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PERMIT # ZtaoS-5 - Operation Permit
New Installation LJ Septic Tank E:1 Repair /Witrification Line E:1 Expansion
PROPERTY LOLATION: SrZ 17o-7 A es.-r.(-A i3dyL-b fz fl
Name: (owner) 4~--,_ t3~~Qc~le. s SUBDIVISION 7- P4=:~ LOT # -2
System Installer: Kf--.' Je-4Q &DeeP-g~ Registration #
Basement with plumbing: ❑ Garage VPublic umber of Bedrooms y_
Type of Water Supply: ❑ Community ❑ Well Distance from well feet
System Type: &'croLV) 2 o~~,ct ;C-2M g 71-1(4-- 3 Types V and VI Systems expire in 5 years.
Air I
(In accordance with Table V a)
Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas oeen instauea in compuance with applicable North larolma beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. 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:
Following are the specifications for the sewNe disposal system on the above captioned property.
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Type of system: ❑ Conventional M Other e,5P,6 lttk i2~s ~1 F'7- L 7-,,re ~ Septic Tank: / D O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 206 feet ditches .3 feet ditches / L inches
French Drain Required: Linear feet
Authorized State A n1,"...- Date 7
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