OPHTE# r�- 5=�ra. arnet County Department of Public Health
PERMIT #� Operation Permit 233919
l New Installation Septic Tank Nitrification Line 11 Repair F-1 Expansion
PROPERTY LOCATION: t._..�ct�;Q,P,
Name: (owner) ►ga 5 SUBDIVISION LOT #
System Installer: Q:>"1'=' tt.,tc`G.t —ta'vD Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms --4
Type of Water Supply: ❑ Community X 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
PERMIT CONDITIONS:
I. 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:
V. Other:
❑ ID-Box ❑ Pump ❑ Alarm ❑
Following are he specifications for the sewage disposal system on the above captioned property.
Type of system: entional J' Other Nresq---� C, E :-L e>v Septic Tank: 1' 00 0
Subsurface No. of exact length width of
Drainage FieldItches of each ditch r-5 feet ditches
French Drain Reouir% r feet
Authorized State Agent Date
1-12O1-ine ❑
PWR Line
gallons Pump Tank: 100 O gallons
depth of
feet ditches inches
an
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