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PERMIT # �—� 1Q� eration Permit -
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lew Installation 11--Sep-tic Tank J�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Uav-'�rfu Csr(l
Name: (owner) noVcc�-- SkAkC,jlM SUBDIVISION QZti A rzsnvsc 51g, LOT
System Installer: i%A Registration #
Basement with plumbing ❑ Garage h" er of Bedrooms
Type of Water Supp,.' ❑ [ommuniry CYPublic ❑ Well Dist from well feet
System Type: 25`/n llamaut- N iAt Types V and VI Systems expire in S years.
(In accordance with Table V a) Owne must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Saates, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorisation
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring. As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D•Box ❑
Pump ❑
Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewagedi3pposal
system on the above captioned roperty.
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Type of system: ❑
Conventional O'Other
Z$% a,A. �2
Septic Tank: lr>cj6 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch /(X0 feet
ditches 3 feet ditches Zn inches
French Drain Required:
linear feet
Authorized State Agent Date
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