OPHTE# 1L'SHarnett County Department of Public Health
PERMIT # al111~"1 Operation Permit 22441
New Installation X Septic Tank XI Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: UP S-tew NQ:, 9-j>
Name: (owner) Y,6ov4tArc 1--5 Glass SUBDIVISION Soa)ta L 0 T #
System Installer: L-a~*s,C. ~ZHNSaN Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well lY) 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.
ISO,
e
1 P 't ~
s
1j oN
Q,
t
GI Z.
PERMIT CONDITIONS:
1. 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 cc
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E Z~C t~01Y Septic Tank: tO C1 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch t OcJ feet ditches feet ditches V9 inches
French Drain Requiredi feet
Authorized State Agent Date