A28 74Person County Health Department
Sewage System Improvements Permit
_�=1z �'his Permit Void After 5 Ye,ars
Owner: l -r P i
Location/Directions:
SR#
Subdivision Name: a Lot # [�
Lot Size: Type of Dwelling: . �'
Water Supply: Private: Public: ` Community:
Bedrooms: 3 Garbage Disposal �
Basement � Basement Fi ures � (�
INFORMA N D BY �s � �
5�711I�I1�17: wner or repiesentative ��
REPAIR: REEVALUATION: �
------- ---------- ---�
Size of Septic Tanle: gallons Size of Pump Tank:
Nitri�cation Line: � (�,/7 �i i ? `
Depth of Stone: 12 inches
Max Depth of Trenches
Altemative System: Conv. Pump LPP Pump
Remarks:
-------------------------
Date Well Approved: Well should be 100 ft� from any sewer system
BY Sanitarian
Date Sewage System Appmved:
By Sanitarian
CERTIFICATE OF COMPLETION
Coniractor.
------------------------- �
Sewage System location, installation, and protection must meet state and local 'i
regulations. 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'd
nitrif'ication line must be inspected and approved by a member of the Person County �
Health Department before any portion of the installation is covered and put into use. If
the site plans or intended use change this permit is subject to revocadon.
(G.S. 130 A-335F)
Location 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.
(1) (2)
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