A24A 67The Distr-�ct Health Department
Orange, Person, Caswell, Chatham, Lee Couniies
Water Supply and Sewage.,,Disposal
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Date��r��-.
Owner:
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Location•
Contractor:
Wa3er Sup ly: iva e � Pu lic
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Sewag�eP isposal Facililies: No. bedrooms ...�_ Dis , D' �1,
wasiy�(�iachine, other sutomatic appliances —
,d ,Y�.e' �r
Size of tank: � Nitrification lin �
�9,u�r/
Other disposal facility:
Water supply and sewage disposal facilities location, installation and
protection must meet state and local regulations.
Above recommendations based on information received and observed
soil condition. Septic tank and nitrification line MUST BE INSPECTED
AND APPROVED BY A MEMBEft OF THE DISTRICT HEALTH DE-
PARTMENT STAFF before any portion of the installation is covered
and put into use.
Date approved:�Q � � •� T
we��: I PROV S PE I. �`, �
Sewage D' s
BY: The District Health Department
. �
untersigned
(OVER)
Location' of well and sewage disposal facilities �sketched on back.
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