OPHarnett County Department of Public Health 23398
PERMIT # Operation Permit
X New Installation � Septic Tank Nitrification Line El
❑Expansion
PROPERTY LOCATION: Reoss E ` -,-
Name: (owner) SUBDIVISION \-A L-4 c- N e. LOT #
System Installer: L_. P CvLj S >-j o cLQ & Registration #
Basement with plumbing: ❑ `O Ga�ra e X Number of Bedrooms _3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 1 ®U 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.
ins system has peen installed in compliance wnn
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North larohna 0eneral )tatutes, NUles for )ewaee treatment and Ulsoosal, and all conditions of the Improvement rermn and t.onstructton Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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 s stem on the above captioned property.
Type of system: El Conventional )< 'Other 0Z VZ , Septic Tank: \00 r) gallons Pump Tank: gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch 79 C feet ditches 3 feet ditches ) inches
French Drain Required: r feet
Authorized State Agent �\� Date
114- 5--3W.6