OP RCounty Department1Public // d
PERMIT # a&� JZ 7 Operation Permit
P" New Installation 2'—Septic Tank R"'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: l,. ; i l L Qc-,r 2d
Name: (owner) , } .I "�,,:• I e� SUBDIVISION LOT #
System Installer: C Registration #
Basement with plumbing: ❑ Garage E❑ umber of Bedrooms
Type of Water Supply: El Community L�' Public ❑ Well Distance from well feet
System Type: ,jl7� 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.
nns system nas oeen msianeo m compuance wan appucame Norm carouna beneral Statutes, Rules for Sewage Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
c%eC-ke - ,1 0-, til ) -6
renrui WIVUIHURY
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 -Bax ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewa a posal system on the abov captioned property.
Type of system: ❑ Conventional Other _ao'tc,u q U«Jt-- Septic Tank:
Subsurface of exact length width of
Drainage Field ditches of each ditch .BOO feet ditches _
French Drain Required ter feet
Authorized State
H2OLine ❑
PWR Line
/000 gallons Pump Tank: gallons
depth of
3 feet ditches / gy inches
Date '�! i5
i
T I
renrui WIVUIHURY
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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 -Bax ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewa a posal system on the abov captioned property.
Type of system: ❑ Conventional Other _ao'tc,u q U«Jt-- Septic Tank:
Subsurface of exact length width of
Drainage Field ditches of each ditch .BOO feet ditches _
French Drain Required ter feet
Authorized State
H2OLine ❑
PWR Line
/000 gallons Pump Tank: gallons
depth of
3 feet ditches / gy inches
Date '�! i5
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