OPHTE# /`/ ari,,t County Department of Public .,4th 2 3 3 6) 6
PERMIT # 2-80(a Operation Permit
New Installation [?""Septic Tank 2--Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:Zk-17t/ ,!tiZ, ,kLe, /4�
Name: (owner),�,,,o,a c,a, tY,,_ SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ kmber of �Bed 3
�rooms
Type of Water Supply: El Community Zr Public L2' Well Distance from well oo ' feet
System Type: s °� jlpvcsu, T & Types and VI Systems expire in 5 years.
(In accordance with Table V a) I�u, `�wner us contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General S R ules for Sewage Treatment an Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule- F9bf - -�
II. Monitoring: As required by Rule .1461.
III. Maintenance: As required by u
Subsurface system operator required? Yes ❑ No ❑ -!1 ! / 114,iAtJC �
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 sewa a disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z5-';& t rr.. Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch 6 feet ditches feet ditches 44—"g inches
French Drain Required: Linear feet
Authorized State Ag Ci�� __ �5 Date jo —/O
14 -5- 33485(2)
14 -5 -33485 (3)
14 -5 -33485 (4)
14 -5 -33485 (5)
14 -5 -33485 (6)
14 -5 -33485 (7)
14 -5 -33485 (8)
14 -5 -33485 (12) 14 -5 -33485 (1)
14 -5 -33485 (9)
14 -5 -33485 (10)
14 -5 -33485 (11)