A27 844 Person County Health Department
Sewaa�: System Improvements Permit
Date:'1.:-���` -� � This P it Void After 5 Years Permit #
Owner: �.1�"+�� �a�.�.'�rn� c!N GV,u%
LOCS[lOi1�D1I�CCU011S: -- � �— „ �—t=J„f.-��v 7
Subdivision Name• Lot #
Lot Size: �"� �o•� � Type of Dwelling: -
Water Suppl Private: C Public: Community: j
Bedc+ooms: -� (r� Disposal rY' '
Basement Basement F'vctures • ';
INFORMA BY fi�- � G« - f�t '
SBIlli8i18i1: � owner or rep�esattative
REPAIR: REEVALUATION:
, Size of Sepdc Tank: -��(� gallons Size of Pump Tank: ---- �
, Nitrification Line: �C 3' ��1�,�.��_
Depth of SWne: 12 inches - o`
Max Depth of Trenches: .
Alt�xnative System: Conv. Aunp LPP Pump
Remarks: 1
� � � � � � � � �� _� � � � � � � � � � � � � � �
Date Well Approved: Well should be 100 h, from any sewer system
BY Sanitarian
Date S%� �y tqyn/( roved: �,�' 9/
BY '�/n.1/„L!'/ �.. _ �-Sanitarian
v - ��-�ic i t�►i � vr �,v � i iviv ,,.�
Cont�actor.— ���.,��� �w�pJ' �e
— — — — — — — — — — — — — — — — — — — — — — — — — ��
; Sewage System location, installation, and protection must meet state and Iceal �
regulaaons. Septic tank 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
ni 'tnficadon line must be inspected and approved by a member of the Person Counry
Health Depuunent before any portion of the installation is covered and put into use. If
the site plans ar intended use change this pemut is subject to revocation.
(G.S.130 A-335F)
Location of sewage ciisposal sewage systcro sketched on back.
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'Tax
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PERSo COU Y HEALTH DEPARTMENT
084�
WELL A SEWAGE SITE, LOCATION IMPROVEMENT PERMIT
Map # � '`� Parcel #
❑g * - . T�ownship •
er/Contractor �.t n � � Date � � — �� - � �
Subdivision Name Lot#
SEWAGE SYSTEM SPECIFICATIONS
Repair Lot Area a� � Size of Tank
SFD Mobile Home Size of Pump Tank
Business # of Bedrooms Nitrification Line
Max Depth Trenches
Permit Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site
Well u ����
or i�r�en�,ed use chapged.
Comments: -
Date Installed by
WELL SYSTEM SPECIFICATIONS
by
Individual 1/ Semi-Public Required Slab _
Public Re lacement Air Vent
Site Approved � Required Well Log
Well Head Approved Well Tag
Approved
Comments:
Date Installed by Approved by,
This report is based in part on information provided the homeowner or his/her representative in the application submitted for this permit. The
environmental health specialist is not responsible for false or misleading information contained in the application. The environmental health
specialist is also not responsible for concealed condirions on the property or for statements in this report that may have resulted from false or
misleading statements provided ro him in the applicadon. Neither Person County nor the environmental health specialist warrants that the septic
tank system will continue to function satisfacrorily in the future or that the water supply will remain potable. c:\amipro\permit.sam 01/95 rev.1.0