OPHTE# 10 - s-~~ NI'A Harnett County Department of Public Health
PERMIT # ~~l b Operation Permit 21 6 2 3
~~,\\New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) G OED~Lo2E25 SUBDIVISION C ~.~,a SF~soNS LOT # L~3
System Installer: 16 N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community 'L Public ❑ Well Distance from well `V~)6 feet
System Type: ~ 0, 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.
ims system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT rnNn1TIANC.
I. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ "OX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the above captioned operty.
Type of system: ❑ Conventiona Other Gaar,L-1- CQ ut c.z-~- y Septic Tank: t 4 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of h ditch -feet ditches -feet ditches 34. inches
French Drain Reauired: \`-11
Authorized State Agent ~N ~~5 Date °[1180
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