A32 123��.
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� Person County Health Department
Sewage System Improvements Perm�t
Date: ^�',�� is Permit Void Afte 5 Years �
Owner: """� , SR# a
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Location/Dir�c 'ans: _ _ ,� �
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Subdivision N C: VX "�r K/ �P3't" � �h �,.0�
Lot Size: �i�,�� t-r� Type of Dwelling:5" �' �� �►'J .
Water Supply: Private: �— Public: Community:
Bedrooms: � Garbage Disposal
Basement Basement Fixtures
INFORMA 1� D�BY� i / �—�' ` � �-�
Sanitarian: `�{/� W,,�q owner or represcntauv
REpAIR: REEVALUATION:
Size of Septic Tank: � gallons Size of Pump Tank:
Nitrification Line: -�/��C�?� 3 •
Depth of Stone: 12 inches
Mar Depth of Trenches:
Altemative System: Conv. Pump I;PP Pump
Remarks:
-------------------------
Date Well
BY
Date S
BY
Well should be 100 f� from any sewer system
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��`� �"-_ I R CATE O COMPLETI N I
Contractor. ^
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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 yeazs 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 Counry �
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 revocation.
(G.S. 130 A-335F)
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Locauon of sewage disposal sewage system sketched on back. �j
-'f�: y�'i',����_ Go►,�'1'rcc-�'v� ��„c�c�.q��� !
p (OVER) �
�n-� U�" ����� I?� �. �r C�j 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 suppiies on adjacent lots.
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� � Person t�ounty Health Depar�ment �
Well Permit . �
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ate• �—� This Permit Void After 3 ears a�� 'd
��; a r SR# 1fl�
= :ation/Directions: �
n v ., 4' / �:.
nbdivisionName: .� f' �x. S�<• -�I.ot# _
�ling Contractor. � � �
WELL CONSTRUCt'ION � .. �
� tance hom Nearest Propesty Line Dist�ce from Source of
�llunon • �; D.
otal Depth: c Ye18: �,_GPM Sta6c Water Level Fc
latcr Beazing Zones: Depth Fe. � F� F�
uing. Depth: From �_ to F� Diameta'� Incha
TYPE: Steel • Galvaniud Stxl
If SteeI, does ownc appzove:r No
Wcighr Thiclrnas: 1 Height Above Groimd: Incha
Drive Shoe: Ya No •
� . Were Problems Encouncaed in Setmng th�Casing? Yes No
. If "yes" give :sason:
Grout Type: Neat San�an Canaete :
. Annular Space Width ��--- Incha
Wata in Armula Spacc Ya • No ) :
Method: Ranped Po�sefl� '' `- m
��; �� ��_Fc. '
Matcrials Used: No. Bags Portl�d Canrnt Weight of 1 bag
Ibs. _.
If miznu�e (sand grave cvarngs) - Ratio: to
= ID Plata: Ya � No �- � �
4 x 4 sIab Yes �i No
[EREBY CER'IgY THAT Ti� ABOVE INFORMATION I3 C
�S �IELL WAS CONSTRUCTED IN A ORDANCE WTTH
)RTH BY THE PERSON COUNTY �I ��}P?►1i�1{F�T
tRECT AND THAT
ULATIONS SEI'
Date -
� �
Date Lssued