OPHTE# /y -S �S�el�Harnett County Department of Public Health
23682
PERMIT # al�s Operation Permit
ENew Installation 2�Septfc Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 23-")-3 Xd
Name: (owner) 3tre- SUBDIVISION LOT # /
System Installer: :%c k/o...J Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms -3
Type of Water Supply: ❑ Community Id Public ❑ Well Distance from well 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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rtKMI l IUNUI I IUNs:
I. Performance:
System shall perform in accordance with Rule .1961.
II. 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.
E
Type of system: El
Conventional Other 62---/,)
Septic Tank: ZCrj gallons Pump Tank: gallons
Subsurface
No. of exact length
width of depth of
Drainage Field
ditches _1 of each ditch tQU feet
ditches 3 feet ditches inches
French Drain Required:
Linear feet
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Authorized State Age
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Date �- z �/✓
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