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CASWELL - CHATHAM - LEE - PERSOtJ COUPlTIES
�/���r �up�ly �nd ������ ��������
IMiPROVEY�IdT� �EANIIT ,�Io� -��
ai �� �`
Owner• �:-� lv'� ��� l� 1��:#c�
Location: ���
�,
. �, �, . !a�
Contractor: ���C"'' 'D` i't � �: �
r � �,,
Water 3upplp: Private .i�
3ewage Disposal Facilities: No. bedrooms �— Dishwasher, Disposal,
washing machine, other a tomatic appliances
Size of tank: _, � Nitriflcati�n line: �''�'��i
Other disposal facility:
Water supply and sewage disposal facilities location, installation and
protection must meet state and local regulations:
Septic tank should be pumped out every 3 to 5 years an3 shall be main-
tained by owner in such a manner as not to create a public health hazard..
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVEB BY A MEMBER OF THE DISTRICT HEAI:TH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE. .
Date approved:.
wen: �'`
5ewage Dispost
�
BY:�
� �, ,
� i�1� — Signed ' .. ' �'.
Sa itarian
—�1y�� Count - � �' ' '
'L�r�c eigne . ' � ' � :
( wner or is representative)
Cegtiiicate oi Compl�3ion ., f � ,
,� '' j '; -
Date Approved: �"1� �� By: � , .'`' �i���:��i
S n'tarian
(OiIEA)
Location of well and sewage disposal facili4i�es sicetched os� b�acAs.