OPHarnett County Department of Public Health 23300
PERMIT # (DC) Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: auto
Name: (owner) vr�e �°�``�� 1�cw SUBDIVISION LOT #
System Installer: 77� . Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well i ° 6 feet
System Type: 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.
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
PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 operation a
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above capt ed property.
Type of system: El Conventional ,� Other "' - i .� Septic Tank: # c-,0C) gallons Pump Tank:
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1'80 feet ditches feet ditches
French Drain Reauired: Lin et
Authorized State Agent � _____ N� "rte Date Co
PWR Line
gallons
inches
1Lj- 5- lac,3�