OPHTE# /o-s-- ag5'6.3 Harnett County Department of Public Health
PERMIT # 3 0 eration Permit 21 5 5 3
New Installation Sepfc Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: v (,r )ed .
Name: ,vt /twf k~4 -bw,
(owner) SUBDIVISION c LOT # 186"
System Installer. cam.- Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 777 G 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.
This 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 CONDITIONS:
I. 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 required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-120Line ❑
PWR Line
Following are the specifications for the sewage disposal system on the bove captioned property.
Type of system: ❑ Conventional L Other C7 AZ ;s Septic Tank:
Subsurface No. of q0 gallons Pump Tank: gallons
exact length width of
Drainage Field ditches depth of
of each ditch feet ditches 3 feet ditches `Z ! inches
French Drain Required: Linear feet
Authorized State AgenftI/,~.~~ ~ ~~-t,.: ~1~, Date 7/.?(/ Q-W C)
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