OP4TE# Aarnett County Department of Public Health
PERMIT Operation Permit
New Installation �< Septic Tank Nitrification Line El Repair El Expansion
PROPERTY LOCATION: 1.
Name: (owner) CP'v cz> 011_0 11,14 r. SUBDIVISION W LOT # ` ZS
System Installer: € -, C Registration #
Basement with plumbing: ❑ Garage "�W' Number of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t 0 15 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 larohna beneral )tatutes, 6ules for )ewage treatment and Uisposal, and all conditions of the Improvement Permit and lonstruction Authorization.
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PERMIT CONDITIONS:
1. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D -Box ❑ Pump ❑ Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above, caption ♦ roperty.
Type of system: ❑
Conventional Other A��
Septic Tank: ���
gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length
d' es of each ditch feet feet
width of
ditches
depth of
feet ditches �`� inches
French Drain Required:
— _ ______ .Linear feet
Authorized State Agent Date 10131