OP Ri�
HTE# -7 � q ei . ett County Department of Publ, Health 20244
PERMIT # 1 Operation Permit
New Installation, .Septic Tank El Repair Nitrification Line El Expansion
PROPERTY LOCATION: A16 d
Name: (owner) uljbi C" A SUBDIVISION LOT # � Q
System Installer: Registration #
Basement with plumbing: ❑ Garage 72f Number of Bedrooms
Type of Water Su ply: El Community Public El Well Distance from well `s feet
System Type: 'fl '2 F ll � Types V and VI Systems expire in 5 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:
III. Maintenance:
IV. Operation:
V. Other:
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.
Following are the specifications for the sewa disposal sy em on the above captioned property.
Type of system: ❑ Conventional Other k i� Septic Tank: i gallons Pump Tank: - gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date ��
q
J-
�
�
�
g
!�
�
M
m: