OP RHarnett County Department of Public Health 2 3 5 J
PERMIT # l ® Operation Permit
New Installation � Septic Tank "'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: e cam G t. \Q 4 Aso r t
Name: (owner) arz R!,� C-u -,m SUBDIVISION LOT #
System Installer: )D -.v \,s 1�, tica..z-��A Registration #
Basement with plumbing: ❑ Garaged Number of Bedrooms
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well feet
System Type: 1 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.
ims system nas oeen mstauea m compoance wim appucame norm rarouna uenerai sramtes, naves ror sewage irearmenr ana uisposai, ana au conamons or me improvement rerm¢ ana construcnon Autnorization.
PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
4S A t
"i c)v -5 r,_
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)FI,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above rapt ned property.
Type of system: El Conventional � Other C r�s� c35n ( -C '
Subsurface No. of exact length
Drainage Field ditches 1 of each ditch L--t 0b feet
Alarm ❑ H2OLine ❑ PWR Line
Septic Tank: ldb O gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches �� ®�'`S inches
French Drain Req Linear feet
Authorized State Agent Date
t,A- 5.3a-)Olfz
1L-1-- 5 -3a-1 ovo,
1 �-- � -3a-� o��..