OP RHTE#cHarnett County Department of Public Health 21 13 7
PERMIT # 00, eration Permit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION:
Name: (owner)yA,i t•~r'~rvc`~u~ SUBDIVISION raerc,~ ter LOT #
System Installer. v Registration #
Basement with plumbing: ❑ Garage K'umber of Bedrooms .3
Type of Water Supply: ❑ Community L~' Public ❑ Well Distance from well feet
System Type: , 2, 1 B 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.
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 Authorization.
t2. _ _ -fX as'
J~
J /
C 1(
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
Following are the specifications for the sew )(e dispo I system on the above captionf$d prope
Type of system: ❑ Conventional Other ro~tp {-d Ca' VCSeptic Tank: 0Q.1
Subsurface No. of exact length width of gallons Pump Tank: gallons
Drainage Field ditches °Z depth of
of each ditch ~7 S feet ditches feet ditches /(y .12 5"~ inches
French Drain Required: Linear feet
Authorized State Agent rL 5
X41 Date D2-01 , wl%o
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.