OPHarnett County Department of Public Health 24572
PERMIT # �) t'� Operation Permit
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: $ct •6s5
Name: (owner) Goat-) N0Sti+6,5 SUBDIVISION g+raNG,65, FPctsr LOT #
System Installer: C -co Q' y -,r vGca, Registration #
Basement with plumbing: ❑ Garage �5 Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: = b 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 Dicpocal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
too
�iovSC
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2d �
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 ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above
captioned property.
Type of system: ❑ Conventional
I Other 9U TV7, 0 QU1a`
Septic Tank s Oa 0
gallons Pump Tank 1 000 gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
1 of each ditch
300 feet ditches 3
feet ditches S inches
French Drain Required:
Linear feet
Authorized State Agent � : � E8- Date Oyl