OPHTE# —' �3 � 1 Harnett County Department of Public Health
23627
PERMIT# e�.`b> 6 Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: `x t LO w 'YA d -Y4 IN Gf as.; 0,L
Name: (owner) Gkv-i-,+ t'3 c- SUBDIVISION V\Prf\QE- 6eA4 -�'DC;e LOT #
System Installer: V4e+a-o--,w <E>C t G Registration #
Basement with plumbing: ❑ Garage KNumber of Bedrooms
Type of Water Supply: ❑ Communi Public El Well Distance from well IQ)Q feet
System Type: 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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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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional A Other Py ref —70 Septic Tank: 10O d
Subsurface No. of exact length width of
Drainage Field ditches 1 of each ditch `-i<3 feet ditches
French Drain Required Linear feet
Authorized State Agent '\"k-, Date
H2OLine ❑
PWR Line
gallons Pump Tank: 1600 gallons
depth of
feet ditches inches
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