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A25 201 (2)•.. , .t � � � - � a -1-aa � � " T�c Ma �#k � a ADOIIC3'b017• DafB' , .. �. � � • . � rQ � p' . ,�mourrtPaid: � . . � � � P�rcEi�� �� � ' ��E�pt�: � � � j� . . � � ��.�� �� . I�I�I�.����T . � � �- . - .��--���- �('� . . ���.m,,.,,,..,,�.,��.�� �rm,.��� . o 1.�.� �'7"_ - � APPLlCJtTiON FOR SEit1RIC�S • 1) PenNt requested by: (Ownerlagentlprospec�ive ownery: �A�v�4R✓3�.� aAyit] Home Phone: �� 9- �7 � Address: � L Fv g Business Phorte: Zo � z7 2' Name and address �f cament owner. �of �`�2T ��SAy GtJ�/1c�2 �//( 3 �'fa.� Go2 D -G �F"�O ,P4� /eOX�D�b�, /� �r �.%_�� 3) Properiy �escription: Lot size: Z��.sTownship: u�i A_Subdivision: Directions to th� pr�operty (Induding r+oad. names and numbers�: - C = �--.� i ��.,��,��i��n i-,/�.�=',7a�4r .6 t?/. S 4) � 6) Lot# % ? �?C�", �• Proposed Use an �ructure DesepipHon: answer eact� of the following questions: , -_ a) Proposed _, Existin9 _, TYPe of Struc�ure: �a�SE' Wdth: � Depth: .S o r _ b) Number of 8edroom� •.'� Number of oa�pants o� peopie fio be served: , • c) Basement Yes � No _ WiII there be plumbing in the basemenY? �?'c�'S , d) Garbage Disposat Yes J No � Waber Supp(y Type: Private _�new _ o� eads�rlg �, PubGcJ Cammunity � Spring _ . Are any wel� on adjoining property? Yes ��Na _ If yes, ptease indica�e appro�dmate loc�ion on the siie ptan. l.�o,�o'� —' � �C!x?oc�I Do� the pr+opsrty contain previousiy ddentifled jurisdictional w�lands? Yes _ No � �oc�TTo•� PLEASE NOTE TNE FOLLOWING: ' 9 A PlAT OF ilE PROPERTY OR S1TE PLAPI NUST BE SUBlI�1TiE�D Wi1'Es THIS �►PPLlCATtON: 9 PR�PERTY L1NES AND CORNERS MUST BE Cl.FARLY NAR�. ➢ THE PROPOS� LOCATiON OF ALL STRUCTURES NUST BE STAI� OR �LAGGED. • � T9�iiE SiTE MUST BE 9i�ADILY ACC�SSIBLE !FOR API E1/ALUATION BY THE HEd�LTi1 DEP!►RT�AE�iT STAFF. 1• hereby make a�plication to the Person County Heaith Departmerrt foc a siie evaivation far the an-site sewage dis�osal systern for the above-descn'bed properiy. I agres that the conte�ts of this aQplic�tion are true and represe�rt the maximum fiaa7i�es to be placed on the properiy. I understand ii the siie is a�e�d ar the intended use changes, the permit shalt became invalid. �7 � //% or Pc�o. �ev. �an7ro� —4 Duke IIniv. Federal Credit - . M rzrc 7a _ / � . � � tr� . . V �N • . � . . �3 �o�' o � N � .C~ JV 0 '-+ g p„ Z .. � u� a N d � � cs � ° °�,� 3� g ��a �`� . W �r tif � ~ � O � � � . � �� y 3� �a A s �, � � L �� � � � , n � £ �Z . 0 : � � � Z 3 C� �± � Q� . � ' V i Z W =N< Q W � . N � �d� .�r.i � N File No. ' ' _ W � � i Q^ . �. . � L� n � � �3 I �a , �� .s p � o . � N I ��i. Gi N � Y '� -." ` ` _ J `l� .. � �' � 3.SS,t5.L0 S tZtiSy�� ��I ` ��� N - a'f � � Br� � , �,� zsoe9 �'ft2• � "f rt � CL'18L P � �t'y� f9'LS► , � * W �� d �i e � r P� � ci W ° = p � c*� O Q Q � � +' n N p W o ` N r� � �,,� 0 $'� O. 2� z _. �t O � O �n�' � z N �-� N y CV ��,��� _, �- .. • �ea► - _^"".. s _ „�-•- - sc•+�o �,r+�.ca a ��� p�� 96�At o rtcz ' � o. L O� 1�C� . . �N � . �-� f ���.� �� �.� . , � � ���� •.���n�c^QD�n�na:�n.�.tn.� ����.�.��a Ta�x M�� � P�rc�el # i � Suhci'ivi.s�ion • 'Fh��s�e Sect�ion Lot � Applicant: �ano� Qen �q..V 1 d Location: 7 i�J P �a�1Ct�r'o� - C.zFFD K,aa.d Q.� /at bcSicl c '�l Fa VolurtEc�tr' Fi rc Ocoa rt�r, c.,1rt Permit Valid for '✓Five Years Type of Facility: 1 c aa # of Occupants c+. ,# of Bec Proposed Wastewater System: � Proposed Repair: L, P, �� ui aFf,cr (ni�a( SyS�cm ►n,SEa/ Permit Conditions: �lG+.� Sv�St S ldc 1 i nS� c� �.i,e �o Sb' arL (o�e�td t� a.c �fe Owner or Legal Represe ati e S Authorized State Agent: . Improvement Permit No Ezpiration � i l d W� Il i� New �Addition _ rooms 3 Projected Daily Flow 3(po tm Z' a-�i v c C�.S � 2cduc�h'an [cs .SuFFicici�e Spacc ,`s ct�a�la6(c �c�r Z� Water Supply i vai� W�(� g.p.d. Type: I1I�bi c��, Type: _� t� arld ���t d�-! !� Gu- ct Ftc-r' I�t iS C,ft� rr.� . Con�b"�c{�r z s nrsc t� d r`,�{,�,c.rb �h c- � i I� c t� SyS-eun (o a' p FIC' . ... . � _ � -- �_ . . . _ . • . . _ . �-t o- e � e i� hzScmcrtt plu � a(ar cr 4, �"��� - 9 _ Puvr�p W � u 6 c r-e�'d � Date: -- � - � Date: �,.0 -�l -p� The issuance of this permit by �e Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicandproperty owner to in sure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the slte plan, plat or the intended use changes. The Improvement Permit is not affected by a change in ownership of the property. This permit was isaued in compliance with the provisions of the North Carolina `Laws and Rules for Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). Authorization to Construct Wastewater System �Required for Building Permit) * See�siteplan and additional attachments (�. � C�v:Qi.�c�o�- � �- l 3-C� c� ���-� Propose Wastewater System: U rr10 Si'�r1av�-��V e- Type��i Wastewater Flow ��.p.d. New � Repair Expansion Soil LTAR: . daS g.p.d./ ft 2 Type of Facility: f i nq(� Fam r 1+� �W t,j (��n�i Basement _ Yes _ No Wastewater System Requirements Size: Septic Tank: �,�Op gal Pump Tank: � gal r e Trap: ���i gal E S�' Cs�u� �, u�s� 5 d t field: Total Area: �� sq ft Tots�l Length t Magimu ench Depth �S in zh Width 3 ft Minimum Soil �over: � in Minimum Trench Separation: -( ft Distribution: Distribution Box Serial Distribution � Pressure Manifold : �nc � r��, Authorized State Agent: _ Permit Expi c �4r'c.a�, 0 � I Cc�l e� t�+� i I l ha u c. Date: Lo 3p—O'1 Date: l.� � - c7� The type of system pemutted is Conve�t' nal Innovative Alternative. I accept the specifications of the peimit. � Owner/I.egal Representative: " r Date: - � � :, $� iCt�tE� �l�C FG! �eCLi1C3�. S�C2f].CaC�Q1S � � �� � � �� = rr� _ �i� _ ��� lIt = ��I = �►t = /�►11=t11-- 111 / ..,�' -• - .�. . > ' . Undergrua�d Cable In Cond�sit pith Se:ita6le Sealer In Boch Fs�ds Of Conduit �, _.�r � • � •• ■ •• �• - _; • . - �-� � � ■� - r •• ��� •• i� � . � - • • � •�c- . - -. .. _, . , .- _...� .. . m i or c�.i�u I urt �����° dc l�'�tr 'Ibt7bl+e � � Z.GO,kI�OnS/cy��c. � _" + � - Sc�bmersible � Effluent Asrp ��� 4'` �' Concrete Blodc : � �Sin91e � ' s��..i r_i■-• o : • - '� -a+ .•� � h - �r«• �c� _� • •..�� _� � • � r �i • •�r: �=i o � in*eh CsL�C � v � Iti = ��1 = �!� =. !tl = 1rt = ..._ I11 = 1�1 = 1�1 = !tl = 1�1 111 = l 11 = t t i = I[ 1 -�s�—�..._ .''` • • . . � :�= . . � �� � I � Q� -- Gallan T�Ic . • r��� . � �. , � � i „� �9uppip L.me 'f° -Ee ' �_! � . Di.amecer S�edute 40 PVC . a pi�s • _ ]LIl PI,I[p �� cnl- � .. a . ' csdCe iia.tVe 'Ih=eaded Unian • . Chedc�Valve 3/16" Syp� Hre�lces Fiole � . Ia�atxf Stra�s�Ara��tl Cts� ---�— � ALacm Float {el.evation) . "pu� on,� Float (elevation) ' ` "P�snp Of£' Floac (���°n� y' a r . �oe I lcr ( 90 � �Qu.i �a(e nt , � PUHP EtATING p��[�lust Be Rated To Deiiver GalLons Pet Hinute Against �,S Feet OE Tota Dynamic Head (TDH)• a a . � � � .' . .• . . a a � • • ' •n � � � � d•a ' ', - . a • d � . � � . • . � . , . '�17i.S T�1S.� S'�11. be af a St� � R�P �t �' � �1 s$Il i� rs�c � ar�ite . PUMP SYSTEM DETAIL SHEET See FolLowieg Sheet For AdditionaL Specifieatioas, Noces, And Explanatioas. � -1'Elcvc��on �I'S'Tan K zz' C3 x ���) =a�.3� �zat� ?j�.� 1 '�' Z� I�'1an � FaIA =3`�.$1 ' 35' -r��� '