OPHTE#_1 S — Aarnett County Department of Public Health 2 3 6 41,
PERMIT # Operation Permit
New Installation Septic Tank 'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: iri c ca v x.
Name: (owner) rid 55 SUBDIVISION f'l C—C- LOT # 4
System Installer: Esc o5 Registration #
Basement with plumbing: ❑ Garage El Number of Bedrooms 3
Type of Water Supply: El Community' X Public ❑ Well Distance from well 1 O O 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.
inns system has peen installed in compliance with apphcanle North Carolina beneral Statutes, Rules for Sewage treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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 cc
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
French Drain Required_ e
maintenance and reporting.
Pump ❑ Alarm ❑
sewage disposal system on the above captioned property.
Other �� ��-��rr Septic Tank: IOQ�
exact length width of
of each ditch S feet ditches
"Linear feet
Authorized State Agent �`���� &15 Date 5
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches ` inches
5 - 5 - 354 )