OP RHTE# o-,-s- Harnett County Department of Public Health
PERMIT # mss` ~'A Operation Permit
21576
New Installation `K Septic Tank Nitrification Line ❑ Repair ❑ Expansion
Po,.rat3z asQ~-i~.~y
Name: (owner) 1Aor,E6 LN PROPERTY LOCATION:
G SUBDIVISION GAn.o~,,~A ~oN
System Installer. H A~Ly G~~cE2 LOT # 'T
Basement with plumbing. ❑ Garage Registration #
Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well k C >O _ feet
System Type:
accordance with table V a) Types V and VI Systems expire in 5 years.
(In 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:
L 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
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other
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❑ D-Box ❑ Pump [I Alarm ❑ H20Line ❑
Following are the specifications for the sgwage disposal system on the above captioned property. PWR Line
Type of system: ❑ Conventional Other 'T, (La- C,,A-.,pf
Subsurface No. of exact length Septic Tank: t co o gallons Pump Tank: 1006 gallons
Drainage field ditches a f each ditch `7 5 depth of
french Drain Required: feet width of ditches 3 feet ditches
et inches
Authorized State Agent
efuo Date _ S15116
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