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� Person County Health Department
. Sewage System Improvements Permit
Date: �"1 � This Permit Voi Af r 5 Years Permit #
owner: � e t4�'—T� �-t�� sxa l'3�
Location/Directions:
Subdivision Name: ��' �� ✓ P t� �✓ esk Lot #
Lot Size: ����(� (��� � Type of Dwelling:
Water Supply: Private: —{„�— Public: Community:
Bedrooms:� Gazbage Disposal ' �_,
Basement � � Basement Fixtum ..
INFORMATiON CER,TI�IED BYs_,..— . ,r{.t (.i''
REPAIR. � r � T, REEVALUATION:
Size of Septic Tank: � gallons Size of Pump Tank:
Nitrification Line: � 3 �
Depth of Stone: 12 � ^�
Max Depth of Trenches:
Altemative System: Conv. Pump LPP Pump
Remarks: — _
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Date Well Approved: Well should be 100 f� from any sewer system
BY Sani
Date Sewage System pproved: � Zy - 9Z
BY c,�.. Sanitarian
CERTII�iCATE OF COMP �
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LETION ,�
Contiactor. �-�a n �i f ,� �
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Sewa,ge System location, installation, and protection must meet state' and local �
regulations. Septic tanlc 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 hazard. Septic tank and D
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 permit is subject to revocation �'f�
(G.S. 130 A-335F) '� Z
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L.ocation of sewage disposal sewage system sketched on back. �p,
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