A29 1461,�;�'Qcu�
P�rson County Health Department
Sewage System Improvements Permit
Date: �-,�,i-q�This Permit Vo'd After 5 Years eimit #—
Owner. ��'01 � .� �.� . S✓� � YS v 1LL. SR#
L.ocation/D' � ns: �.� � : - -
Subdivision Name: `� Lot #
Lot Size: T�e of Dwell�in�; �
WaterSupply: u'�ubLc:f'�`��� ��"'`� munity:
Bedrooms: Garbage Disposal 1
Basement Basement F'vcAires
INFORMATT CE Y -
Sanitarian: „ �►a «r���u�e
G
REPAIIt: VALUATION:
Size of Septic Tank: �dd�gallons �Size of Pump Tank:
Nitrifcation Line: �f� � X /
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remarks:
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Date Well Approved: Well should be 100 ft from any sewer system
BY Sanitarian
Date ge y m pprov • '-15-
BY Sanitarian
CER CATE OF COMPLETION ,.�
Contractor. ��`"� �-��S ' �
------------------------- �,-�,
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Sewage System location, installation, and protection must meet state and local �
regulations. Septic tank should be pumped out every 3 to 5 years and shall be maintain
by owner in such manner as not to create a�blic health hazard. Septic tank and
nitrification line must be inspected and approved by a member of the Person Counry �
Health Departrnent before any portion of the installation is covered and put into use. If �'
the site plans or intended use change this petmit is subject to revocatioa
(G.S. 130 A-335F) �
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Location of sewage disposal sewage system sketched on back. �� ��
(OVER) , � �
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