OPHTE# 0j- ~5-- I9-D 3) Harnett County Department of Public Health
PERMIT #Operation Permit 2 2 0 9 0
New Installation ❑ Septic Tank D"' itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 17tf), ~ -i- rr~i A:crje/ .,i SUBDIVISION .a-> " ~ ~•c~z~.._ LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Dumber of Bedrooms 3
Type of Water Supply: ❑ Community IJ Public ❑ Well Distance from well feet
System Type: ? IZlvcfk',-` le, K-Z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner st contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with
i~r
North Carolina General Statutes, Rules for Sewage Treatment and
7
2
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PERMIT CONDITIONS:
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance wtt u e .
As required by Rule .1961. Lt 5? .5v its /Lp
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D-Box ❑
Pump ❑
Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa a disposal system on the above captioned property.
Type of system:
❑ Conventional EOther;
n~?-/&i oteu
Septic Tank: JO&0 gallons Pump Tank: gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
of each ditch ► 70 feet
ditches -3 feet ditches ZI inches
French Drain Required: Linear feet
Authorized State A Date -2 l r
Permit and Construction Authorization.
Ila
and all conditions of the
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