OPH T E # O~ -SI-ZtUOV Harnett County Department of Public Health 21 0 2 9
PERMIT #,7j ,2576 / Operation Permit
r;I New Installation 1~ Septic Tank ❑ Repair Nitrification Line El Expansion
PROPERTY LOCATION:,
Name: (owner) SUBDIVISION LOT # 3V_
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: ~59bZXbO A2_62-) 'i 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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1. Performance:
11. Monitoring:
III. 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 ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sew,T disposal system on the above captioned property.
Type of system: ❑ Conventional 2 Other disposal
j7i ib LA-20 Septic Tank: I Lb D gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 13 S~ feet ditches 3 feet ditches 3L' - Irj inches
French Drain Required: Linear feet
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Authorized State ent t Date '4 - G3 -A)
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