A40 190. '.
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Person County Heaith Department �
Sewage System Improvements Permit
Date: �- .-�`�Th' Permi Void After 5 ears
Owner: � ' SR# `� � -S�
Location/Directions: „
Subdivision Na e: —� %� �� � ► ►�l' ✓" �f�i�
Lot Size: Type of Dwelling:
Water Supply• Private: Public:
Bedrooms: _�_ Garbage Disposal
Basement Basement Fixtures
INFORMATI� .CE D BY _ � __f����
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Community:
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REPAIR: � REEVALUAT30N:
Size of Septic Tank: �/��- gallon � S�ze of Pump Tank:
Nitrification Line: .�� _ X �
Depth of Stone: 12 inches `
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remarks:
-------------------------
Date Well
BY
Date ew�
BY
Well should be 100 ft� from any sewer system
Contractor.
------ — --------------- �
Sewage System location, installation, and protection must meet state and local '�
regulations. Septic tanlc should be pumped out every 3 to 5 years and shall be maintained ►��-
by owner in such manner as not to create a public health hazard. Septic tank and'd
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 pernut is sub,ject to revocation.
(G.S. 130 A-335F)
L,ocation of sewage disposal sewage system sketched on back.
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NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water
supplies, etc. Note special problems existing on lot. Write in measurements in order that installations may be located
at later date: Note location of water supplies on adjacent lots.
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��A 0435
PERSON COUNTY HEALTH DEPARTMENT
WELL AND SEWAGE SITE, LOCATION IlV�ROVEMENT PERMIT
Tax Map #/� �-p Parcel # Z 9l)
Zoning Township F�-F�'-�` ��=z.�=�-
Owner/Contractor ' � ° Date J� -'7 - 8`'f`
Location/Address Is7��-�9 �°°� ��- �%`, ����� /.�%�
S.R.# 1S� :,ezA��
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SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area !. o(�u�c_.e_ Size of Tank ��-9�--
SFD �/' Mobile Home Size of Pump Tank
Business # of Bedrooms � Nitrification Line '�d o �X 3�
Max Depth Trenches
Permit Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site is altered or intended use changed.
Well and Septic Layout by J �� d�
Comments:
Date� �,,;--��� Installed by G� Approved by �� w� �'
iividual
blic
ell
Date
S
by
SYSTEM , PECIFICATI
Required Slab
Air Vent
Required Well
Well Tag
by.
This report is based in part on infonnation provided the homeowner or his/her representative in the application submitted for this pertnit The
environmental health specialist is not responsible for false or misleading infocmation contained in the application The environmental health specialist
is also not responsible for concealed conditions on the property or for statements in this report that may have tesulted from false or misleading
statements provided to him in the application. Neither Person County nor the environmental health specialist wazrants that the septic tank system will
continue to function satisfactorily in the future or that the water supply will temain potable. c:4lmipro�pennitsam Ol/95 rev.1.0
ORIGINAL