OPHTE# IJ'S—�1e1 Harnett County Department of Public Health 23831
PERMIT # Operation Permit
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Nw 9 4a 1
Name: (owner), NL ;H Cy i—+ m t N G5 SUBDIVISION LOT #
System Installer: %5 Registration #
Basement with plumbing: ❑ Garage—K Number of Bedrooms
Type of Water Supply: ❑ Community � Public El Well Distance from well SO feet
System Type: l \ g Types V and VI Systems expire in S years.
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(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ibis system has been installed in compliance with applicable North Carolina General Starnes, Rules for Sewage treatment and Disposal, and all conditions of she Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Noo
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 s stem on th above captioned property.
Type of system: ElConventional Other z—
Subsurface No. of exact length
Drainage Field dit`I,ess of each ditch 50 feet
French Drain Required: V Linear feet
Septic Tank: VnoO gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 3a_ inches
Authorized State Agent -alse�s w e�-.,s Date IS
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