OP RHTE# a42. Ha,.,ett County Department of Public Health
PERMIT #~qS3 Operation Permit 2 2 4 2 7
New Installation A Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (~v~ccrl~v~ CZZ
Name: (owner) ,ii-'q SUBDIVISION S® LOT
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public '*K Well Distance from well %0-0 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
rtKMI I IUNUII IUNS:
1. Performance: System shall perform in accordance with Rule .1961.
Il. 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:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~Z 'F I-6 v✓
Subsurface No. o exact length
Drainage field ditches ` of each ditch `4;_0 feet
French Drain Required: y ~-,f.l eet
Authorized State Agent t0w
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: N 00 d gallons Pump Tank: gallons
width of depth of _
ditches 3 feet ditches inches
Date Z b't I 1 ~1