OPHTE#Og- S-- z2,,1/ Harnett County Department of Public Health 2 0 8 8 5
PERMIT # Ise!/o /Operation Permit
Ld New Installation Ld Septic Tank ❑ Repair /Nitrification Line ❑ Expansion
PROPERTY LOCATION:sr-/y6.3 W
Name: (owner) --/4-a ,e Faviceft~ SUBDIVISION LOT
System Installer: Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms
Type of Water Supply: ❑ Community 1Z Public ❑ Well Distance from well feet
System Type: 15% $1C~-zc~a ~ T~ F~2 Gr--Zcaa..r 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 TreatmentVDissposal, and all conditions of the Improvement Permit and Construction Authoriyarinn
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PERMIT CONDITIONS:
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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.
Following are the specifications for the seewwa~disposal system on the above captioned property.
Type of system: ❑ Conventional LVf Other VS% f .t J Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 00 feet ditches -3 _ feet ditches A inches
Frencb Drain Required: Linear feet
Authorized State Ag 4' Date 1- 2 8
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