OPHTE# )S^-�5_ —AHarnett County Department of Public Health 23782
PERMIT # 28q Sy Operation Per it
New Installation Septic Tank /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIONSzil- hk-XA)s' /z1S
Name: (owner) C_6nAvx_� �► SUBDIVISION LOT # 5'Z_ _
System Installer: 7055cM. fPKwW* s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Q' Public ❑ Well Distance from well feet
System Type: 254'6 I'U-2ih) C TXAr-j - 975 Z. % o s V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must c6hlfAralth 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.
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PERMIT CONDITIONS:
I. Performance:
IL 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 ❑ _
Following are the specifications for the sews a disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other 1!;%M0Cl—te- Septic Tank:
Subsurface No. of exact length width of
Drainage Field ditches 3 of each ditch �� feet ditches _
French Drain Required: Linear feet
Authorized State Age
H2OLine ❑
PWR Line
/Dao gallons Pump Tank: gallons
depth of
'3 feet ditches 7, inches
Date $ 11 1.5—
15-5-36366 (1) 15-5-36366 (2) 15-5-36366 (3) 15-5-36366 (4) 15-5-36366 (5)
15-5-36366 (6) 15-5-36366 (7)