OPHarnett County Department of Public Health 23295
PERMIT Operation Permit
New Installation Septic Tank "'� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:i,�.��.� i3c>wa�t6`io�
Name: (owner) � fqy CGS SUBDIVISION nP�m-�F 2>C-_LL_ '?_ -.tic E LOT #
System Installer: Hc>, <tz ;,.f o C,- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: =;5 Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
finis system has been installed in compliance with applicable North larolma beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
rr.nrn, MIUMV113:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: Z_N s ; tca t_. C-GPDa "Q' s '54 o ,cam, i3 vC`7 - 60 �t �cne� v S; ug in : ' CL
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR line
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other _ Z Septic Tank: t 40 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches �'2� inches
French Drain Required: sn _ inear feet
Authorized State Agent 7� \ R(_N-11 5 Date
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