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OPDepartmentofPublic PERMIT # 7 `3581 / Operation Lr ration Perm —/ ❑ New Installation � Septic Tank Nitrification Line ❑ Repair ❑ Expansion PROPERTY LOCATION:? r �x�� � �d•� Name: (owner) 1-u/ / r �. SUBDIVISION LOT # 3 System Installer: Registration # Basement with plumbing: ❑ Garage ❑ Number of Bed oms _q Type of Water Supply: ElCommunity ElPublic © Well Distance from well /®y' 4" feet System Type: ilu , 4-o es% � �S. 2 es V and VI Systems expire in 5 years. (In accordance with Table V a) Owner must contact lth Department 6 months prior to expiration for permit renewal. This system has been installed in compliance with applicable North Carolina General Statutes, Rules for PERMIT CONDITIONS: I. Performance: 11. Monitoring: III. Maintenance: IV. Operation: V. Other: .xr�a L � a irte— Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. t -tea ��- 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. ❑ D -Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line Following are the specifications for the sewa disposal system on the above captioned property. Type of system: ❑ Convent ZOther Z<% )Z61>ycrLv— Septic Tank: 10& gallons Pump Tank: dgallons Subsurface No. of exact length width of depth of > t Drainage Field ditches of each ditch Lf 56 feet ditches feet ditches inches French Drain Required: Linear feet Date Authorized State A nt %�v��h > � . yy,. � � . ....... .. . .,�«�r. y:, 165-3602 (1} 165%2/ (2) 15-5-36010 (3} 15-5-36010 (4} 15-5-36010 (5)