OPHarnett County Department of Public Health 2 0 8 0 5
PERMIT # X51-1 °l Operation Permit
New Installation 4!~, Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: 4bt c l
Name: (owner) ii)-o aC-bc N py,-p a_ SUBDIVISION LOT #
System Installer: 's,dA-gr E Registration #
Basement with plumbing: ❑ Garage ❑ ~fln+nbet e4 Bedreet 1uC-) 9 o. O p" c-o-r<
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well lbw feet
System Type: 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.
ims system nas peen mstaueo in
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
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1. Performance:
II. Monitoring.
Ill. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other. ~aac~~~t C ,s~~ Pvl Pt r S~,LL`~o $r; ~~c~~ °N 9~a.11~~1
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other i'umy'a ,s.,~icltr,t Septic Tank: '4500 Q) gallons Pump Tank: ~~ad gallons
Subsurface No exact length width of depth of
Drainage Field ditches --L of each ditch fed feet ditches 3 feet ditches l~'3 inches
French Drain Reouired: \ ~~kDa a
Authorized State Agent Date g\
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