OP RHTE# 6I -5 — 2°7-1 V7 11—
PERMIT # ZU5 4'5—
Name: (owner) r
System Installer:
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type:LSylolZt}cvs2st8�J
(In accordance with Table V a)
Hai. ett County Department of Publit. dealth
Operation 1) mit 2226
El New Installation [Septic Tank Nitrification Line ❑ Repair Expansion
PROPERTY LOCATION:
t SUBDIVISION LOT #
Registration #
Number of Bedrooms
Public ❑ Well Distance from w II feet
7 2 Types V and VI Systems ex ire in 5 years.
0 ntact Health Departments moods prior to expiration for permit renewal.
This system has been installed in compliance vi h applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and an'cc
jr2� .
sab
I t`
Tv'
t
r
of the Improvement Permit and Construction Authorization.
)� 5115 j s& -eat I
6c To iifts� 124>
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
C'>f Other s `!� i2 (%6 V cis 0,3 Septic Tank: /20 0
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch f ly-O feet ditches 3
feet ditches Z9, —)(8 inches
French Drain Required:
Linear feet
�I
Authorized State Aunt
Q,
Date
° 10 Z.
11- 5- 27727R (1)
11- 5- 27727R (2)
11- 5- 27727R (3)
11- 5- 27727R (4)
11- 5- 27727R (5)
11- 5- 27727R (6)
11- 5- 27727R (7)
11- 5- 27727R (8)
11- 5- 27727R (9)
11- 5- 27727R (10)