OPHarnett County Department ,. Public a a 1
PERMIT O.iDeration Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION' 1 V_o
Name: (owner) 7-.1- -L p,cL—c �An cnE2 SUBDIVISION �c*.�.® cAs �e� e t LOT #
System Installer: -,_57oK4@f2 �SQ.Oy`G Registration #
Basement with plumbing: ❑ Garage '>0umber of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well c b ® feet
System Type: 0, 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 oeen mstauea in compuance wo appucame nortn Lamina aenerai statutes, naves for sewage ereatment ana
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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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewige disposal system on the above captioned roperty.
Type of system: ❑ Con entia Other C_" aw, t?s �� u Septic Tank: 6t°?O ® gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 1 of each ditch L 5 b feet ditches feet ditches 3(-"Qt") inches
French Drain Required: Lilnar e
Authorized State Agent Date