OPHTE# Sti—S--Z -0 Harnett County Department of Public Health 24091
PERMIT# 071✓: Operation Permit
New Installation- Septic Tank )kr Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Docs
Name: (owner) �YNN C0N3-50 vcCSUBDIVISION IeZ—,,Q2s Q:,aGC LOT #
System Installer. Irsooioo5 ndt-U nssyN Registration #
Basement with plumbing: ❑ GarageV Number of Bedrooms t" —T
Type of Water Supply: ❑ Communit Public El Well Distance from well 106 feet
System Type: LUA 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 Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constmction Authorization
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required! Yes ❑
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 system on the above captioned property.
Type of system: ❑ Conventional
�J Other EZ 4.
Septic Tank ICxiC7 gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
I of each ditch 640 feet
ditches feet
ditches inches
French Drain Required:
Authorized State Agent 4*35 Date
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