OP RPERMIT # 2--) -51 Operation Permit
New Installation li< Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
t1 PROPERTY LOCATION: ono v5
Name: (owner) SUBDIVISION LOT # T
System Installer: t ,,, N 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.
This 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
�FS-
D -Box
�r
❑ H2OLine ❑ PWR Line
Following are the specifications for
the se age disposal system on the abpve cap . ed property.
r
I �
Septic Tank: 10 0 gallons Pump Tank: gallons
)
No.
I
width of depth of
t�
ditches
PERMIT (ONDITIONS:
I. 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 ❑ N OIN
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 se age disposal system on the abpve cap . ed property.
Type of system: El
Other sic F-'L- ( !
Septic Tank: 10 0 gallons Pump Tank: gallons
Subsurface
No.
exact length
width of depth of
Drainage Field
ditches
of each ditch I C) feet
ditches feet ditches inches
French Drain Required:
11 et
Authorized State Agent , ��. ___ Date IQ V-7