OPHTE#D"I-s = 1'757o3 Harnett County Department of Public Health 2 0 9 0 8
PERMIT # 43940/ Operation Permit
14 New Installation EX Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: sc-i4r63 4.0c'-h.~
Name: (owner) 3 ~tuc-z-> F?-,-h •b SUBDIVISION _(~l(~,~6U ~,,Cp LOT # 5_
System Installer: c- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community L~ Public ❑ Well Distance from well feet
System Type: L'Y'lb Dtrt9~o~J 3„ ! ~ Types V and VI Systems expire in 5 years.
(In accordance with Table V a) ! K, Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his 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 CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sew Me disposal system on the above captioned property.
Type of system: ❑ Conventional 10 Other Z5'16iZE~cst6 S,haL _ Septic Tank: /ooo gallons Pump Tank: /oe c> gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches
3 feet ditches Z4--rfY inches
french Drain Required: Linear feet
Authorized State Date 3 - °t -/C)
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