OPNTE#'°-s-14o.,~ Harnett County Department of Public Health
PERMIT # Z5_ 7 31 21062
0 erati0n Pe mit
New Installation Septic Tank ❑ Repair /Nitrification PROPERTY LOCATION: Line ❑ Expansion
Name: (owner) _~t~+~t 42~~)
System Installer: SUBDIVISION LOT
Registration #
Basement with plumbing, ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well
System Type: !:~/n feet
-rrt~`"~ Types V and YI Systems expire in 5 years.
(In accordance with Table Y a) /
Owner must contact Health Department months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina
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Statutes, Rules for Sewage Treatment and
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and III conditions of the
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PERMIT CONDITIONS: e
L 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 ❑
IV. Operation: If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
Permit and Construction Authorization.
Following are the specifications for the sewa disposal system on the above Captioned property.
Type of system: ❑ Conventional t3 Other zaEb& aCD
Subsurface No. of `M " Septic Tank: IQgallons Pump Tank: Drainage Field ditches y length width of d gallons
of exact each ditch g b depth of
French Drain Required: -96 feet ditches feet ditches Zy - (f; inches
Linear feet
Authorized State
Date 10
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