OPHTE# Harnett County Department of Public Health 24300
PERMIT # ac� o 03 Operation Permit
New Installation X Septic Tank D< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Fo-,.t.Fasi 02.
Name: (owner) `t-twov6n. } AoSUBDIVISION LOT # a-)
System Installer: C'+erss u4.a.9 Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 CIO 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.
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 ❑ Nkl
If yes, see attached sheet for additional operation
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ElConventional )91� Other EZ Septic Tank. 100 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of , -�
Drainage Field—dtchesof each ditch OO feet ditches 3 feet ditches inches
French Drain Requite- '-.Linear feet
Authorized State Aeent ��� ��� �S Date ll)
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