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A24 136z ` person County Health Department � Sewage System Improvements Permit Date: Z- - 3 This Permit VRid After 5 Years Permit #�• Owner: �ti v�n /�/ 1 C�Gl Y I lir� eI SR# ��� Location/Directions: Subdivision Name: � Lot # Lot Size: �--��e s Type of Dwelling: Water Supply: Private: Public: mmunity: Bedrooms: 3�0� b���'°'" arbage Disposal ' Basement Basement Fix ` INFORMATION CERTIFTED BY Environmental Health Specialist: ` "�`� "`'e REPAIIt: REEVALUATIO : Size of Septic Tank• gallons Size of Pump Tank: ����� L�� �------- ' --•-- Nitrification Line: - ��� � J. _ _ /'> � � Depth of Stone: 12 inches �n��� �� M� Depth of Trenches: �''� Altemative System: Conv. Pump LPP Pump � Remazks: r1 � � . � � /' - ,A , l Date Well Approved: Well should be 100 f� from any sewer system BY Envir nmental Health Specialist Date Sewage System Approved: ✓ ' � '� ` BY� � Environmental ealth Specialist � a � ,,,i CERTIFICATE OF �OMPLETION ,..3 COIIiCdC[Ol: �� ^ �• � � � r � _ _ _ _ _ _ � _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ � 'C3 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 s�li 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 Counry Health Departrnerit before any portion of the installation is covered and put into use. If the site plans or intended use change this pemiit is subject to revocation (G.S. 130 A-335F)' L.ocation of sewage disposal sewage system sketched on back. o�.., / (OV � 1/ • ��i ` "' � I�-��;���I� �/��,, ou�• :, ,. .- � `" / •� Person County Health Department � Well Permit � Date�-`I-°� 3 This Permit Void After 3 Years o,F� Owner: �'w. ,M L�► ✓I a,,�-� SR# r 3 z 2 Location/Directions: Subdivision Name: U��C I�� 1►1`j�. Lot #�� Drilling Contractor. WELL CONSTRUCi'ION Distance from Nearest Property Line Distance fzom Source of Polludon Tatal Depth: FG Yield: GPM Static Water Level Ft Water Bearing Zoncs: Depth Ft Ft. FG Ft. Casing: Depth: From to Ft Diameter: Inches TYPE: Steel Galvanized Steel If Steel, does owner appmve: Yes No Weight: Thiclrness: Height Above Ground: Inches Drive Shce: Ycs No Were Problems Encountered in Setting the Casing? Yes No If "yes" give reason: GrouG Type: Neat Sand/Cement Concrete Annular Space Width Inches Water in Armulaz Space: Yes No '-� Method: Pumped Pressure Poured k Depth: From to FG Materials Used: No. Bags Portland Cement Weight of 1 bag „� lbs. � If mixture (sand �avel, cuttings) - Rado: to ID Plates: Yes No 4 z 4 slab Yes No De th From To Formation Descri don •d � I HEREBY CER'TIFY THAT THE ABOVE INFORMATION IS CORRECf AND THAT � 'THIS WELL WAS CONSTRUCfED IN ACCORDANCE W1TH REGULATIONS SET ,� FORTH BY THE PERSON CO HEALTH DEPAR'TMENT. � C-'^y `` - —� of Con�actor Date ��' � '� z q3 I rj,,,` �v�.,� ' anitarians SignaNre Date Issued � Sanitazian's Signatuze Date Completed Sketch well locadon on reverse side. 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) ■■■ .■ . ■ ■ ■ .■■■� .■ ■ ■■ ■ ■■■■ ■.■. ■�������������������������a■ ■�o��■���������������������s ■��������■�����������������■ ■��■�s��������.��������■���■ ■��������������������s�■���■ ■��������������������������■ ■��o����■������������������■ ■������■������ �■�����������■ ■��������s�����������������■ ■�����������■��������������■ ■����o���������■����������■ ■������■������������������■ ■��������������������������� Person County Health Department � Well Permit � Date:�"y� � 3 T�h�isp etmit Void After 3 Years Ovmer' �` M �+�1 C FA YI � N� Location/Direcdons: Subdivision Name:. Drilling Contracwr. o T� sR# I 3 � z L.ot # WELL CONSTRUCi'ION Distance from Nearest Property Line Distance from Source of Pollution Total Depth: Ft Yield: GPM Stadc Water L.evel FG Water Bearing Zones: Depth Ft Ft. Ft. Ft. Casing: Depth: From to Ft Diameter: Inches TYPE: Steel Galvaniud Steel If Steel, does owner approve: Yes No WeighG Thiclmess: Height Above Ground: Inches Drive Shce: Yes No Were Problems Encotmtered in Setting the Casing? Yes No If "yes" give reason� / ' Grout: Type: Neat SandlCement Concrete Annular Space Width Inches Water in Armular Space: Yes No " Method: Pumped Pressure Poiaed Depth: From w FG Materials Used: No. Bags Pordand Cement Weight of 1 bag lbs. If mixture (sand, gravel, cuttings) - Ratio: to _ ID Plates: Yes No 4 x 4 slab Yes No I HEREBY CER'TIFY THAT THE ABOVE WFORMATION IS CORRECT AND THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W1TH REGULATIONS SET FORTH BY THE PERSON CO HEALTH DEPARTMENT. �� � of �actor Date � � � �.�. � yj`�3 � U,,,,, a.,.,l ` anitarian's Signature Date Issued Sanitarieri's Signature Date Compleud Sketch weA location on reverse side. 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 oi water supplies on adjacent lots. (1) (2) ■�����a������■■������������■ ■������������� ������������ee ■�o������������������������■ ■��������������������������■ ■�����������������e�������■■ ■�������������������■���■�■■ ■������������� �������■��■��■ ■�■o���w������������������■■ ■�����e■����������■����■���■ ■��������������������■�����■ ■��������������������������■ ■��������������■�����������■ ■������a�������������������■ ■��■e�����������������������