Loading...
A26 172���,s� ���.��� � "�^ � � � � � Jl I���.a-��,.-�-n ��¢�.7L IF—IL�.�.IL�I� Applicant: Location: T��x M�a��� i ��= Pau�ce-I # S�u�hcilivi�s�ioi�i �I � -� t.r _ Ffa.�•se Sectioii Lot # � Improvement Permit Permit Valid for ✓ ive Years No Ezpiration Type of Facility: t1�C New ✓ Addition Water Supply �_ # of Occupants # of Bedrooms _? Projected Daily Flow �� g.p.d. Proposed Wastewater System: ^//�- �/�n�iL[ Proposed Repair: �,�i1!h1�G Permit Conditions: Owner or Lega1 Representa.tive Authorized State A� �*^,,.�� r ../'�V Type: � c� Type: _ _ Date: z The issuance of this permit by the Health Depaziment �does not guarantee the issuance of other permits. It is the responsibiliiy of the applicant/property 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 site plan, plat or the intended use changes. The Improvement Permit 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 and Rule�or Sewage Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. Authorization to Construct Wastewater System �Required for Building Permit) * See site plan and additional attachments� (_). Proposed astewater System: ����/��04�Zt��II'�. New � Repair E ansion Type of Facility: �r,� Type i� Wastewater Flow �O g.p.d. Soil LTAR: •� g.p.d./ ft 2 Basement _ Yes _ No Wastewater System Requirements Tank Size: Septic Tank: �� gal Pump Tank: gal Grease Trap: gal Drainfield: Total Area: Zp� sq ft Total Length _�'�� ft Mazimum Trench Depth /'�' in Trench Width � ft Minimum Soil Cover: � in Minimum Trench Separation: _� ft IDistribution: � Specifications: �C Distribution Box Serial Distribution Pressure Manifold I/ . _ _ !i. i � �A� % Authorized State Agent: Permit Exp: Date: /� b The type of system permitted is onventional vative Alternative. I accept the specifications of the permit. � 2 � �3-a� Owner/Legal Representative: .�ti Date: PCHD7/30/2002 .L,.��y )� �� ���� `L.J�.i � . . �'" � ,." . � � ��� �" mm�aa-m,-* ,..,.,� �aa�.ffi.11 � 3i�a.Il�a � � � Si'I'E. ��.']CCI-�: N�ame �i/�y o� 1/oi� Tax lYla.p #�Zl� Parcel #/ 7Z Subdivision !L • Section/Lo�„t# q . // - Z/' O 3► Autho:rize State t � Date ���5�p /�7/D]. °� sy�, ��o� ��s�t �pro�� �contours only. The contractor must, flag the system prior to lreginning the ixistadlatron to i�rsrsre that,{ir+vpergrade is maintained': .. y, t� ...y � .. .... � � •,' • . � � `� • \� �� , � . .� 8�z��a M �lv� qPD/• 3' c.T'4-2-. v /�� � Z . !'bQ G,�/ �T G� !,✓i✓f� G / oQo�� �G�oN✓�✓n � /i✓�✓o ��i✓� �'�2 . ���Gh� ��til� /$, � ��l/ � ,�,�� (�v�,r�a�/5 Con/�`� d��r�'� y��• . �. . -�"� 7' / �q0 �i_ � � Scale� � / � tV �'�J t-•� �� �� c;� 4.("') C''�t �-- � r�. �} � ! �� . � �. � /� c� �� �l��- , `�' �--'`�... ��� ! �',,,.., — � � � � � -' ��„f„�� r-�.. j t�.� " r-� � �, ��. , �`::a � � r� � ' � A ,�,. � � �` ) � V Y� � � . .` � �� � . �� �� � I �� �. P-�., i � � /(,//Pi Cn ��- ' �p� � -}" b-F��' , , � IOoo�- � g�{�'�c io' T�*� � , ,� ,'`�, c�� ,,,. ���,. � � �� ���,,� � � � , ` � .��'� �� � � �, ,,� 2 C3 ,, `°, �. � � �b, ��NV�`��'�� � (...� �'`. , `,•, � ��\ C'1 �•4�� �\ ��, \ _ . , �T � '� � fi� �. 5 '� � '��, �. ? .a . r---- � Y-�1 - ° ���.,�- �� Q.� ��..� �� � � � �a {. , � 3:��, �-, � � � �, ,� �� ��� , t � . � � `�� �: �� �. �5f � � ,� i - [.� � - ,.� . '> �� (�0 ` �4.. �� ' ��. � ,� ��� �� �. r �' � � � \ '`� / _... � � '� .� . .. " /� PGHD, iev. 09/12/Ol �.._....,��.�.- �� � . � r • ; � �.,� . � . r1: � ;7 '�.,., ff.` . Y `�..,.�� 1 � � r� �. � �) � � i �J ._�.�1� ,�-a� � T� r�v �' ��. �J �.J� �l V 1 ��T I��.-�..�-�o�.-�-TM-n ���.�. I�-3C��.�� . . � � ' A{�p�lc'dt7t L�n�„lood Lncaiion-�--� � /� i� �...Jn —fnn � � . � � �}x M � arc Su:ar�liv�isicn ,� . i � .�15-'? �7.��^i I 6] 10 O � rT O•r �'•�1'l7:(l; � i 5 a � . �r��� � �� 1°� . . : . . � , Syst�m Typ� {In �nrdanc� W�h Ta�l� ita�: � . THIS SYS'TEi9A �S �E�d IAiST.Al.i.�ii � INI CL3�ilE'LI�iR1G� V�IiH ��4..1�.��..E N��Tt-t .. �AR�d:,19�► G€�.AL 5i�'iUTES, Rl�L�5 ��3E� S��,rG� TR�T�EiV'F �L� D1�PbS�1L.; . AAiD Aa:.L ��lkl�3iTl�i�s • C�F `�'f1�9E i�A���3i1f��' P�I� Al►�� Ct3Pd5'�RUcilaN � �UT4�C0 �. . � � . � � . �r Z�,d 7 . � o�d St� Ag�rrt � • . Da#e ' tnstall�i 6y: � • �.�,��co- _ � ' D�• �7 - 2�l - 07 ' � �'�r �, � . `� o � ��' T � . v� : � 0 t ��'..�� �.�t�� �����'�� ����� � � ] �� �� . T� NI�p � ,�� Pa�� # � 2- � � Sys�m Typ� (table ��) Jlct • . owned�p�iica� Subciivisicn 1�1; (� Qose � Add'res�.��a#ion Se�Pn�s � � _ 9 � 0 � .{ . ..� .: }j..'.. . ••y�..:-'_4'.i:....`'.'�.� '. � . �• .:.�:.. : �: .���"' 'V��•�� . ^�• ii`i. . � , �V� �,����y��� �- � .... ...,_ . .. .. . .. r" :' � , • , �!!''��y��:�� .. ,-•- 4 � ;���•��� .:.:.. :}: r .:l_vu+- � :'i'.v�':v}r: �'+;+Y;'.-..... ..,.•�+',4:�.•... .. . : :. . ... ...... . v ♦ . .. .. �e•: . ..... . :..r..:. �. � .. . . .::: .'.' �. n .. � . •.. .. . ..: � �:�1,:��3I�,�.�':��a; •. : � t.s�.-��a�a�:ars..—��_>ara_ , �� , .�,��� , ;��� � � � � � � r Tax Map � Applican� _ Subdivision: Location: __ a � Parcel # /7Z T�o�vnship: . '1`ype of �Vater SuPP%"• �.. Individual ']�teqnirements: Lot # Commimity Pnblic Site Appmved By: S ? -3� Grouting Approved By: . . � w�u �� � PumP 'Fag: � Well Tag � AirVeut: � � � J ��-� Hoae Btb• � Casing Heigh� � , Con«eta Slab: � � � - �. � �- , Well Approved by: . ****See Attac�ted Sfte Sketci�**** Liner: �Installed by: � Depth se� ; . cuouted: Date: . Water. Sanzple: � Wells must be 10 feet from property lines. ° Wells must be 100 feet fi�m septic systems. V.Vells must be at Ieast 25 fest from any bnilding foundatian. Other conditions: Date:, . PCffi� rev 01I27/04 0 AUG-12-2007 09:54 PM ���. � ����1" �� � � � ���� IE �rav� u y- m�� ao us. �.ea. Tl 7�-3L o.a►.Il �lln Owner: � Location: Subdivision: �' 1'I�iC'f �� # �y Com,�.�.ny N.�;me� � � � Dat�e Orillecl Lot # t Log n Tax Map lv ��parccl # � � Well Construction Distance From ncarest Properry Line (Minimum 10 feet) ' Distance fro j�c System (Mini um 60 feet) � Total Depth: U ft Yield: GPM Hc Water Lovel: � f} Water Bearing Zones: Depth ,�� ft_ i �S f} �� ft R Casing: � � Depth: From _�_ to ft. � Diameter: � in Type: Galvaniztd Steel L� ' Weight: Thickness; �� Height abova Ground: � 2. in Drivc Shoe: Yes No Any problems encountered while setting casing? ,Yes .'�No Lf "yes" give reason: -- Grout: . Neat: Sand/Cemcnt ✓ Concrete GraveUCement Annuiar Space Width 1 Z, inches Water in Annu�ar Space Yes � No Method of Grout: Pumped Pressu.re poured �� Depth to Ft, hlaterials Used: No. Bags Portland cement Weight of 1 Bag Pounds If mixture (sa , gravel, cuttings) — Rario to ID platcs: ____ Yes _ No , 4 x a slab �Yes No Liner; —"" —" Depth: Date installed: Grout: Installed by: Driiling Log Location Drawino �� � ��. �� � �� , ����� � t�.1'�t�- . _ �:i�'�I%1�1'i��• �� P.02 I hercby certify that the above information is corrcct and that this well was constructcd in accordance with regularions set ior.h by the Person Counry Health Departme�t. ' c• Si nature of Contractor ' �� � �. g ._�s� 2310 Date � 3 0`r , , i'ump Ynstallment ' . Pump Installation Contraccor: Stat� Registration Number: �� Pump Depth: ft Static Water Level: � Pump Make & Model: Pump Si2e and Rating: : hp �tn I hereby certify that this pump was inscalled and thc well head compleied according to the Person County Well Rules in effect on this date and that a copy of this record has been providcd to the well owner. . Pump Installer Siguature Date: PCF-ID rev O1i27/04