OPH T E # a s 5 - a Harnett Count Department of Public Health
Y p 231919
PERMIT # z 377 3 'iJ Operation Permit
0 N'ew Installation Septic Tank "itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �i�t'i Cl1L -rI z,�� -u. �.a
Name: (owner) C' n E— ` ��� �� SUBDIVISION LOT #�
System Installer: fz cb ° i r Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community ErPublic ❑ Well Distance from well feet
System Type: 05% 1Z-�';6r- w11.:r,. -- �; _97&2 is Cr ,� Types V and VI Systems expire in 5 years.
(In accordance with Table V a) — f r 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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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
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.
IV. Operation:
V. Other:
❑
D -Box
❑ Pump ❑ Alarm
❑ H2OLine ❑ PWR Line
Following are the specifications
Type of system: ❑
Subsurface
Drainage Field
for
Conventional
No. of
ditches
the sewage disposal system on the above captioned property.
E3' Other S 3-1 -
exact length
of each ditch y °L�= feet
Septic Tank: 1000 gallons Pump Tank: gallons
width of depth of
ditches feet ditches 2 inches
French Drain Required: Linear feet
Authorized State Ag t Date
i1,
F,77r"77r M."TTRI