OPHTE# d- s--Z1ZLC. Harnett County Department of Public Health 21 0 4 3
PERMIT # 25--7 15- ~ Operation Permit
/
New Installation Septic Tank ❑ Repair 2/ Nitrification Line ❑ Expansion
PROPERTY LOCATION: sr,s~ /040
Name: (owner) Z G^ SUBDIVISION Cs~4~o~ LOT
System Installer: jrt 1Vv a/ / Registration #
Basement with plumbing: El Garage umber of Bedrooms
Type of Water Supply: ❑ Community L Public ❑ Well Distance from well feet
System Type: D r- z Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner dust 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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1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sew ge disposal system on the above captioned property.
Type of system: ❑ Conventional Other 1S6/orZf Dv c3 Uri. 54J Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches Z of each ditch I.50 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Ag (~a" Date 6 --'j /d
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