OPNTE# N- HanitLt County Department of Public wealth 1 9 7 9 5
PERMIT # ✓—) N— Operation Permit
���1!_New Installation -&—Septic Tank ❑ Repaii;40 Nitrification Line ❑ Expansion
PROPERTY LOCATION: \ �-
Name: (owner) wri SUBDIVISION Co Z,M) TT iu LOT #
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System Installer: ��) r PA 1, Lomas- Registration #
Basement with plumbing. ❑ Garage O� Number of Bedrooms 2—
Type of Water S poly: /01 ommunity Public ❑ Well Distance from well $ J feet
System Type: L n— n., 4 1 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.
Ibis system nos been imtalled In compliance with applicable North Carolina General Statutes, Rules fa Sewage Treatment and Disposal, and all mndiliom of the Imprmement Permit and Canstmclion Authanution.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional oyer;
IV. Operation:
Other.
1961.
maintenance and reporting.
following are the specifications for the sewage disposalstem on the above captioned property.
Type of system: ElConventional Other i
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