OPHarnett County Department of Public Health 23723
PERMIT # Operation Permit
New Installation X Septic Tank V Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M U Goa iV
Name: (owner) SUBDIVISION M2d v g4 LD LOT #
System Installer: M o 5 5 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 0 feet
System Type: Z=% 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.
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This system has been installed in compliance with applicable North Carolina General Statut�es� le folwage Treatment and Disposal, 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.
Il. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox1
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 above captioned property.
Type of system: ❑ Conventional Other FL, t Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches II of each ditch feet ditches feet ditches l '.2 inches
French Drain Required: 6oear feet
Authorized State Agent Date '7 bh�
15- 5-- 3,5 a"y --�