OP RHTE# ?-5YY4 Harnett County Department of Public Health 2 0 8 9 3
PERMIT # D4-57-Za2:re 0 eration P mit
New Installation Septic Tank ❑ Repair Nitrification Line ❑ Expansion
PROPERTY LOCATION: S+!/yob
Name: (owner) SUBDIVISION LOT #
System Installer /n,& Registration #
Basement with plumbing: ❑ Garage /Number of Bedrooms ~ _
Type of Water Supply: ❑ Community Y Public ❑ Well Distance from well feet
System Type: ZS°/.?Xz-b,OU2,~1 62cAf T'7p''"& 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.
tms system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sew tment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS: U
1. Performance:
II. Monitoring:
Ill. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other ZS'h+Q~DorstD~ aye Septic Tank: 1 0 0 b gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches '.J of each ditch 8b feet ditches 3 feet ditches zZ inches
French Drain Required: Linear feet
Authorized State A
gt~s ~r Date ! 1 -11-01 10 -a 0 , / l`~
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