OPHTE#lb— 5-3%Harraett County Department of PubliL Health 24129
PERMIT # 15171� Operation Permit
H"Iew Installation Septic Tank ErIN'itriftcaetion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /Dab DLct
Name: (owner) , SUBDIVISION LOT #
System Installer: i ag 'Joy -0'e2, Registration
Basement with plumbing: ❑ Garage LXNumber of Bedrooms_
Type of Water Supply: ❑ Community ublic ❑ Well Dista ce from well feet
System Type: �'� o.p_ �'� Types V and VI Systems expire in S 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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PERMIT CONDITION4
I. Performance:
II. Monitoring:
III. 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 conditions, maintenance and reporting
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewag4 disposal system on the/�bo�f captioned property.
Type of system: ❑ Conventional Q Other �.y�Knl Septic Tank: U 0 d gallons Pump Tank: 00 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches �_ of each ditch r7 feet ditches_ feet ditches "�y' inches
French Drain Required: Linear feet
Authorized State Agent'— �7rtt� Date J ' Zk —1
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