OPHTE#TL%"5-3t3L17 Harnett County Department of Public Health 24104
PERMIT # `� Operation Permit
New Installation X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
SGL ��m� PROPERTY LOCATION: �1�NF1Loc� Qt.
Name: (owner) l� 7 �+G SUBDIVISION 6KY-ti .7: LOT # y�3
System Installer. fl NEcv Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 13
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: q 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H2OLine
❑ PWR Line
Following are the
specifications for the disposalsy�tem
on the above captioned(property.
Type of system:
ysew�age
❑ Conventional `� Other �a'!3tbo
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Septic Tank: 1000 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditc e 1
of each ditch IS -0 feet
ditches _� feet
ditches inches
French Drain Required: near
feet
Authorized State Agent fc'-"* ) Date
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