OP RHarnett County Department of Public '.'I •
PERMIT # '�- IC-021 Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1 Q Pi
Name: (owner) SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 51 -X4(l
Type of Water Supply: ❑ Community ❑ Public �< Well Distance from well 50 feet
System Type: 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.
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned prty.
Type of system:
El X Other E r e
�1TX K-i, a Septic Tank: `fib C) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of WA -3 t
Drainage Field itc es — _ of each ditch J 0 feet ditches � feet ditches �,/
! inches
French Drain Required\
Authorized State Agent �� ~�y Date 11A1
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