OP4 rHarnettCounty Department Public
•r'
PERMIT # Operation Permit
v New Installation 'K Septic Tank Nitrification Line El Repair ❑ Expansior
PROPERTY LOCATION: %-"- L-vcp�t'
Name: (owner) SUBDIVISION 8,4Ga- TwsaS'cA- LOT # 113
System Installer:ra2s»S97Q C- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: G 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 has been installed in compliance with applicable North Larolma General Statutes, Rules for Sewage Treatment and
rtRrn I I.UNUI IIUNS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
and all conditions of the Improvement Permit and Construction Authorization.
S J' "CL --i Sri a .
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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other fes. -2� Septic Tank: tU0 r)
Subsurface exact length width of
Drainage Field ditches of each ditch 5 feet ditches —3
French Drain Required: n t
H12O1-ine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches 4 a inches
Authorized State Agent �, �_ ��� ``� Date r.15—
15 -- S- 3 S' 0� �2�