OPH T E # /Lt-s-3y-7e?ic Harnett County Department of Public Health 23686
PERMIT # oZiJol�e�o Operation Permit
21' New Installation ZeSeptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: LA-; l4 -,f'
Name: (owner) SUBDIVISION LOT # /t
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Q' -Public ❑ Well Distance from well feet
System Type: 7 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.
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[his system has been installed in compliance with applicable North Carolina General Statutes, Riles for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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DCDMIT fnllnlTlnllc.
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 sew!disposals stem on the above //captione property.
Type of system: ElConventional Z Other ,j ,c—K , .- —., ,?— Septic Tank: /G00 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch feet ditches feet ditches JO '45 inches
French Drain Required: Linear feet
Authorized State Agent �� i(f - �r� Date I! 12—
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