OP R]TE # 1 (3 — S - �" Q Aarnett County Department of Public Health 2 3 0 3 V,
PERMIT # j Operation Permit
New Installation 7K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 2) 6Z.p,�. DiL ';v a
Name: (owner) vA A. Gy rn SUBDIVISION Q-d s s MC,9- 9 a.,� LOT #
System Installer: a V4C-N - v, �0(—�(15 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 4.1
Type of Water Supply: ❑ Community Public ❑ Well Distance from well C ®O feet
System Type: y 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.
Ims system has peen Installed In compliance with apphcaole North t.aroima beneral statutes, Rules for Newag
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Ireatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications
for
the sewage disposal system the above captioned property.
Type of system: ❑
Conventional
( Other —Z-- z—dw Septic Tank: 0O CQ0
gallons Pump Tank:
Subsurface -- _ _
No. f
exact length width of
depth of
Drainage Field
ditches
of each ditch —1 S feet ditches —
feet ditches
French Drain Reauired:
•.
.. idea► feet
Authorized State Agent ��a �`\�� )�5 Date
PWR Line
gallons
inches
► ®- 5 ILL LMi ,