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Person Co�nty Health Department
� Sewage System Improvements Permit
Date:���This P t Void Af 5 Years Permit #��5�
Owne�r:: �,�JP_ I_� ,����.J� � SR# �
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Subdivision Name: Lot #
Lot Size: !. ��'�—. Type of Dwelling
Water Supply: Private• Public: Community.
Bedrooms: e Disposal
Basement Basemenl Fi
INFORMATION CERT�D BY
Environmental Health Specialist o�n� �
REPAIR: REEV ATI .
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Size of Septic Tanlc gallons Size of Pump Tanlc
I�'itrificatiion Line: � /
Depth of Stnne: 12 i�hes
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Aunp
` Remaiks:
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Date Well Ap�oved: � ' Well should be 100 ft from any sewer system
BY Environmental Health Specialist
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Sewage System locacion, uutallation, and protection must meet state and local
regulatians. Septic tank should be pumped out evay 3 to 5 yeazs and shall be maintained
hy owne� m such maaner as �t to caeate a p�blic health hazard. Septic t�ic and
ni�sificatian li� must be mspected and app[ored by a member of the Pcrson Camty
Health Department before any portan of the mstaIlatian is ooveted �d put into ise. If
the site plans or inte.nded tue change this pe�i[ is subject to ievoca�on.
(G.S.130 A 335F)
Incation of sewage dicposal sewage system skdched a� badc.
(OVFR)
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