OPHarnett County Department of Public Health 2 3 5 3 1
PERMIT # 0 enation Permit
New Installation Septic TankR)Nc-
Name:
itrification Line F-1Repair El Expansion
PROPERTY LOCATION: J uNa (owner) GASB 5 12> v 1 I-gNSUBDIVISION 1 i LOT
System Installer: Coo- c Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community � Public ❑ Well Distance from well 10 CO feet
System Type: e. 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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No;
If yes, see attached sheet for additional operation co ditions, maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications
for the sewage disposal system on the above captio d property.
Type of system: El
Conventional X Other
�.\a�c NLQ>0�� Septic Tank: a Ob ®
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch a(50 feet ditches
feet ditches I? inches
French Drain Required: inear feet
Authorized State Agent s Date )iD i-�