OPHTE #/7-` — 3z_3g0
PERMIT # 27 � �i '�-;
Name: (owner)
System Installer:
Basement with plumbing: ❑
Type of Water Supply: ❑ Co
System Type: 'b ft 1.+4r`
(In accordance with Table V a)
This system has been installed in comt
ZHHar et t County Department of Public Health
e ration Per --''�� 2 3 01 7
New Installation Tank L�' Nitrification Line ❑ Re air ❑ Ex ansion
P P P PROPERTY LOCATION: SUBDIVISION LOT #
Registration #
❑ Kuinb of Bedrooms ..3
�Publ' ❑ Well Distance from well feet
a Types V a d VI Systems expire in 5 years.
Owner must conta Health De artment 6 months prior to expiration for permit renewal.
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Osposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwa� disposal system on the above captioned property.
Type of system: ❑ Conventional L�' Other Zak% ( Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 1Z O feet ditches feet ditches %2 t inches
French Drain Required: Linear feet
Authorized State enter ��-` . -- .� Date °' Z� " Y