OPHTE# 1,5- 5- OJ'59 6 arnett County Department of Public Health 23676
PERMIT # I8l 6& Operation Per It
dNew Installation L" Septic Tank E� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ..1 'P.
Name: (owner) %�i�ttJ �n✓� 1��✓ SUBDIVISION �, �� �e LOT # /
System Installer: Ve 09 Registration #
Basement with plumbing: ❑ Garage � "ber of Bedrooms �
Type of Water Supply: El Community �YPublic ❑ Well Distance from well feet
System Type: 9 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 aoolicable North Carolina General Statutes. Rules for Sewage Treatment and Disnnsal_ and all rnnditinns of the lmnrnvement Permit and rnnctrurtinn dnthnri7ntinn
rtKMII LUNUIIIUM:
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
111. 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 sew disposal on the above captioned property.
El of system: Conventional Other Septic Tank: /00() gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f of each ditch f 0 feet ditches 3 feet ditches �' inches
French Drain Required: Linear feet /
Authorized State Adept/ �i�
/%,/` Date (� I 2°/J�
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rtKMII LUNUIIIUM:
I. Performance: System shall perform in accordance with Rule .1961.
IL Monitoring: As required by Rule .1961.
111. 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 sew disposal on the above captioned property.
El of system: Conventional Other Septic Tank: /00() gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches f of each ditch f 0 feet ditches 3 feet ditches �' inches
French Drain Required: Linear feet /
Authorized State Adept/ �i�
/%,/` Date (� I 2°/J�