OPHTE#09 - socl- aIHarnett County Department of Public Health 21 1 7 7
PERMIT # Operation Permit
New Installation [~Z Septic Tank ❑ Repaii~>Z Nitrification Line ❑ Expansion
PROPERTY LOCATION:- A/( Name: (owner) SUBDIVISION LOT #
System Installer: r I c ow Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Suppl A ❑ Community ❑ Public Well Distance from well 1034 feet
System Type: q\-. % t" i & Types V and VI Systems expire in 5 years.
(In accordance with Table V a) 91- 1 Owner must contact Health Department 6 months prior to expiration for permit renewal.
mu system Pas Been mstaieo 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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PERMIT CONDITIONli-
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 ❑ No
If yes, see attached sheet for additional operatio
IV. Operation:
V. Other:
maintenance and reporting.
Following are the specifications for the sewage disposals m on the above captioned property.
Type of system: ❑ Conventional C~1 Other ~'A , t lk ~A Septic Tank: ►J00 gallons Pump Tank: gallons
Subsurface No. Of v7"- exact length ~ width of depth of Drainage field ditches of each ditch AS 0- feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Agent \sA k4 )i ~ 5 Date la- 1