A41 48�
Person County Health Department
� Sewage System Impr`otv_ements Permit
Date: �-� q3 P�m¢�o' ,�'�`�r S� Y'�rs� # N/308
Owner: '� � SR# �/l�
Subdivision Name: � Lot #
Lot Size: �W�°S Type of Dwelling: �
Water Supply: Private: Public: Community:
Bedrooms: 3+6 4� Gazbage Disposal
Basement Basement Fix es
INFORMATION CERTIFTED BY
Environmental Health Specialist: owne� resentative
REPAIR: REEVAL ATI
-------------------------
Size of Septic Tank: �� gallons Size of Pump Tank:
Nitrif'ication Line: �[� � ,X � '�
Depth of Stone: 12 inches
Malc Depth of Trenches:
Altemative System: Conv. Pump LPP Pump--�-
Remarks: n �, ..a, n/ I` / �
,J '1'7�. i s �evN„�-
Date Well Approved: Well should be 100 ft from any sewer system
gy Environmental Health Specialist
Date Sewage System Approved:
gy Environmental Health Specialist
�
�
CERTTFTCATE OF COMPLETTON ,.�
Contracwr. �
------------------------- �
�
Sewage System location, installation, and protection must meet state and local �
regulations. 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 Persoi► County
Health Department before any portion of the installation is covered and put into use. If
the site plans or intended use change this pemut is subject w revocation
(G.S.130 A-335F) �
Location of sewage disposal sewage system sketched on back.
(OVER)
A001075
� • PERSON COUNTY HEALTH DEPARTMENT
WELL SEWAGE SITE, LOCATION Il�IPROVEMENT PE T �
Tax Map # Parcel # �
Zoning Township '
Owner/Contractor Date �— 3 — � �
Location/Address . _ _. , i;1 7— 2 � R S'I
� _ �,�-� � c3�
�
1 ° �.� „`
tayoUt `�
ks`r� Jo r�."��L J,
3•,
5 � `��
��� w
� U -
`� ,.i ,� -
�l . ! A � \0 �/ - ,
�
\v � v ..
� / .,':
�1 ""' S.R.#
Lot#
as �iea
<
Permit Void after 60 months. Permit Void if not in compliance with zoning regulations.
Permits may be voided if site is altered nten d use c ged.
Well and Septic Layout by
Comments:
Date Installed by Approved by
e S �,.—�'� WELL SYSTEM SPECIFICATIONS
Indivi'd�a,��'""�� Semi-Public Required Slab
Pub� Replacement Air Vent
Site Approved �/ Required Well Lo� _
Well Head Approved Well Tag
Grouting Approved
Comments:
Date Installed by
Approved by
This report is based in pazt on information provided the homeowner or his/her representative in the application submitted for this pemut The
em,irornnental health specialist is not responsible for false or misleading infonnation comained in the application. The environmental health specialist
is also not responsible for conceated conditions on the prope�ty or for statements in this repoR that may have resutted from false or misleading
statements provided to him in the application Neither Pecson County nor the environmental health specialist wazrants that the septic tank system will
coMinue to fundion satisfactorily in the fiihue or that the water supply will remain potable.� c:�amipro\permitsam O 1/95 rev.1.0