OP RHTE# OHarnett County Department of Public Health 2 0 5 3 9
PERMIT # ra51 1 Operation Permit
~9,, New Installation ~K Septic Tank ❑ Repair"N Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner) CL-Ku.-f-- NdMs-i SUBDIVISION C,~~t✓w~ ba.~~ LOT # ltd
System Installer: J o N ~5 S \ c- Sc(.Y~ cj;- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t00 feet
System Type: - -4~ o, 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.
finis system nas Deen mstanea 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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I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qu;c--4 CA oNrr,®ea, (ti Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches of each ditch ol`3 feet . ditches 3 feet ditches 316 inches
French Drain RequiretL_ car feet 58
Authorized State Agent \ f~S Date 3