OP RHTE# Y q p' Harnett County Department of Public Health
PERMIT # a 35~ 1 Operation Permit 21 6 5 6
~0-- New Installation ~ Septic Tank RT Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I I I Lf 01,
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Name: (owner) Art sue,. SUBDIVISION C t 1-fr t ► r LOT #
System Installer: 0, S fa,~ [ A-j Registration #
Basement with plumbing: ❑ Garage F Number of Bedrooms 3
Type of Water Supply. ❑ Community 9 Public ❑ Well Distance from well l o- feet
System Type: L 2 f= I D w 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.
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PERMIT CONDITIONS:
nas oeen mstanea in
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with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
111. 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 ❑ H20Line ❑
PWR Line
following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other r - 2 Flow Septic Tank: 00Subsurface No. of gallons Pump lank: gallons
exact length width of depth of
Drainage field ditches of each ditch w feet ditches 3 feet ditches t y
French Drain Required: inches
Linear feet
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