OP0&_5-11411 t Hat nett County Department of Publt, Health 18773
PERMIT # a$31 Operation Permit
New Installation X Septic Tank ❑ Repair>( Nitrification Line ❑ Expansion
` PROPERTY LOCATION: �socgiPPoo ?'DName: (owner) MoetL. I'6y%T�i' SUBDIVISION 9-o. F -s c . LOT # , I
System Installer. RAti N1noaC Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well 100 feet
System Type: $' Types V and VI Systems expire in S years.
(in accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been instilled in cmnpliance with applicable North Carolina General Statutes, Wes fm Sewage Treatment and Disposal, and an conditions of the Improvement Permit and construction Audtnnation
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No^
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other edi�"ep zsf_ cc_'�19.,cm Size of tank: Septic Tank: IFfnn gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch feet ditches -3 feet ditches 3f--,'$ inches
French Drain Featured: Linear feet
Authorized State Allent as Date
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