OPHTE # 17- 5 - 9 H arnett County Department of Public Health
PERMIT # 2: l S ' Operation Permit / 22453
/New Installation Septic Tank CZ' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Sc jyYQ za Po-b
Name: (owner) _(3 L SUBDIVISION :5w"� LOT #
System Installer: FF Registration #
Basement with plumbing: ❑ Garage lirNumber of Bedrooms
Type of Water Supply: ❑ Community I1 Public ❑ Well Distance from well feet
System Type: 7 +r m 1 ?40L T e 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 Carol General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961. ° " V f„*•-
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 conditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications
for the sewage
disposal system on the above captioned property.
Type of system: ❑
Conventional Other
Septic Tank: 1
gallons Pump Tank: /1 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch feet ditches 3
feet ditches inches
L %°le
is 14.1
French Drain Required: Linear feet
Authorized State ent - Date el a zq'1 L
12 -5 -29348 (2) 12 -5 -29348 (3) 12 -5 -29348 (4) 12 -5 -29348 (5) 12 -5 -29348 (6)
12 -5 -29348 (7) 12 -5 -29348 (1)