A23 104' Person County. Health, Department
Sewage System Improvements Permit
Date Z' This Permit Void After3 Years o��
Owner: SR# Z Z
Location/Directions:
SubdivisionName: FJC�fT J'C�In� (Ln[#��
Lot Sizc: • g1 a Type of Dwelling: .
Water Supply: Private: Public: Community:
Bedrooms: " �-Z - Garbage Disposal
Basement Basement Fixtures
INFORMA�'��1�D BY
Sanitarian: �( owner or represaitative
REPAIR: REEVALUATION:
Size of Septic Tank: �Q�2 gallons Size of Pump Tank: � �
,
Nitrification Line: St�b � 3X ' ./ „�„ �=�, /��� J �y �:. / .,L
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump LPP P�mp
Remarks: L
Date Well Approved:
BY
Date Sewage System Approved:
Well should be 100 ft from any sewer
Sanitarian
BY Sanitarian
CERTIFTCATE OF COMPLETION
Contractor.
------------------------- �
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 Person County �
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)
L.ocation of sewage disposal sewage system sketched on back.
(OVER)
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.
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