OPHTE# K, -5327;n Harnett Lounty Department of Public Health
24293
PERMIT # Operation Permit
New Installation '1;� Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
a� PROPERTY LOCATION: C�) vi
Name: (owner) a a NAttaY N [eery, SUBDIVISION Pt ro c l\ S LOT # a
System Installer, 1--4- 'S)no2 C-- Registration #
Basement with plumbing: ❑ Garage �Q Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: _� 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.
Ibis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all ronditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
H. 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 a
IV. Operation:
Other:
maintenance and reporting.
❑ 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 N Other EZ Septic Tank: 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field _ ditches Li of each ditch feet ditches 3 feet ditches ; h,1) `-i inches
French Drain Requi Linear feet
Authorized State Agent ��\ Date 101'x„,111b
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