A23 134��
Person County ,Heal,th Department
S�e,��e System Improvements Permit
Date:—���1+� e� V����� ��o vv �'"r v s `3 �.3
Owner: ( L��'E��k{� e r�k�1 � er�� �-1
Localion/Directions: ? E,�a�;,M1,� �, , -, � T,�_,__•_ ,►� �
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Subdivision N • b���..�_ �
Lot Size: � � �f �,��T��Type of Dwelling: . �
Water Supply: �ivatc: Public: Community: �
Bedrooms: Garbage Disposal �` �
Basement !� n ,' Basement Fix�ures - � „ _ „
— ' � — � � '-' - - — owner or repssqt�auve •
$8I1][aI1871: ✓
REPAIR: REEVALUATION:
Size of Septic Tank: ��� lc�f� �e of Pump Tank:
Nitrification Line: � �
Depih of Stone: 12 inches �
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remazks:
0
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Date Well Approved: t�! << L�`r��ell should be 100 ft from any sewer system �
BY anitarian � \
Dat ewage ste roved: �-,�-"7-�I �-
BY Sanitarian �
CERTIFTCATE OF COMPLETION L,
Contractor. �
_ ►-3'-
:
Sewage System location, installation, and protection must meet state and local '� S
iegulations. 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`O
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) ( ,
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Location of sewage disposal sewage system sketched on back. �„_
���0 ✓ ���YhOG �(/%f-� �
�r z aGX Bz (OVER)
A� t6 .� df1, zyjZ °
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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The District Health Departmenf�
CASWELL - CHATHAM - LEE - PERSON COUNTIES
Water Supply ond Sewage Disposai
IMPROVEMENTS PERMIT No.
permit YOID aiter 3 Year Dat '
Owner: a �'
Location:
Contractor: _..,,��.6.21�ri S
Water Supplp: Private � Public
Sewage Disposal Facilities: No. bedrooms Dishwasher, Disposel�
washing machine, other auto atic appliances �,
Size oi tank: NitriBcation line: --�
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 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 INSPECTED AND AP-
PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT
STAFF BEFORE ANY PORTION OF THE INSTA TION IS COV-
ERED AND PUT INTO USE. _
Date approved: � Signe
Sanitarian
Well: -
Sewage Disposal: � , Counter �
--•-_"".."` aigne �`
HY� (Owner or his epresentati
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1`, ^ l� � '
\ �: � S '�`�� � ��
By: . �
Sah tari�i
Cer�eate oi Completion . �
Date Approved: �
(OVEB)
Location of well and sewage disposal facilities sketched on becic.