OPHTE# / yip art. -`t County Department of Public .'ealth 23423
PERMIT # o2—Z 6 Operation Permit
X'New Installation Septic Tank Ci Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) .4 ks- ConAn- - `Lon SUBDIVISION LOT # -ZIf
System Installer: f�k :�_ Registration #
Basement with plumbing: El Garage El Number of Bedrooms ,7
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: LYL q 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 Larohna beneral }tatutes, naves for )ewage treatment and uisposal, and an conditions or the improvement rermtt and Lonstrucbon nutnorization.
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if 1 5
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PERMIT CONDITIONS:
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 ❑ 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 sewaa disposal system o� the above captioned property.
Type of system: ❑ Conventional J/J Other �ZP -7, Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ! of each ditch a d0 feet ditches feet ditches (P.- inches
French Drain Required: Linear feet
Authorized State Agen -.. Date & :3 /ZIZYI
/ q °s - ,3qr 60