OPHarnett County Department of Public Health
PERMIT # C Operation Permit 21 81 4
fdddd~ New Installation Septic Tank L7 Nitrification Line ❑ Repair ❑ Expansion
,n PROPERTY LOCATION: USerL- -46d
Name: (owner) G -y-t/ ,C.c> 4f-, /tom J` SUBDIVISION e.. .r LOT # 3 Q)
CIA C/
System Installer: bf-.1 .-fs c.d,
Registration #
Basement with plumbing: ❑ Garage Its' Number of Bedrooms 2
Type of Water Supply: ❑ Community AX"Public ❑ Well Distance from well feet
System Type: Z? Gi- 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.
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: eve. #V-4-
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 ❑
Following are the specifications for the sews disposal stem on the above captioned property.
Type of system: ❑ Conventional Other I-- 7-~' F'Cv
Subsurface No. of exact length
Drainage Field ditches -3 of each ditch ~ feet
Alarm ❑ H20Line ❑ PWR Line
Septic Tank: 100 0 gallons Pump Tank: gallons
width of depth of
ditches feet ditches inches
French Drain Required: Linear feet
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Authorized State Agent Date Xa~
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