OPHTE# 0 1- ~J3- 1Y17) Z Harnett County Department of Public Health 19802
PERMIT # o~`j )1 A Operation Permit
J* New Installation JL Septic Tank ❑ Repair Z Nitrification Line ❑ Expansion
PROPERTY LOCATION:
_ a~
Name: (owner)A L
,SUBDIVISION
LOT # -
System Installer. S hr>~ t Registration # t~
Basement with plumbing: ❑ Garage M Number of Bedrooms 2 t~' y L~c2~j
Type of Water upplY: ❑ Community gr Public 11 Well Distance from well SJ feet
System Type: %y tt, C- q CU Types V and VI Systems expire in 5 years.
(In accordance with T le V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
erns system has bw maw in com ante with apoka* North tara6na General statutes, Rides for Sew Treatmcnt and Disposal, and a! conditions of the Im orement Permit asd ComtnKfiM kd*fintion.
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PERMIT CONDITIONS:
I. Performance:
If. Monitoring
Ill. 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 ❑ No [a
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposa~ system on the above captioned property.
Type of system: ❑ Conventional [Other Arh-t{~ ~1 Fla, Size of tank: Septic Tank: 1013,0 gallons Pump Tank: 100-> allons
Subsurface No. of -exact length width of g
depth of
Drainage Field ditches of each ditch 2\~ feet ditches feet ditches 1'7 inches
French Drain Required: linear feet
Authorized State Agent 0- Q J~'~) Date ~ v16 - q