OPHTE# 0 �j'�3�15� arnett County Department of Public Health 23724
PERMIT # Operation Permit
New ®Installation X Septic Tank 1`_ Nitrification Line ElRepair ❑ Expansior
PROPERTY LOCATION: G _
Name: (owner)SUBDIVISION `T���S� �fl�t- LOT #
System Installer: 5� c) yn o N,, L -v Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communiy Public ❑ Well Distance from well 4 Z) Q) feet
System Type: _ Li 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
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PtRNII LUND11IONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Na
If yes, see attached sheet for additional operation c(
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Bax ❑ Pump ❑ Alarm ❑
Following are the specifications for th sewage dispol system on the ab 'v c toned property.
Type of system: ElConventional Other L'-��_"a � Septic Tank: t C)0 ,
Subsurface Nor -of exact length width of
Drainage Field ditches of each ditch t o feet ditches
French Drain Required: n ® r feet
Authorized State Agent :!� �4'f S Date
H2OLine ❑
gallons Pump Tank:
depth of
feet ditches
'15�1
PWR Line
ll'W inches
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