OPHTE# T� ' -ZS- yet ty epartment of Public Health
PERMIT # Operation — Permit 22451
NewI.,,�,�Si tall! ation Y Septic Tank' Nitrification Line El Repair El Expansion
PROPERTY LOCATION:ILLiZ7qL4 60 i`S
Name: (owner) &co SUBDIVISION LOT #
System Installer: 6134-5, _ Re A rati
Basement with plumbing: ❑ Garage ❑ uriber of Bedrooms t
Type of Water Supply: ❑ Community 1Z Public ❑ Weq, nce fro feet
System Type:
'y and VI Systems ex p re in 5 years.
(In accordance with Table V a) Owner must contact Heath Department 6 man s prio to expiration for permit renewal.
This system has been installed in compliance with applicable No th C olina eral Stat es for S ge reatment and isposal, and all nditions of t e Improvement Permit and Construction Authorization.
V,-
�
r;GrS k-1/ L # 'Pt l
��
i
�
L11 SUS +t^ --ire
V
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance wt s I`� ,"Cl 120
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 sewwaaSe disposal system on the above captioned pro erty.
Type of system: El Conventional Lf Other �SJ <p I`b;,UJ -44— Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 2— of each ditch 100 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State APeot'm
12 -5 -29583 (2) 12 -5 -29583 (3) 12 -5 -29583 (4) 12 -5 -29583 (5) 12 -5 -29583 (6)
12 -5 -29583 (1)