A40 235Person County Health Department
Sewage System Improvements Permit
Date:1�� This Permit Void After 5 Years Permit #�� ����
Owner: SR#
L.ocation/Directions: Sv
_ .�� _
Subdivision Nam : r'� �t �'�` r�Lot #
Lot Size: t P Type of Dwelling:
Water Supply: vate: Public: Community:
Bedrooms: � Garbage Disposal
Basement Basement Fixhues
INFORMATj�Q �EyR/�� D B
C7Tt}r,T�]n• /Yn t�e [d 1! .c . � OW�I O( fCD��t34vB
REPAIR: " � ' — REEVALUATION:
------ -------�--
Size of Septic Tank: p� gallons Size of Pump Tank:��'
Nitrification Line: _� t1t�Li� +? �
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
-------------------------
Date Well Approved: Well should be 100 ft from any sewer system
BY Sanitarian
Date Sewage System Approved:
BY Sanitarian
CERTIFICATE OF COMPLETTON
Contracwr.
Sewage System location, installation, and protection must meet state and local
reguladons. Septic tank should be pumped out every 3 to 5 years and shall be maintained
by owner in such manner as not to create a public 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 ar►d put into use. If
the site plans or intended use change this pernut is subject to revocation.
(G.S. 130 A-335F)
Location of sewage disposal sewage system sketched on back.
(OVER)
NOTE: Make sketch of installation showing lot size and shape, location oi 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)
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