OP• Department of Public1 2355
PERMIT # 2�— Operation Permit
l New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 7:�,-Nq5�: Q,,-< QL
Name: (owner) `v�.t>,�1 �C sc;.u� �,GN7 SUBDIVISION P i--�mf�-j C2,ossLOT # -)
System Installer. Registration #
Basement with plumbing: ❑ Garage ;Eg� Number of Bedrooms��
Type of Water Supply: ❑ Communi k Public ❑ Well Distance from well 1010 feet
System Type: c, 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.
ims system nas peen mstauea in compliance with applicable North Larolma beneral Statutes, Rules for Sewage Ireatment and
NtKMII LUNUIIIUNS:
I. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
11okSF—
p(q�, tc--
and all conditions of the
a
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No,�Z
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: 10®G gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditc es of each ditch feet ditches ' feet ditches )"��` inches
French Drain Required: lk�l___ Linear feet
Authorized State Agent�� ��`�, Date 3
I - b- 350�q