OP RHTE# �`S'"`�-3sugs'tZ arnett County Department of Public Health 23783
PERMIT # 28z `/0 Operation Permit
New Installation Septic Tank itri6cation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION
Name: (owner) Sl1BDIVISI
System Installer: j �... egistr ion
Basement with plumbing: ❑ Garage Number of Bedrooms 0 % feet ��,�•
Type of Water Supply: El Community Public ell Distance from well feet
System Type: o t % CZ pes V nd VI Systems expire in 5 years.
(In accordance with Table V a) Owner must conta ealth partment 6 months prior to expiration
This system has been installed in compliance with applicable Nth Carolina General
Rules fpr Sewage Treapent ao Disposal, and all conditions of the
0
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 conditions, maintenance and reporting.
IV. Operation:
LOT # I
permit renewal.
Construction Authorization.
Xes
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property. u R p allons Pum Tank: gallons
Type of system: El Conventional I'Other L54 -Y6 "" —��— Septic Tank: t g P
Subsurface No. of exact length width of depth of
Drainage Field ditches 2 of each ditch J'LO feet ditches feet ditches Z `'"�� inches
French Drain Required: Linear feet
Authorized State A
,A,,,, Date
15-5-35495R (1)
15-5-35495R (2)
15-5-35495R (3)
15-5-35495R (4)
15-5-35495R (5)
15-5-35495R (6)
15-5-35495R (7)
15-5-35495R (8)
15-5-35495R (11) 15-5-35495R (12) 15-5-35495R (13)
15-5-35495R (9)
15-5-35495R (10)