OPHTE# QP1-SHarnett County Department of Public Health 21 2 51
PERMIT # 2-5'1'1 Operation Permit
New Installation )K Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: ~L2~~~. P2
Name: (owner) ~LPc.wF_ 1~ntY,~~ SUBDIVISION LOT # X1`'1
System Installer ~'Ns J-rn.,c,~ct t Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well LO 0 feet
System Type: :;Zz d 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.
ms >pmn uas peen ins[anea in
vntn applicable North Carolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
L-Q1'-'1E Qom.
DCCMIT rnm NTIAM
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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other L-Z. ~1ow Septic Tank: ~DO6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch d feet ditches 3 feet ditches 3(Z) ' inches
French Drain Reouired: ~I;npl.fppt
Authorized State Agent ir- ,5 Date
✓ 600~06-St- OU-
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