OPHTE# 14 --5-- -3-3ZCf? Harnett County Department of Public Health 23209
PERMIT # Zi"irtS �,�Operation Permit
New Installation 12 Septic Tank Nitrlfication Line ❑ Repair ❑ Expansion
PROPERTY LOCATION 7_ ?w �; " _ -
Name: (owner) SUBDIVISION LOT #
System Installer: 1k% Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms I
Type of Water Supply. LE-1 Community El Well Distance from well feet
System Type: S— w s 7� , ' and V Systems expire in 5 years.
(in accordance with Table V a) Owner must contact Health Departri ent 6 months prior to expiration for permit renewal.
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This system has been installed in compliance with aooli ble North Carolina General Statutes —Rules for Sewaee Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other a'o Septic Tank: r gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches + of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
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Authorized State Ag Date