A26 136_ � � .
. i�er�an �ounty Health Department
` �w�ge System Improvements Permit
Date:Z��This Permit Void After 5 Years Permit # EN- 15'7'7
Owner: �� n� �- n �V �� r-1 SR# -�.� �
Location/Directions: '
c� ��� 133 in, ��.¢ rw
Subdivision ame: Lot #
Lot Size: Type of Dwelling:
Water Supply: Private: 1� Public: Community:
Bedrooms: 3 Gazbage Disposal
` Basement � Basement F' tG�r ��
INFORMATION CERTIFTED BY
Environmental Health Specialist: `O` r�u°e
REPAII2: REEVALUATION:
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$ize of Septic Tank: _s `-1-C'` gallons Sizg of Pump Tank:
Nitrification Line: _r c"'� r �C3
Depth of Stone: 12 inches
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remazks:
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Date Well ved: ' � 2- �� Well should be 100 fk from any sewer system �
BY — Environmental Health Specialist �
Date Sew stem roved: 3- � 2'��
BY Environmental Health Specialist
CERTIFIC�,TE OF COMPLETTON � '
. ^ � 1�nr,/OC'
Contractor. 1;�,
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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 maintaine�
by owner in such 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 Departrnent before any portion of the installation is covered and put into use. If
the site plans or intended use change this pernut is subject to revocation 11 y
(G.S. 130 A-335F) -�-
Locacion of sewage disposal sewage system sketched on back. ���
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