OPHTE# la- : - 55Y Harnett County Department of Public Health 23889
PERMIT # Z78&7 / Operation Permit
Eg New Installation ❑ Septic Tank L7 Nitrification Line ❑ Repair [2 'Expansion
PROPERTY LOCATIONS/sYz�s
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Name: (owner) //�✓ /� is.Wt d✓fn� 4 SUBDIVISION -.S;� LOT # .
System Installer. xTv.✓s�,x T Registration #
Basement with plumbing: ❑ Garageumber of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: r __ Vaod. I.Systems-expire-io.b..years; ....... ...
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(In accordance with Table V a) Owner\must contact ealth Depart nt 6 months prior to expiration for permit renewal.
This system has been installed in compliance wit applicable North Carolina General Statutes, Rules f4 Sewage Trea d Disposal, and all conditions of the Improvement Pe it and Comwaion Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. 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 ❑ H2O1-ine ❑ PWR Line
following are the specifications for the sewa disposal system on the above captioned property.
Type of system: ❑ Conventional 70ther ZS9,, a,* 1 -;1 .o-.S G, d: j n— Septic Tank: 6}{ gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches �_ of each ditch feet ditches feet ditches ZL inches
French Drain Required: Linear feet / A
Authorized State AgenC` ,, G �/ a�l� Date J-1-1— 16,
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14-5-33484 (1) 14-5-33464 (2) 14-5-33484 (3) 14-5-33484 (4) 14-5-33484 (5)
14-5-33484 (6) 14-5-33484 (7) 14-5-33484 (8)