OPHTE# �S `3 7zsg Harnuct County Department of Public-.zalth 24207
PERMIT #/ 0 eration Pe It /
r� New Installation Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION�Ic/s;) jgil&,&� .�
Name: (owner)SUBDIVISIONLOT #182�
System Installer. T Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Wat Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type::__n7p_4mD-2�%h � Types V and VI Systems expire `n S years.
(In accordance wits Table V a) Owner must contack Health Department 6 months p\n to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statute, Rules for
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
and Disposal, and all conditions of the
ll���CIS
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.
.a
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sdisposal system on the above captioned properly.
Type of system: ElConventional ewage Other eZ'Z Septic Tank: gallons Pump Tank: gallons
Subsurface No. of lexact length s width of depth of r
Drainage Field ditches of each ditch Z J1) feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Ag t lodi , I—e Alte� Date
15-5-37258 (1)
15-5-37258 (2)
J 1
15-5-37258 (7)
15-5-37258 (6)
15-5-37258 (3)
15-5-37258 (4)
15-5-37258 (8)
15-5-37258 (9)
15-5-37258 (5)