OPAarnett County Department
PERMIT #.°�5' Operation Permit
New Installation :R Septic Tank X Ni{� Ification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: to o c, %o
Name: (owner) (. SUBDIVISION LOT #
System Installer: ' Q-Y-1 0�\N Registration #
Basement with plumbing: El Garage 1 Number of Bedrooms -.k-
Type of Water Supply: ❑ Comm ' Public ❑ Well Distance from well "'�) feet
System Type: C_ 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.
[his 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
1 1111111 6VI \VI I IV11 J.
I. Performance: System shall perform in accordance with Rule .1961.
II. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew ge disposals stem on the above captioned property.
Type of system: ❑ Conventional Other VU ®'-! Septic Tank: I gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field 'it &es ` of each ditch 5 feet ditches feet ditches inches
French Drain Reauired: "I
Authorized State Agent r�c_ )-�5 Date t
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1 1111111 6VI \VI I IV11 J.
I. Performance: System shall perform in accordance with Rule .1961.
II. 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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sew ge disposals stem on the above captioned property.
Type of system: ❑ Conventional Other VU ®'-! Septic Tank: I gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field 'it &es ` of each ditch 5 feet ditches feet ditches inches
French Drain Reauired: "I
Authorized State Agent r�c_ )-�5 Date t
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