OPHTE# /s -'5-- 9b/ &45 HL ett County Department of Publi, Jealth 23620
PERMIT # Z85F Operation Pe it
M New Installation Septic Tank C2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:t.
Name: (owner) SUBDIVISIONLOT #
System Installer: — Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 12""Public ❑ Well Distance from well feet
System Type: 2-5.Fa ! �' pes V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contac ealth Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications
for the sewaK disposal system on the above captioned property.
Type of system: ❑
Conventional E Other
Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of t'
Drainage Field
ditches
of each ditch D 8 feet
ditches 3 feet ditches r inches
French Drain Required:
Linear feet
Authorized State Age Jal 11 � �y1.9� -�_�T �' Date —j'` 2 1 /A.e
15-5-36166 (1)
15-5-36166 (2)
15-5-36166 (3)
15-5-36166 (4) 15-5-36166 (5)
15-5-36166 (6)
15-5-36166 (7)
15-5-36166 (8)
15-5-36166 (9)