OPCounty DepartmentofPublicHealth
23622
PERMIT # 5� Operation Permit
New Installation Septic Tank Nitrification Line ❑ Re air ❑ Expansion
PROPERTY LOCATION: \'A 0-a114 61 0
Name: (owner) G,;N-j C-5 SUBDIVISION r4.) LOT #
System Installer: N," S Z.Q'S 1 G Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well b O feet
System Type: o 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.
11t�
q - 1 T
r
110vSE
t
'T1 LQ SS JaOVA 1AN Q�
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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_I-K�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewa a disposals stem on the above captioned property.
Type of system: ElConventional Other Z VL -a Septic Tank: 1 �% gallons Pump Tank: gallons
Subsurface No. of exact length 0 width of 12, depth of
Drainage Field ches of each ditch feet ditches feet ditches inches
French Drain Required: Lind et
Authorized State
Date 91 D