OP R1��.Health
23628
PERMIT #--1ti0 Operation Permit
J New Installation X Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
�\ PROPERTY LOCATION: \-I%�
Name: (owner) S4cyyy �1Vrn&5 �--I--c- SUBDIVISION t. o,w S's 2,25 LOT # C-z,`l
System Installer: \-1 ao)rt � C— Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 O ® feet
System Type: 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
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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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:SGC-.. 5 V-:ec+c.- b c.Q I)C- IF,N e.�� 1-0GAI )da
❑ D -Box ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned -property.
Type of system: ❑ Conventional ,)52 Other Py rr,q e Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditch3 of each ditch ® feet ditches _
French Drain Required: Linear feet-
Authorized State Agent\\ . 'Vk�" v __«N\5 Date
gallonsPump Tank: 1100 0 gallons
depth of
feet ditches f �' -a' l inches
�3 -�-, 5 6 -2,7 //?-