A32 1B_ _--- _ __._- ____ __ _ _ _ __
NOTE: Make sketch of installation showing location of house, septic tanks, privies, water supplies on
adjacent property, etc. Write in measurements in order that installations may be located at later
date. � � -
' FINAL INSTAI.S.ATION (Date �
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The District Health Department
Orange, Person, Caswell, Chatham, Lee Counties
Water Supply ond Sewage Disposal
IMFROVEMENTS PERMIT No.—�--
' Date�'�.. :"7� _ --l�
Owner: � l i1 0� •,� � 1� �'"r'�j � P
Location: �. �
'� � \ C1 Cl �
Contractor:
Water Supplp: Private �_ pubi��F
--�� l�\04 � d1.iX �- N a t> 1r
Sewage Disposal Facilities: No� bedrooms *
Dishwasher, Disposal,
washing machine, other automatic appliances
Size of tank: �._ C� � 2 Nitrification line: -+�� �(�� '
Other disposal facility:
Water supply and sewage disposal facilities location, installation and
protection must meet state and local regulations.
5eptic tank should be pumped out every 3 to 5 years and shall be main-
tained by owner in such a manner as not to create a public health hazard.
Septic tank and nitrification line MUST BE INSPECTE73 AND AP-
PROVED By A MEMBER, OF THE DISTRICT I�EALTH DEpAR,TMEN'�
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AI�TI3 PUT INTO U5E.
Date approved:� 1 C.��� (�
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Well:
Sewa�e Disposal: �/
Signc, � ��-
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Counter � �, �—
9igne , .� �
(Owner or his r esentative) �.
Certificate of Ccm,pietion !
Date Approved: ��" gy; r � :
n'tarian
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Location of well and sewage disposal facilities sketched on back.
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The District Heaith Department
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water `Supply and Sewage Disposal
- IMPROVEMENTS PERMIT
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Own��;�, � � � ,� . .
Loc tion: `v� " o ' ��� I
Contractor:
Water Supplp: Private �, ./ _ public
. 4�t •
Sewa e Dis " '�
g posal Facilities: No. bedrooms I
�ashing mac n� th.er automatic appliances _
.._____--� �%�,�
Size of tank: Nitrification line:
Other disposal facility:
u.�i�
Water supply and sewage disposal facilities location, insta lation and
protection must meet state and local regulations.
Septic tank should be pumped out every 3 to 5 years an3 shall be main-
tained by owner in such a manner as not to create a public healtfi hazard.
Septic tank and nitrification line MUST BE INSPECTED AND AP-
PROVEB BY A: MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND PUT INTO USE.
Date approved:
Well: •
Sewage Disposal:
By:
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Signed ✓fv�►�w� 'T' ° �C�l. `
Sanitari
Counter- ,+, t �-�%�i � �t�w �D �
signed_��,�.IC ,H��
(Owner or his rep e�sen ative)
Cestiticaie of Completion
Date Approved: �_:�� gy,
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The District Health Department �
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply ond Sewage Disposal
IMPROVEMENTg pE IT.�I�,�
� ) ate��.�t7 ' gfi�—
Owner: �
Location: �. . �O �
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Contractor:
Water Sup -1 : Prf ate Pub 'c
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SeWag@ D'15 Sal Facililies: No. bedrooms
Dishwasher, Disposal,
WBShing machine, aoth r automatiC appliances
Size of tank: � �� _ p� �
Nitrification line: Y
Other disposal facility:
Water supply and sewage disposal facilities location, installation and
protection must meet state and local regulations.
Septic tank should be pumped, out every 3 t0 5.years an3 shali be main-
tained by owner in such a manner as not to create a public health hazard.
Septic tank and nitrifieation ]ine MUST BE INSPECTED AND Ap_ !
PROVED BY A MEMBER OF THE DISTRICT HEALTFi DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV-
ERED AND pUT INTO USE.
i
Date approved;
Well:
Sewage Disposal:
BY: � .
t
Signe (�
Sanitari
Counter-
signed
(Owner:or his representative)
Certificafe of Complefion
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Date Approved: � � B � /' ;` � �
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Page 1 of 1
Person
� �< ,� � � � �" 3 Printed March 17, 2016
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NOTKE Recently, we h �.� i��,i�s� �<il u�us �-port�bio_sr� com,patibility issues ��:hen tiying to access oui <IS v:c�Lsii� i u�cally, the problem stems from users who have
recently upgraded to the Windows 8 operatiny system or a new version of Internet Explorer. We were able to resolve tlus issue by directing users to the Internet Explore
Compatibility View tool. This link iz to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-US/internet-explorer/produds/ie-9/features/compatibility vie�
f this does not solve the problem feel free to contact us at the number listed on our main pa9e. Wekome to the Person County GIS Website. ConnettGlS has beer
prepared for the inventory of real property found within Person County, and is compiled from recorded deeds, plats, and other publlc records. Users of GIS system arf
notified that the aforementioned public information sources should be consulted for verification of the information in this system Person County, Mobile 311, ConnectG]`.
assume no leaal resqonsibility for the information in this system. Grid is based on the NC state plane coordinate system, 1983 NAD.
http://gis.personcounty.net/ConnectGlS_v6/DownloadFile.ashx?i=_ags_mapol � l Ofcf4a64... 3/17/2016