • ' � Accei� Carer• • , ' : ; � •1 . ; • r � 1 � ' • i. .� � � � . . � � a l 7 �i , . �' � I ' e Fillea With � i,• �P �►C • Anti Siphon Hola' \ InLt From Saptic Tank Foztlax�d Cament Gmut �� g� d" SCH 40 PVC Pipa � � � Check T;��x M��i,�� P�►rc•c�.l # S�i�,►ael��ivis;oia Pla��sr� S�tct�i�i� Lr�t # Duct Saal Hoth End� Of Tha Co�duit . 24" Minina�m —i r..,.-, ... Threided G�te Valme Zip Cv TiPa Concrete Rissr 6" S.puation . . ' ;� ;,d',�/,�.~-- ;�,r;,_..--Poxtland Concreta Grout � �� �ift1C • ' : :� � . •'�. � . . � Opaning Fillad Witk Supply ' � portland Coment Grout � Lin.o � • ' . Outkt To D'utnbntion 2". SCH40PVC Pipa � • Valw , �Pa ' Float Wite� .` � • High Water Alarrn Lov�l ' " ' " (6" Separation� • r . •. �;,.., HiLh L�wl- Pssmp On •, i•. ' • � . % � u �Vapor Lock F1oab : .. ' '• Hola ♦ • . . . � Drav,down U H�11 ltemovabk '.•' � .� � P )• �Float Tra� � . Law Lavel -Purnp Ofi' �_, • . . Pump ,.• ti : . � � ' 4" Coxczete ' �' ' ' P:ecut Concrnt� Taa]c ,� ' •�;.; Matezial Stre h a3500 P Ebck ' I " � ,�, .. , . , . . _ '.' ' '` . • `-ti • • i .4: , , . . . , , . � � � � . � � �1a�� ��ort� T� . ;:.. , �� u -� � 3a ��� C �� ` � lt � ���, s f� I�I�I�..� �� y- �_ \1.� � 0.../' .l 7 � � JGnn-vnn�•ca�en�txn��ra�E.en.11 ]HL�x,,.11�El�. Owner: Tak Map: � � Parcel #: 7 2 Date: Line Tap Tap (Sch) Tap Flow Line Length Flow / foot # Diameter(in) ( m) (ft) 1 � i. ` � rp 2 3 . . 4 5 6 7 8 � 9 10 3 (st0 ft of line x 65 al. per 100 ft= ;' l00 =�� gal 75% x gal =� gal per dose 7if� gal per minute (gpm) = Flow Rate Friction H d - �� Loss: ��ft per 100 ft o supply line x�" Z�� ft of supply line = 100 = ft ft x 1.2 =� ft of friction head . 1VIanifold Size: �_" Force Main Size: 2" PVC Total D ynamic Head =�ft of Elevation head +�- ft of Pressure head +�ft of Friction Head = Z� TDH Pump Requirement: �� GPM @ ZLZ ft of Head. Drawdown: gal per dose ,—` 2l gal per inch = � inch drawdown per dose �i• (�iJ� � � n:9i� � ■ ti � �\ '���_�� • � : _ ..'•''� � � � � m �«�������� -�-�-.. <.-„-o-<.-�: �-�-o-o-..-e-�-�-�-�-o-�-�-�-<: �-�-�-�-�-�-�-. 1�I 1�1 (�) 1�1 ����������������*�����s�������� ..... .... .. .. ��.�a�.���.�����������.i��������.�.�.� ! � � � ' : � _ : :� � :� : : �: r�� �aim� 2" adn Sc]tedule 40 PVC � 3" 4" 6n Size / � Taps No. Taps off one side v %i for tanpin� both ; 4 Z _ g g 3 16 9 `' 40+ 22 ]Z .. . ' Flow er T� -- Sue �llnterial Flow GP�� ;c " Sd�ed 80 5.5 � ;. " Sched 4U i.l 3/, '. Sclred 80 1 Q.1 ?, '• Sched AO 1 i. ? :; ; ! .�.��� � ���� �� ' ' 'l.� � �l.J l�`1 1L � ]�mm.-.��-d,,,.,.�.,,�m.�.g ]E�L��.11� ,n� �►� � ,r■1. � . ! �• � r: �, � i �•■ -. v � .-� � Tag Map # A��{ . Pa:�ce1 # 7Z SCCt101]�LO� � �.-7i -� 7 ' • Date . System cvmpo�rents s�epr�srent a�iproximate�cont�oun only: The coniractor m�stflug the rystem�rior to beginnisg the installation to i�sure thatpm�bergmds rs mai�tai�ed _ _ _ �,�__ _ _ _ c�= � r� i � � � o r r ! `'' 1--+ r-' �IN Y� N �N � O� � ,�'(� a� � j �f�i � � �-, a � � ��� w z� 32 � �!� � �� 22\ \ yf � �C ~ o w Nr �- L r t-h �� S s-�,� --3�.0 �a. �3 b�. g�P ,� 3 �b � � ���-�� � Pu`n1' �-- l2" -�ev��I� lo��o�-s .� s. w og , � � �` S4, rss9 �,F o �� Z� � ` `� � O O �b O � - ���� � � � v,A l �, � - �0 o��� � z ' � � ��� g�� a�d��o►�al. � er s Sf�w� S'o i ( Cb�e� °� � 2 � o� . o �ti 2 rn� ti� V y .� � Z y � �� � r � .�----_' _ 1 ����: j���3o / t , � o ��� � •! � 91�1 2!S Ol � / �,, . . b �' ` , , � ; �, �s , - - fD'- - 3��L0�9So�blS Z J W 0 .P � O N nl N N � c0 �A � O —i D r - -fDr _ � � �; w 0 cii � �