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A40 228r"�� ,�.�.•�a� �-r�- ao .� Person County Health Department Sewage System Improvements Permit Date: �' � This Permit Void After 5 Years Owner: � ��'� � y SR# //�i'�9 r ..,....;,...m:�o,.�;,.n�• _�,:�F�\ _ / l �F 4 �— // � 2 Subdivision Name: Lot # Lot Size: T O 2�� Type of Dwelling: 11'1 •�� . Water Supply: Private: 1� Public: Community: Bedrooms: 3 Garbage Disposal � ° Basement X/-' Basement Fixtur s/✓J � INFORMATION� CER D BY � SaIli[3ilall: , o r or npresen 've REPAIR: REEVALUATION: Size of Septic Tank:1D-�'Q"' gallons Size of Pump Tank: ""' Nitrification Line: � 3-S"t��X3 � Depth of Stone: 12 inches Max Dep[h of Trenches: ��—� �. �2, Altemative �Sy s�tc�m: Con� m1'u p'� . LPP Pump Remarks: �`i��'.� �( ��t—�X".�.�.�,—f' s�-O'� z � � re � -----�-------------------- Date Well Approved: Well should be 100 ft, from any sewer system BY Sanitarian Date Se e S s p roved: — BY Sanitarian � ERTIFiCATE OF LETIO Contractor. �_,� �� S i e � YP ------------------------- � Sewage System location, installarion, and protection must meet state and local � regulations. Septic tanlc should be pumped out every 3 to 5 yeazs and shall be maintained � by owner in such manner as not to creaze a public health hazard. Septic tank and`d nitrif'icauon line must be inspected and approved by a member of the Person Counry � Health Depaztment before any portion of the installation is covered and put into use. If the site plans or intended use change this pernut is subject to revocation. (G.S.130 A-335F) � I.ocation of sewage disposal sewage system sketched on back. • 1 (OVER) N N � 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. (1) (2) � f�erson County Health Department � Well Permit � Date:��This Perm' Voi ter 3 Years '� Owner. SR#li�Cf I.ocationNirecdons: ' S •� � �- Subdivision Name: Lot # Drilling Contractor. � U ir-.� g je �� WELL CONSTRUCTION ►ti Distance from Nearest Ps�erty LineG�__ d/t�s Distance from Source of �' Pollution w • cn Total Dep : FG Yield: GPM Stadc Water Level ��Ft � Water Bearing Zones: Depth �FG�'FG FG FG Casing: Depth From �_ to �� Ft Diameter: � Inches TYPE: Steel Galvanized Steel ✓ If Steel, does owner approve: Yes No Weigh4 �_ Thicimess: ��ieight Above Ground: ,��--�nches Drive Shce: Yes� _� No Were Pcoblems Encoimtered in Setting the Casing? Yes No � If "yes" give reasom ''d GrouG Type: Neat v Sand/Cement Concrete � Anntilar Space Width 3 Inches Water in Armular Space: Yes No � Method Pumped Pressure Pour�,d �" Depth: From � to Ft. ' Materi Used: No. Bags Portland Cement � Weight of 1 bag T' lbs. If mixture (sand, gravel, cuttings) - Ratio: �_ to % ID Plates: Yes �✓ No .� 4 x 4 slab Yes �— No :: I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT THIS WELL WAS CONSTRUCTED IN ACCORD'ANCE WITH REGULATIONS SET FORTH BY THE PERSON COUNTY HEALTH DEPARTMENT. � of Contiactor ' Date Issued Sanitarians Signature Date Completed Sketch well location on reverse side. � 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. . �I��S��r��1� �� P�� '�� 1��0 �� 1�� 1�� 1�� 1�� 1�� 1��