OPHarnett County Department
1 Public Health
PERMIT #7T `� 1 Operation Permit
New Installation )� Septic Tank, ° Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: C�oc�s
Name: (owner) "NA-'nN N cLv�—�e e� to SUBDIVISION P_ LOT # 1
System Installer:'?t_vey,5AN Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: ? ^ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wd Owner must contact Health Department 6 months prior to expiration for permit renewal.
Itis 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
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H111lll LUNUII1U173:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional , Other UE—2—'FLw
Subsurface No. of exact length
Drainage Field ditch- -- of each ditch t d 0 feet
French Drain Required: ,,eLinear feet
Alarm ❑ H2OLine ❑
Septic Tank: 1000 gallons Pump Tank:
width of depth of
ditches 3 feet ditches
Authorized State Agent_ Date r-/ a`7/J S`
PWR Line
gallons
3' __ 1% inches
l� - 5 -32-)1 A