OPHTE# QcT-- -,Z2-%1 Harnett County Department of Public Health 2 0 7 0 4
PERMIT # a S~S~(7 y Operation Permit
ff New Installation Lam" Septic Tank ❑ Repair RNitrification Line ❑ Expansion
PROPERTY LOCATION: d 4e f-4
Name: (owner) ter, ca,. ~or..e r,>1~~L. SUBDIVISION -7-,`/l -;CA Pte, LOT # -73_
System Installer. t-a c v SP4 : c Registration #
Basement with plumbing: ❑ Garage ~ umber of Bedrooms 3
Type of Water Supply: ❑ Community LK Public ❑ Well Distance from well 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 ermit rene al.
This system has been installed in compliance with applicable North Carolina General Statutes Rules for Sewage Treatment and Disposal and all conditi a Improvement Permit and Construct Authoraation.
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PERMIT CONDITIONS: A
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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. fns U
Following are the specifications for the seewws disposals stem on the above captioned property.
Type of system: El Conventional Ld'Other Z. &0 c,'--' Septic Tank: f00 a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch -R-70 feet ditches. feet ditches inches
French Drain Required: Linear feet
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Authorized State Age ~~~f Date ~q aQ
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