A32 117!'� r
Person County Health Department
Sewage System Improvements Per it
Date: �-.�s�� This
Owner: -� �'+'� n
Localion/Directions: _
Subdivision Name: —
Lot Sizc:
Water Supply: Private:
Bedrooms:
Basement .
REPAIR:
Void After 5 Years
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' Lot #
Type of Dwelling:
Public: Community:
Gazbage Disposal
Basement Fixtures
owner or representauve
_
REEVALUATION:
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Size of Septic Tank:�
Nitrificauon Line: ,
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump
Remarks:
�ize of Pump Tank:
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LPP Pump `��� �'�`A� .
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Date Well Approved: Well should be 100 ft� from any sewer system
Da Sewage System Approved: 5���� �.`�¢. � 3-�b
BY Sanitarian
CER FICA OF COMPLETION
Contractor. �1 y,�, .�a.
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Sewage System location, installarion, and protection must meet state and local ''�
regulations. Sepdc tank should be pumped out every 3 to 5 yeazs and shall be maintained .��-
by owner in such manner as not to create a public health hazard. Septic tank and'ts
nitrif'ication line must be inspected and approved by a member of the Person County �
Health Depaztment before any portion of the installation is covered and put into use. If
the site plans or intended use change this pennit is subject to revocation.
(G.S.130 A-335F)
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Locauon of sewage disposal sewage system sketched on back. �. .�'
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(OVER) O �
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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.
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