OP RHTE#`o~-~' any'-~'16~ Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 3 3 7
New Installation ~ Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC,1)05
Name: (owner) ~ac 2,y S cl -\,4,50m 1AuTcNE6, SUBDIVISION Gw ,,,t 00.5 LOT #
System Installer: CJh ).,5 c-~t -Q,rsS~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1~ a feet
System Type: 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 LONDITIONS:
1. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field -'Tt ttch-~
French Drain Reouira6,
Pump ❑ Alarm ❑ H20Line ❑ PWR Line
sewage disposal system on the above captioned property.
Other PV <,N9 --y, ~_Z"Fipw Septic Tank: VQ)®ei gallons Pump Tank: 100O gallons
exact length width of depth of
of each ditch S feet ditches feet ditches inches
Dear feet
Authorized State Agent QG*1%5 Date CI)
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