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Person Count Health De artment �
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Sewage System Improvements Permit
• l�-..7t}. �!U This Permic Vaid After 5 Years
Owner: ��
Location/Directions: -
(�r'�.�� t-.� �,
SU�iV1S10�0: � r� i r '
Lot Size3? �C,. e.�� c� Type of Dwelling:
Water Supply: Private: �'"� Public:
Bedrooms: ___� Garbage Disposal
Basement Basement Fixtnres
INFORMA'�fCS�f CE�TI�.I�D �Y
REPt1IR: t✓ -- - -
Size of Septic Tank:
Nitrification Line: �
Depth of Stone: 12 in
Max Depth of Trench�
Altemative System: (
Date Well Approved:_
BY
Date Sew Sy m ,
BY
SR# +� �
Lot�" �
� „�_
Communiry: _�_
owner or representat
''�lb�t�x -.. _.._
ALUATION:
� allons Size of Pum Tanl
��r _,_
. Pump � _ LPP Pump
� Well should be 100 ft from any sewer system
TE OF COMPLETION
_' � � �
Sewage System location, installarion, and protection must meet state and local �
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't1
nitrificatiori.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 ��,,'a
the site plans or intended use change this permit is subject to revocation. (;� "�"
(G.S. 130 A-335F) a' n �;
Location of sewage disposal sewage system sketched on back. � n� �A
�S S,
(OVER) �c
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Person County Hea�h Department �
Sewage System Improvements Permit �
Date: �^� "l�t
Owner: ��
Location/Directions:
V'd Af r 5 Years
� SR# , %��
Subdivisio,{� �N� e: (,er)•� r S f''x`ti ��'�' � c, ���,
Lot Sizci1, ''Y'r 5c U+ � Type of Dwelling: '
Water Supply: Private: Y Public: Community:
Bedrooms: ____ ��9.2� Garbage Disposal `
Basement —L Basement Fixtures g—�- � �
INFORMA'��f CE�I�D �Y Jl �r.��.l �Y_ �a.
REPAIR: v – - —
Size of Septic Tank:
Nitri�cation Line: �
Depth of Stone: 12 in
Max Depth of Trench�
Altemative System: C
Date Well Appmved:_
BY
Date Sew Sy m ;
BY
���oaner or repces�ta[
ALUATION:
� -
�gallo�nCs3Size of Pum Tan]
�� i i
_ ._. _ � _._
�
. �
b
LPP Pump
�
t
r�
►Well should be 100 ft� from any sewer system
_ Sanitarian
.TE OF COMPLETION
---------- _ ,� .
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'icaaon 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 �qD,,�
the site plans or intended use change this permit is subject to revocation. �°n G6'�
(G.S. 130 A-335F) � � �
s o oW
L.ocation of sewage disposal sewage system sketched on back. ��A
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(OVER) �'�
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C.�n� � � °.�fi �
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NOTE: Make sketch of instailation 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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