OPHTE#ILAtHarnett County Department of Public Health 23549
PERMIT # Qr01r00Operation Permit
New Installation '�< Septic Tank `�( Nitrification Line ❑ Repair ❑ Expansion
�^ PROPERTY LOCATION: L-C—� Ceiu�►.ti' L—�NG
Name: (owner) cNcL- SUBDIVISION -® LOT # 3
System Installer:1 L.<uL'Y M �.pl.tys Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X, Public ❑ Well Distance from well 1bP 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.
anis system has peen Installed in compliance wan apphcaule North larohna beneral Statutes, rules for Sewage treatment and uisposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
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 system on the abo a capt aged property.
Type of system: ❑ Conventional Other Septic Tank: q gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Fieldilitthes- �, of each ditch feet ditches 3 feet ditches \8-3y inches
French Drain Required: —��ar feet
Authorized State Agent Date al 41 S