OPHTE# Hao ;tt County Department of Pubilh. Jealth 23741
PERMIT # �'Z"1 Operation Permit
New Installation �, Se tfc Tank Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: P t ;A
Name: (owner) cf, CQ,<�3s5 SUBDIVISION LOT #
System Installer:F.Q- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: 1:1 Community � Public El Well Distance from well 1 a feet
System Type: ZZ -1 F 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 Uisposal, and all conditions of the improvement rermn ana eons[ruc[ion Numorizaaon.
6
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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
If yes, see attached sheet for additional operation ct
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface of
Drainage Field ditches
French Drain Reauirecl...\,_
maintenance and reporting.
Pump ❑ Alarm ❑
Kther
disposal system on the above ptlone roperty.
"Mt"-gir. — �-1Septic Tank: {OdGi
exact length width of
of each ditches feet ditches
�""'%,,Linear feet
H2OLine ❑ PWR Line
gallons Pump Tank: gallons
depth of
feet ditches a�il-3C inches
Authorized State Agent ,� ���� Date nazi I I