OPATE #—I S Aarnett County Department of Public Health 2369
PERMIT # '1 peratlon Permit
New Installation . Septic Tank Nitrificatiorl line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Pi., °'
Name: (owner) T -1 SUBDIVISION 0 L- C% QKW 7—) LOT #
System Installer: _. ���� aztic..a� Registration #
Basement with plumbing: ❑ Garage IZI Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 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
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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 ❑ No
If yes, see attached sheet for additional operation co
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional '.9� Other U_2 7..01w Septic Tank: 1(5100 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage -Field ditches L'A of each ditch t 0 0 feet ditches 3 feet ditches 43'3"G inches
French Drain ReQui Linear feet
Authorized State Arent �� ' i5 Date
15-5 0)-,s