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A26 1A
_ ---��_ .���u �_�:: . ��r.� — ��� �o� � �.v,v��i G'.�,s, �'�( G�-�l ����`` �' � � � �,� � �,.�"� w� �� . �' g" a3�C�� - I c Z C:�SU `� �'�- c� f��, � � �►�-�., t,,�c�l-� , ��e, �'nAa �'lc� � c�. , , ,.....,,j � �. �, ���`cw�� _� n�„� �. �=�� �vz..�..:� �� ��. � � � �� ��� ��� �„�..� . �,-. C � °`�` °�." 3/�/° 5' ��-�� �,�a, y 9' �.�,�ca''�' �.v •9�Li /�� r/s �r� „�►t��C �vG'�✓�-�lo�y $�D .:'.��►� �,a. ���/�J '� � z���}' ';� � ' �ji 'C'f?/�� �'GcJ � 5 �� � �assi6l�t � �,�'�� ti�� , c�� �- ���"jd ♦s �r/� �'f�v���'• �Gll� � CPI� ��6 � /'it/� ��:�� � � � �cG�� � � ��/'y � �� � /� .�no� �'�� ��� ��� 6� �o.,� . ��,�.�x Z�o ' ��s�'u� l'a��.�c-� .�� �;� �.�7�a�/.�<,�/� � ,�.,�g� -� 3Q " � ��/���0 ��'.�� - . ��� � ��-6� � �� -�-� ��d� s��S. 1 � S-0 � � Appiication� Date• . " `. 1 AmaurrE Paid: . Rec2ipt�': � � � �i� � �� Tax flAag # RarcEl��k � � %� , � � ���� �� _ I�'I�I�..����T � � �-���� �����.��� ��.�.�� � APPUCJkT10N FOR� SER1R(C�S ' SHALL BECOME INVALID. � 1) Permit requested by: Ownerlagentlprospective owner}: I�-I C:�fY1 �' � � Home Phone: - a5 4� Address: • Business Phone: 5 - l �,n x(-� �20 . tie, a'15�3 __ Zj Idame and address of carrent owner. ��-A `� � rJ► e- �JC�-�P� -4-0�.1 �I i�m 12d . � �'� 3 3) Properly Description: Lot size: ���" Tawnship: Directions to th� pr4aertv_(Inciuding road. names and � 4) Proposed Use an Structure Descriptton: answer eac�► of the follov+nn question; a) ProPosed , F�s�'n9 �, TYPe of Struc�ure• � ��e. M µ-- �. b) Number of 8edrooms: '� Number of occupants eople to be served: _ c) Basement Yes _, No �II there be plumbing in the asement? d) Garbage Disposak Yes � No ✓ �Lot�: c' !� U/�1 Ml�o(� nl ��..�,� 1� c�rn �,�, (L�� !-llGi.�fSo�� w ; I � r- + rr4� �I-h � s I�� rn� . �D � Depth: � � � Water SuPP�Y �YPe: �m� _�(new '_�r e�dsting �, Pubiic� Ccmmunity _, Spring _ Are arry welLs on a�joining property? Yes � No _ If yes, please indicate approximate locatton on the site plan. 6) Does the property contain previousty identifled jurisdicttona! wetlands? Yes _ No _ PI_EASE NOTE TNE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR S[TE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. ➢ PROPERTY L1NES AND CORNEi�S MUST BE Cl.EARLY MARI�D. ➢ THE PROPOSID LOCATION OF ALL STRUCTURES MUST BE STAKED OR FLACt�ED. � 9 THE SRE MUST BE READILY ACCESSiBLE FOR AN EVALUATION BY THE HEALTH DEQ�►RTAAEAIT STAF�. i� hereb� make appl'�cation to the Person County Health Department foc a siie evaivation for the on-siie sewage disposal system for the above-described properiy. 1 agree that the cantents of this appl'�cation are true and represent the ma�dmum faaii�es to be placed on the prope . 1 understand ifi the site is alteted ar the intended use changes, the permit shaii b invalid., � � Owner or Legai Representative � � PCHo, �� �ar�7ro� �-��, ; , �� ���� �� �. � � ���� I���a.a-��.�-r. ����.71 IE���.IL�I� Applicant: Location: � T��x M���� : � Pai�cel # - " ' S�uhe1'ivi�s�ion 'Prli_�a;setSec.tioi,��Lolt # Improvement Permit Permit Valid for �F've Years No Ezpiration Tyre of Facility: usc New �/ Addition Water Supply �C _ # of Occupants —� # of Bedrooms � Projected Daily Flow 3� o g.p.d. Proposed Wastew�ter System: �,,/�p�,/ o�,/ , f L b ��v.� . Type: �� Proposed Repair: �� Type: Permit Conditions: ��o�.� S� �i p.�,¢.✓ _ -- . Owner or Legal Representative Sign e: Date: a'� U a Authorized State Agent: Date: � The issuance of this permit by the Health Depariment in es not guarantee the issuance of other permits. It is the responsibility 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 Rules for Sewage Treatment and Di�osal Svsterns' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to fwnction 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 Wastewater System: Con��/�im,,/,� �/l��o Type� i�� Wastewater Flow ��- ,�D_g.p.d. New � Repair Expansion _ � Soil LTAR: •�a g.p.d./ ft 2 Type of Facility: ��� Basement Yes ✓IVo Wastewater System Requirements ank Size: Septic Tank: G�D gal Pump Tank: lb00 gal Grease Trap: ga1 ►rainfield: Total Area: /�,p0 sq ft Total Length �4 ft Mazimum Trench Depth � in 'rench Width 3 ft Minimum Soil Cover: � in Minimum Trench Separation: �_ ft . Distribution Box Serial Distribution X Pressure Manifold Specifications: ��,� � �'D � Authorized State Agent: � Permit Expiration Date: The type of system permitted is � the perrnit. Owner/Legal Conventional Innovative Date: $ ! 7 Alternative. I accept the specifications of Date: � Qa PC D7/30 2002 ���� � ���� �� ��a � `.�. � .--L, � � � � � � �: �w ii � aa sr n �r_ a.-n � irn �L-.aL 71 • 1I � �- .�a.:ll �.iE.l� � Natne ���1�1 z F�-f�. �.��..� �-abr i I Subclivisi�in 11ut�io � � c� te Agent �� �'t�:�y t��; � � i ��n � . Y �ITE SI�E'I'Cfi ` � 1'ax Map #�C� Parcel # �-� � Section/Lot# �/Z�%l� � --T Date Sj�sfe»a co�iapoiiezzts represe�at appsroxitnate contours only. Tlze contractor ��iust flag tlae syste�n�irior to beginnizag tlze i�astallation to insu� e that �i7��1��e�•grc�de is tnaintai�aerl. --- .,�� 4 �, � � �o���£� !�p ' Co,e �9v. �/���� �N I `'l vE ST�a�S Co�/T�-G � ��� �,�T . �`���- ��9a ��;/��-�� � .��,✓,-,e-�ti ������, ;�- �-r��c�� sc�le: � - �--� ' ..,�,;�,,,;� . : � � � t � � w�,-.'.__ � � �� ti1 q�� c-��.� �'.�-'"" 1.. �J,t�� � � GOn%'� � '�'�s � %y ��`i '�� � ��'� ��'�� °�`� - .j.�, � �"'�^;a"'��% �7'� I,� + '�,/�G` _, � ,. � � �rp, ' ��l �r "��� I � � , -_ .;�` ^�- � � %�, � �a � � / �\ ,, .�� _� �-v-av �� w � , , • ��-� .��1►�N. � _ ' ��� ��� �� � . , . _ �� ���,��� . • : . _ ...�--- , � 0 NEI�IA 4%Simpkx Cc�mlPanzl � �` �� n�tse��oth 4" X 4" Pxusass Ts�atad Pott � j g� Of The Cox�t CO�'°t� R"°= Sloped To Shed Water 1�" S�pasatioa 24■ ��. � �I �N� -�� C�„�e � � 0 2Tc tJ l v ll � A r�n.. � 2- , -�� - ► � 3 •2SS -�, � � a���� co� " '' ap s.p��n ; �r�.,a�a c�a v�,� : .- Ux�ion • � b" Cov�s •� ' . Accee� Cover• � , .' . � . . ' .1 , ' �:r.Port].and Cox�cxeta Gzout , • -- _ . • , � . .. � , • s . . y., , .:� , �: Mattia - - ' • � � � � r ; .. � , , ti� . _ . � O e � Pilkd With � Zi Cord p��g � • i. P�6 Anti Siphon Hole Tie� SnPF1Y. .. . Portlard CemantGront • 5 Ialet Fmm Saptie Tai�le� Portland Cameat Gxvnt �� g� . • �° �� 4atkt To Di�t:abution +{ SCH 40 P'inC Pip� „ Chack .f,�y�tt. a SCH44PVC Pipe valve �r� Plost wir�� � � • Hislt Wat�z .�larta Lawl ; r '� . (b" Separnticn) . ;, Hish Level - .s a:ctip Oa ; � !1 m �� r�apo=Loak . Floata •:: 2••5v��v� �!.✓�L ' �• � � Hole • • •.: ��,�. •.. a �� •'. Draardown Ct1P �A �-F7iott I'x�� ��� !( /`OL 7� . • t.o�► L.vei _'�unr off • " � .J '�un � �' �' - %i !���� T'�o` ': . � . �••ti ;�: • p��t co�te T�x a• co�t. �'� 35• S��� '' Mate:ial Str� h>3500 PS Block ' I " r,. . . •+• ','•W; � •� • ; . • - ' , . ,% : • . '� ' . • � � ti � � • ' : . . . � �=T/�'%�Tf�D �j� = 20 � /DOD GAI.LQN'FU1VII' TAPTK _ `-.�.� i �� ���� �.% � �.. = ~ � � � �� � JS ����-m�n.�t���n.��.� �-���.I�.�1�n.n. ax Map � � P�,rc-�e ; i • , u�beilivision Ph�se Section� ot �# # of Be�,rooms Appiicant: '�J��J���,_( ��Qbs,2,f' � Location: e ''.��� p � ' �:' � �ti: i� -s• � x System Type (in Accordance Wifih Table Va): c� THIS SYSTEM F9AS �EE�1 IMSTALLED tIV COMPLIANG� 1fl/iTH APQLICABLE i�ORTH G'AROLIi�lA GENER�OL STATUT�S, 3�ULES FOR SEWAGE TREATMEi�ITT AND DISPOSAL, AidD ALL CONDITION� OF � THE iMPF20VE1VlE�1T PER1V1tT �4ND CONSTRUCTI�N AUTHORIZ�ITI�N. � � � 6S� Authorized St e A e . afe Instalied By: /i/� ��1� y S� `� - . �y. � ��--C_ �, Date: !O`zz��6 � lo� ��i " /� � t� � ��y �). /� �'� - . s'���2 �. ti � . iy G� �T= . - PCHD, rev. 07/29/G4 �) � �` � �i ����$� ���$� ���������� �u��'������ ��4f�� �� � � Tax Map # Parce� # Sysiem Type (Table Va) Owner/Applicanf Subdivision � Address/Location SeclPhas� Lot # State �ID/date�� .� � i , Capaciiy �5 fno D 9a�• Tee a.nd Filter Baffle - Seaiant Riser (ifi applicabie) Tank Outiet Seal Permanent Martcer Pump T�nk /Seaiant Riser Water Tight � � � ��rvep Che�lc Valve/Gate �laive. �41arm (visable and audibie) Electrical Components Rate (gpm) Approved Pump Mode! Blocic Under Pump Pump Removai Rope/Chain . � Distriisution. Sysierr� Seriai Distribution ressure an ol Low Pressure Pipe Aqpr. Pi�e I�iateriai and Grade Width Trenct� Grade � ' Trenc#� Spac9ng Rodc Depth and Qualiiy Dams/Stepdowns etc. Pressure Laterals � Hoie Spacing - o e �ze Pipe. Sieeve Tum-ups/Protectors Requie�ed� Setbac� From� Wells From Propertv lines Surface Waters Public Water Supplies Verticai Cuts (,Z ft.) Water Lines Ve4�icle �Traffic � EasementsiRighf of V� Other Easements Recorded Co�vaanen� � � pc;�d rev. 3/'i3101 , � ���,��" ��I�.��1`� �---= -�-�- c� � ��T°��- ���a�.���.����.�. ��.�.a��. WELL PERMIT PLEASE SEE ATTACHED PLAN FOR WELL SITE LAYOUT _ ,� Tax Map #: �Z{� Pazcel # �Township Subdivision• Secrion• Lot: Location• o �-ra � L t • � T�e of Water Sunnlv: � Individual Community Public Rec�uirements• Site Approved by J� 5 2�{ �� Grouting Ap�roved by Well Log �l � Well Ta� Air Vent ✓' Hose Bib Concrete Slab Well Driller. ���'��T Well Approved By: �I � ate:���`T U S '�°5ee Attached Site Sketch'K* Wells must be 10 feet from property lines. Wells must be 100 feet from septic spstems. Wells must be at least 25 feet from anp building foundation. Other conditions: -- - - PC�ID, rev. 09/07/01 01/25/1995 00:34 8044547843 BENNETT WELLDRILLING PAGE �2 �� %J/e rs � � N . ��. 9,��,� `�.��F � �.�,• .0 .�a�.� �:� � .s.• � � � �l�� nP /�l�J'.l linf 1�nc . ������ •�.3� �l�Q � �Y�'vY7iC���.1.i7[7CA.OmEi'�.� ����7. � � Own�cx� � I,OCBtlon: J $�1�1V181Un: �'i1�0�� Z,O�' '�� � �,2� P�rcel # _� �VaQ CO�AiTUC�A DisC�cc �rom � Prope�tY Linc (M�u�m�m 10 £eet) Distance from Septic Sys�m ���i �- c Waba� Lavel: �S Toax1 Dcpth: _,,,�� R�Ci�td: / GP'M St�i Wat�r Bc�xiag 7.oncs: De� --�— � � �- � � �ng� 1S tp � �. Diamatcr. .�v %S� in Dcpti�: FTvm -_-- �`' w�'��� �� �ei�t abovo C�ad: /�• in � ? Y�s ►y No Drive Shne: �_ Ycs �,,, Na �r p�rob�ems � wht'k scttin8 c�tg �. ]f �" $!Y'G iC89dri: G�'oat: �v�UC'.en�ent Nea�: ✓ SandJ('.ement �, Caax�+ebe An�uleir Sp�ce Width ,,,T .?�,� mCh�s WBtct in Auuule� S[�e Ycs �- No Mathod of Csro� Pum�ped � � Pau�'od �� � tO �-� �t 11�teri�s Us�d: � W�� og 1 Bag �_ Pounds Nd. Ba� Partl,�d cement If mixtun (sa�d, Bravai, �) - �° � �0 - Yes No ID plaC�s: ✓Yca .�, Na 4 x 4 alab � " �r� Date installed: C3rout: �_ Uepth: _ In�talled b�r: � � �o�ti�� Ar�►rriag I htrcby ceztify that the �ve inf�tion is cornct aod tl�t this wocil vvas construcbad 'a� acaordanca w;th rcgul�tions sat � by the Pcrson Caunty �Io' A�e� � ��ture of Costxad�or IA #•� � 9� Date .� •� S- � d a �P � Stabc B�gis��st'iaaa. Numbai: / �G G ��smua�� c�t�� �. U-13e n n k� � � � PumnP �P�� -. $ b ft st�tic wrtar L�evel: p�, si�e ana Ratm�: �hP _..��. B'�� ptt�p Nia1c� 8c luladcl• _,S �``'` �' "�' . • was in�s� at�d.die w�cll h�d cana�plctied ac�8 to ti�e Pexso�n CountY Weil Rules in e�t I hercby certl�Y tt�at this p�p s t�i t� wcll owner- a� this date anci that � copy of tbi� record bas beea t �:.s ;?2�-a S"' gCt� rev Q1C1710� n��..n i..�tr11�' �� �'__ '