OPHarnett County Department of Public Health 24120
PERMIT # �' Operation Permit
)91 New Installation Se tic Tank' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Bow Fac
Name: (owner) "A -0A C0 0512-V (-;;oa5 SUBDIVISION 0AY-s-10 ss LOT # j
System Installer: Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 1-1
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well LO O feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This 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 Authonaanon.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
maintenance and reporting.
V. Other. )N To C ,,c&7_ .SsaPtiaw. 'Pt..PCFn L.aNGz
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E_2— P7!_aW Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field 1 of each ditch 3'} feet ditches feet ditches inches
French Drain Require Linear feet
Authorized State Agent Date z 3