OPHTE#t)6 o)f51 j Hallttett County Department of Public Health 19569
PERMIT # a -�7 w Z Operation Permit
93 New Installation -f2!4-- Septic Tank ❑ Repair -Q Nitrification line ❑ Expansion
PROPERTY LOCATION:' n I L
/
Name: (owner) ink Pnr i nc n) SUBDIVISION C -,-s , w, I .la 1\ s LOT # -3-7
System Installer. —r4s!) ).n- Registration #
Basement with plumbing: ❑ Garage 19 Number of Bedrooms i
Type of Water Supply: ❑Community Public [I Well Distance from well S-0 feet
System Type: -7,�) 4 aim, 17 �, c k Lt 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.
Ion system has been mstalled in cmnpliana with applicable Nath (zrolina General Statutes, Rules la Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Commission Authorization
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring As required by Rule .1961.
111. 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.
Following are the spealications for the sewage disposal tem on the above captioned property.
Type of system: El Conventional 'a( Other It a I� Size of tank: Septic Tank: O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
trench Uram Required: \Ismear�feetn \
Authorized State Agent 'c' - \` 1 Date fll)' of