OPHTE#-D 9- k GjC> Ht.- nett County Department of Pub' Health 2 0 7 4 6
PERMIT # Operation Permit
New Installation ck~_ Septic Tank ❑ Repaid Nitrification Line ❑ Expansion
PROPERTY LOCATIONS ~P
Name: (owner) tPin C r\, . , SUBDIVISION I- n LOT #
System Installer l /:3, C / Registration #
Basement with plumbing' Garage olig, Number of Bedrooms
Type of Water S ly: ❑ Community Public ❑ We11- stance from well feet
System Type:-tom 'T, Types V and VI Systems expire in 5 years.
(In accordance with Table V a) y Owner must contact Health Department 6 months prior to expiration for permit renewal.
This stem has been installed in compliance with applicable North Ca ina General Sututes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
'1 J (6~
2.J~
.5 J
yr
n~
a ,
PERMIT CONDITIONS:
as
1. Performance: System shall perform in accordance with Rule .1961.
ll. 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 a dispos system on the above captioned property.
Type of system: El Conventional sewa Other J2 2 FI-- t/ Septic Tank: gallons Pump Tank: 1!2~k 0 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches J_ inches
French Drain Required: Linear feet
Authorized State Agent :a;
~dr's8LO~~sa
- ~ x
T-7
'Al 71t"
~ i
k~
Jdr'L8LO~Osa
t
r
AW-
R
s
Y SY ~'~r
a'
Y
^
F ^
ow,
41
R,
f
Jdr'178LOJOsa
,
~ e
f
rS
y
i
.g
t
-
e
}