OPHTE# frS�LVv�- Harnett County Department of Public Health 23707
PERMIT # Operation Permit �
C�'7 New Installation Se E is Tank Nitrification Line ❑ Repair ❑ Expansion
t PROPERTY LOCATION: /��rt�� 4,
Name: (owner) crc /—l..1 4tre SUBDIVISION LO
System Installer: c /ey Registration #
Basement with plumbing: ❑ Garage ❑ Number of oms
Type of Water Supply: El Community El Public Bedr 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.
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This system has been installed in compliance with applicable North Carolina General statutes, Rules for sewage Treatment ana msposai, ana an conaitions or the improvement rermit ana Lonstrucoon Hutnortzatnon.
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PERMIT CONDITIONS:
I. Performance:
IL Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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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.
❑ D -Box ❑ Pump ❑
Following are the specifications for the sew disposal systthe above captioned property.
Type of system: El (onventional Other t Z 71y" J
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch 5-0 feet
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Alarm ❑ H2O1-ine ❑ PWR Line
Septic Tank: /000 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches f 6'cZC) inches
French Drain Required: Linear feet p
Authorized State Age t Date
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