OP RHarnett County Department of Public Health 23740
PERMIT # �bOperation Permit
New Installation --�K Septic Tank '�Xr Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ZDact
Name: (owner)gnu : SUBDIVISION n „, Crt c, C LOT #
System Installer: , 14 o -t, ; Registration #
Basement with plumbing: ❑ Garage C>Iumber of Bedrooms H
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ` ®® feet
System Type: _ ' s Types V and A 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 ween msianea in compuance min appucaoie norm tarmma ijenerai matures, ewes tor,ewage treatment ano msposai, and all conditions of the Improvement Permit and Construction Authorization.
�62A1V �C1L,�1
rtnMrt LUNuniuns:
I. Performance:
II. Monitoring:
111. Maintenance:
IV. Operation:
V. Other:
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 u
kousE
e
maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other .:L' L.oN'f
Subsurface No. of exact length
Drainage Fieldes of each ditch 3..'J ' feet
French Drain Required: Linear feet
Alarm ❑
H2OLine ❑
Septic Tank: I ®O 0 gallons Pump Tank:
width of depth of
ditches feet ditches
Authorized State Agent ` � ���� 45 Date � 6 6—
PWR Line
gallons
inches