A23 155�����
�,� Person County Health Department
Sewage System Improvements Permit
Water Supply: Private: Public:
Bedrooms: � Gazbage Disposal
Basement Basement F' es
INFOR�vIATION CER'TIFIED B
Environmental Health Specialist: `
REPAIIt:` � REEV ATION:
Community:
Size of Septic Tank: ��� gall �s Size of Pump Tank:
Nitrificaaon Line: �� n��� �
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remarks: �� % a
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Date Well Approved: � ell should be 100 R from any sewer system
BY Enviro mental Health Specialist
Date Sewa S ste rov •� �'
BY � � Environmental H alth Specialist
� ATE OF COMPLETION ,.,,j
Contractor. �
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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 hazazd. Septic tank and
nitrification line must be inspected and approved by a member of the Person County
Health Depaztment before any portion of the installation is covered and put into use. If
the site plans or intended use change this pemut is subject to revocation. �
(G.S. 130 A-335F) 1
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L.ocation of sewage disposal sewage system sketched on back. —�
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(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.
(1) (2)