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HTE# S = z~~ Ha,-. tt County Department of Public flealth 2 0 8 7 5
PERMIT # Z5730 0 eration PIt
/New Installation E~ Septic Tank El Repair /Nitrification Line ❑ Expansion
PROPERTY LOCATION: X /Y:5b Ball !ZO
Name: (owner) )~W/&Cn~~~ SUBDIVISION LOT # -5'
System Installer: Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Su ply: ❑ Community Lv'j Public ❑ Well Distance from well feet
System Type: 7`" a7-6 C`0 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been in alled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITION . f
I. Performance: stem shall perform in accordance with Rule .1961. U
If. Monitoring: As equired by Rule .1961.
III. Maintenance: As re fired by Rule .1961. Other.
Subsurfa ' system operator required? Yes ❑ No ❑ i
If yes, see attached sheet for additional operation conditions, maintenan(e and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1-9131W~(Itr]d~ 5r,s _ Septic Tank: I-10P_ gallons Pu p Tank: gallons
Subsurface No. of exact length width of d th of
Drainage Field ditches of each ditch ! 1 feet ditches 3 feet d' ches Z inches
French Drain Required: Linear feet
Authorized State Ag Date "Z1 -b I
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