OPHarnett County Department of Public Health 24500
PERMIT # 3S$ Operation Permit
New Installation Septic TankNitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATIONS /c/(/A/"1efZ t)S 9-b
Name: (owner) / / SUBDIVISION 00kZA LOT #
System Installer. 7b Registration #
Basement with plumbing: ❑ Garage � Imber of Bedrooms S
Type of Water Supply: ❑ Community Id' Public ❑ Well Distance from well feet
System Type: z5''�fte42..i� t_� �1,a TyA�s�i L,�! Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact H�th Department 6 months prior to expiration for it renewal
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This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the ImuofrmentKermit and Contraction Amhorizatinn.
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5rb
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ElConventional ElOther IS% /�R�r�r�'t-�� Septic Tank: 106 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch3ip[7 feet ditches j feet ditches 19—neo inches
French Drain Required: linear feet
Authorized State Agen Date 0— b "I
Ytl
9 �
17-5-40980 (1) 17-5-40980 (2) 17-5-40980 (3) 17-5-40980 (4) 17-5-40980 (5)
J 4r-
17-5-40980 (6) 17-540980 (7) 17.5.40980 (8) 17-5-40980 (9) 17.5-40980 (10)
17-5-40980 (11) 17-5-40980 (12) 17-5-40980 (13) 17-540980 (14) 17-5-40980 (15)
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1 ry.
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L'u7W lor
17-5-40980(16) 17-5-40980 (17) 17-540980(18) 17-5-40980(19) 17.5-40980(20)
wit:
ids
17-540980(21) 17-5-40980`(22) 17-5-40980(23) 17-5-40980 (24) 17-5-40980 (25)
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17-5-40980(26)