OPNTE# %6'513094`i Harnett County Department of Public Health 24007
PERMIT # a$4;5O Operation Permit
New Installation X Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: \4 SOGEo t \J thy
Name: (owner) LL c. SUBDIVISION Ttjon" iii gNOA,. LOT # '%
System Installer: C>S Nn Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t 00 feet
System Type: a Types V and VI Systems expire in S years.
(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 Carolina General Sutures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
1. 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 requiredt Yes ❑ No
If yes, see attached sheet for additional operation ca
IV. Operation:
Other.
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maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposal system own the above captioned property.
Type of system:
❑ Conventional
Other PV mo1 n 2 �w w
Septic Tank t 00p gallons Pump Tank 1000 gallons
Subsurface
No. of
exact length
width of depth of
Drainage Field
ditches
t of each ditch t feet
ditches feet ditches inches
French Drain I
Linear feet
Authorized State Agent �1a _��� V11cNS Date
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