OPHTE# SHarnett County Department of Public Health
PERMIT # X13 LA Operation Permit 21 5 8 0
New Installation X Septic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I-) C:)--l
Name: (owner) C g trgtAa V\pr,,e:-l.-Ac, SUBDIVISION M~~E LOT
System Installer: E a {Lp. tc t Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community. Public ❑ Well Distance from well t 4 d 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 Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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I cdNV. ~
P~ctE-t~
PAN 16
115'
L-1~
a
V 4S'
L
DCDMIT rnunlrlnur.
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other
Subsurface system operator required? Yes ❑ No x
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box
❑ Pump ❑ Alarm ❑
H201-ine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the abo a captioned p
Type of system: ❑
Conventional
Other C✓»~r~rL Septic Tank: 1 o
77
X
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch ai5 feet ditches
feet ditches inches
French Drain Required:
I indS. fnuf
Authorized State Agent gx--)~5 Date 1Zj `tj)(5
1 O --S - `~35
~9'' Alm"