OPHTE# ICn 5-3 r 7 Har—it County Department of Public .ealth 24262
PERMIT # 2!5075 / 0 eratlon Pe It
QV New Installation Septic Tank E Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:�l-- lW 96
Name: (owner) bi- VAA SUBDIVISION LOT # 7�
System Installer: C./-r� Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community OKPublic ❑ Well Distance from well feet
System Type: i r" con iTypes V and VI Systems expire in S years.
(In accordance with Table V a) Owner must t Health 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 Consnucdon Authorisation.
b R
Jv
y Kv
rcmvu wnumurts:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 ❑
Following are the specifications for the sa disposal tem on the above captioned property.
Type of system: ElC�nventiona ewa Other Z! /a" oft ice- Septic Tank:1000 gallons Pump Tank:
Subsurface No. of exact length I s width of depth of
Drainage Field ditches of each ditch Z40 feet ditches 3 feet ditches -t)/
French Drain Required: Linear feet
IN
Authorized State Ag Date
PWR Line
gallons
inches
-9
16-5-39789 (1)
16-5-39789 (2)
16-5-39789 (3)
16-5-39789 (4) 16-5-39789 (5)
16-5-39789 (6)
16-5-39789 (11)
16-5-39789 (7) 16-5-39789 (8)
16-5-39789 (12)
16-5-39789 (16)
16-5-39789 (21)
16-5-39789 (17)
16-5-39789 (9)
16-5-39789 (10)
16-5-39789 (13)
°-A
i
16-5-39789(18)
k,A& 3%
16-5-39789 (14)
16-5-39789 (15)
16-5-39789 (19)
16-5-39789 (20)