OPHTE# I 1 -S-DHarnett County Department of Public Health
PERMIT # Operation Permit 21 9 9 9
New Installation 'N, Septic Tank X Nitrification Line ❑ Repair O Expansion
~f PROPERTY LOCATION: G~ E.
Name: (owner) f~.tm '100N SUBDIVISION Sf0-,,,4G5 LOT #
System Installer: E,;y SS6 cz, m Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 2~1-
Type of Water Supply: ❑ Communi ❑ Public X Well Distance from well 1<!)0 feet
System Type: c~ 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.
finis system nas been installed in compliance wltn applicable nortn Larollna beneral )tatutes, Kules for )ewage Ireatment and
and all conditions of the Improvement Permit and construction Authorization.
rcfcrnf LVr 10111M s:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ ND%<
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: N ~6 1 J5-'rA"LGI) ~ \ dF ~ntS CE.~:t®N
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal y stem on the above cap tioned roperty.
Type of system: ❑ Conventional X Other Septic Tank: Yd'Z) 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditehe~ of each ditch S feet ditches feet ditches ►g inches
French Drain Required: _ Linear feet
Authorized State Agent Date '1.
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