OPHarnett Department
PERMIT # 3-- Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Name: (owner) _ �L.�.y b m
System Installer: is ri.�c.� -tom
Basement with plumbing: ❑ Garage �e Numbe
Type of Water Supply: ❑ Community Public
System Type:
(In accordance with Table V a)
PROPERTY LOCATION: °7 Ws� c
g SUBDIVISION S e,E.s f o 1! L LOT # 1
Registration #
r of Bedrooms
❑ Well Distance from well IM feet
Types V and VI Systems expire in 5 years.
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
rtnrttt Wnuuiuns:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional Other -Z- F "Q%g Septic Tank: 100)0 gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditchzs— of each ditch feet ditches feet ditches
French Drain Required: _ fee
Authorized State Agent >`__ \'11-114-A \ V6 Date l
PWR Line
gallons
inches
� -�- 5- -� A'L� G