OP RHTE# /y.S_-71/ Harnett County Department of Public Health 23944
PERMIT # oZ8 fOz Operation Permit
Neww Installation Septic Tank Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: T,`n 3 8 .
Name: (owner) G-;-rV P—ob:nJ'cn SUBDIVISION A2.r e_+ ac LOT # yr, s"
System Installer: `'&� t. c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 2'�Public ❑ Well Distance from well feet
System Type:- 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.
This system has been Installed in compliance with applicable north Larohna General Statutes, Rules [m Sewage treatment and Disposal, and all condmons of the Improvement Permit and Lonstmaion "then[anon.
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PERMIT CONDITIONS
I. Performance:
If. 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.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the seww dispos I system on tthse �bove captioned property.
Type of system: ❑ Conventional NJ Otherl'aZI� Vsn✓Septic Tank: /000 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch c200 feet ditches feet ditches /d'-90 inches
French Drain Required: Linear feet
Authorized Slate A"a'Date J 8 40/ 6
S - 3 q Y 31'A-
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