OP Raa~~(/K
HTE#
4MIr
OBI s' Ha tt County Department of Publi~ dealth 21 2 8 9
PERMIT # Operation Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: Qg/ , i ~ 1~l ,fol.
Name: (owner) F1 's SUBDIVISION e LOT #sf`f,,-
System Installer: 1F /%I"5- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihn 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 Construction Authorization
f V
~r
E
r~mni wnvurvil
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other:
Following are the specifications for the sewwaa dis osalass'stem on a above captioned property.
Type of system: ❑ Conventional Lr Oth, / le- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch ~'/C feet ditches ~ feet ditches 18 inches
French Drain Required: Linear fee
Authorized State Agent Date Z"
~ ~Qld
r ,~Y v
e is
-14 ~v
r
^
I ~Ilvl
v
' ~ k ~'W' p ~ ~ ( 'k~C „ • 11(x• ~i - 1c
V' t Jµz~ S 1 e I !
+ E
H u ~ a
1 ^e
r z'
Viaktt.
40015340
"tics
:•9:'1: 08:46:?
i1 +.ck Type.
pic:k.uv
C,
4tu?11~"F& CAXP* V." ,;ua r
-
fl-V~ ft'3t kppI to
3
if3
'~+Ti3 A
1721
i S IN11,; saOcif(catlon a
Ft r r ys' . . r ~;':6~0 1062 03R for tire chip
SLbOfution for Rock Aggrograte in Nitrification FI9Id3.
~ f }iv C