OPHarnett County Department of Public Health
1
PERMIT # Operation Permit
New Installation Septic Tank `�° Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: '6 —
Name: (owner) YL—, (-UQ.- SUBDIVISION0vG,,4 LOT # QCT 1
System Installer: Com,, Registration #
Basement with plumbing: ❑ Garage �< Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 160 feet
System Type: c 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.
ias system nas peen mstanea in compoance wan appncaoie norm carouna k3enerai statutes, noes for sewage ereatment ana uisposai, ana an conamons or me
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other:
E LRoac, Q !►Q
maintenance and reporting.
rerma ana construction eutnonzation.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system tional Other "Z V�caw Septic Tank: 1 C C3 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch QL00 feet ditches feet ditches inches
French Drain Required: f
Authorized State AtrentDate R ac A S_
I --S� � 'Y�