OP RHTE# 06 - s-'A'1 *9 Har nett County Department of Public rlealth 19259
PERMIT # Zu (}O y Operation Permit
Id New Installation D"'
~l Septic Tank ❑ Repair I Nitrification Line ❑ Expansion
PROPERTY LOCATIONS-/YJY ToVxZnJ Ffic. et>
Name: (owner)OsS/,& ~Sctr~GS SUBDIVISION -Mq~,j Fem.,,; LOT # I3
System Installer. Low,ur E ,TH Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms St._
Type of Water Supply: ❑ Community ❑ Public ❑ Well Distance from well feet
System Type: ZMUD C~ o-J e 4 G 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.
ims system has oeen imtalkU in compliance with applicable North tarolma tieneral Statutes, Rules for Sewaee Treatment and
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and all conditions of the Improvement Permit and Construction Authorization,
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1. Performance:
11. Monitoring.
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
IV. Operation:
V. 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 sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other 159b1~r~uca ts~J rs,t Size of tank: Septic Tank: /lt~o c, gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch Z feet ditches 3 feet ditches Z N inches
French Drain Required: Linear feet
Authorized State Age Date
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