OPHTE �-J-Qq 7(>.3 Harnett County Department of Public Health 23452
PERMIT # �� c3 `�7 Operation Permit
New Installatioc Tank nitrification Line El Repair F-1Expansion
PROPERTY LOCATION: �eQ,1��-
Name: (owner) Cd r', j74'ACJ C k ?'er�>-a�. SUBDIVISION _ � �o r,+ LOT #
System Installer: 04'j- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community [Public ❑ Well Distance from well feet
System Type: fL q 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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PLKMII LUNUIIIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
Il. 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 -Bax ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sew disposal system on the above captioned property.
ntional
Type of system: ❑ ConveOther Septic Tank: /00 Q gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches 3 feet ditches
French Drain Required: Linear feet
Authorized State Ade fwa;..,t�'�/�% Date V /71-z,Xs-
PWR Line
gallons
inches