OP RHTE# gyro-5'ASei't(L Harha.it County Department of Public .ealth 24296
PERMIT# Operation Permit
New Installation "f�k Septic TankItrlfication Line ElRepair ❑ Expansior
PROPERTY LOCATION: ROSSFrL s
Name: (owner) SUBDIVISION LOT # 2)�
System Installer. CopID Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X,, Public ❑ Well Distance from well 10 feet
System Type: 1TCb 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 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
PERMIT CONDITIONS
I. Performance:
II. Monitoring.-
Ill.
onitoring:III. Maintenance:
IV. Operation:
V. Other:
I x�
latlraG � ('�Gyo 1
I?
L` 9o1.0
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 cc
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Followin are the s eciDaoso ti n for thedt th b d -
PWR Line
g p si ewage spos sys em on e a ove capstone ,propf rty. ,
Type of system: ❑ Conventional Other UY✓sP—C o Cl-1Av�86rLlG`�� Septic Tank: 1 py gallons Pump Tank: )00 d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 300 feet ditches _ feet ditches inches
French Drain Required:,`\ \ Llne_ar feet
Authorized State Aeent \ Date
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