OPHTE#`G-ti= 39 89L Ha: r,,tt County Department of Publll _ iealth 24368
PERMIT #2�T� Aperation Per *t
Y New Installation 5K Septic Tank 2 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONS!IIV �;w,ea, c�tir..e Agka,/3 Ab
Name: (owner) �/Z �_'f�JSn�nur,�, SUBDIVISION LOT # L
System Installer: —TAr, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Q' Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must con Health Department 6 months prior to expiration for permit renewal.
this system has been instilled in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
PERMIT CONDITIONS
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
D--� or
d t
ri>
�2.IN[t-t I�iWc� �ryyya d7j}a,a�s �2fi
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.
❑ D -Box ❑ Pump ❑ _ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the sewage disposal system o the above captioned property.
Type of system: ❑ Conventional E7 Other Septic Tank: 1 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of , a
Drainage Field ditches Z of each ditch f S� feet ditches 3 feet ditches a '$ inches
French Drain Required: Linear feet
Authorized Stat � '_5 ej'r Date
• - `�. _ -, •moo �'�
16-5-39896R (1) 16-5-39896R (2) 16-5-39896R (3) 16-5-39896R (4) 16-5-39896R (5)
- '-
pq
16-5-39896R (16) 16-5-39896R (17) 16-5-39896R(18) 16-5-39896R(19) 16-5-39896R(20)
Ir" H � n� �. a •.tea % )
16-5-39896R (21) 16-5-39896R (22) 16-5-39896R (23) 16-5-39896R (24) 16-5-39896R (25)
d.
ow
•�..Y��1Z... .. i r -
16-5-39896R (26) 16-5-39896R (27) 16.5.39896R (28) 16-5-39896R (29) 16-5-39896R (30)