OPHTE#-\ I -5-'a'1'1~-,A. Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 7 4 2
New Installation Se tic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: YP~ GSA C~ay(Ltk
Name: (owner) C.,. SUBDIVISION C;1P (LG55 9o r r,, :E LOT # C,
System Installer: vN cr779 E~ S Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Li
Type of Water Supply: ❑ Community~ Public ❑ Well Distance from well ! b0 feet
System Type: )p 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 CDNDITIDNS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoIR
If yes, see attached sheet for additional operation c(
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Qv mP NO L21-FI-) Septic Tank: 1600 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches ° of each ditch 3bC) feet ditches feet ditches inches
French Drain Reauired: "&ear_feet
Date
Authorized State Agent
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