OPHTE# Harnett County Department of Public Health
PERMIT # ~~a 7 S Operation Permit 2 21 9 0
Rr New Installation R"-Septic Tank Nitrification Line ❑ Repair ❑ Expansion
p PROPERTY LOCATION: ~o ve ~.n
Name: (owner) f e.rrv t~vrf~/1~S"~~ (e# SUBDIVISION LOT # k~
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community I" Public ❑ Well Distance from well feet
System Type: 77Z G 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 Larollna beneral )tatutes, naves for )ewage treatment and uisposal, and all conditions of the
Alarm ❑
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 01
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the s disposal system on the above captioned property.
Type of system: El Conve ewa
ntional Other -I'/ Cko. I
Subsurface No. of exact length
Drainage Field ditches of each ditch 306 feet
rermlt and lonstruCtlon Authorltation.
H2OLine ❑
PWR Line
Septic Tank: /00,0 gallons Pump Tank: gallons
width of depth of r
ditches feet ditches 167- z7 inches
French Drain Required: Linear feet
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Authorized State Agent ~l Date V J, lzc"12-
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