OPHTE# I o~- a~-~~►
Harnett County Department of Public Health
PERMIT #
Operation Permit
2 1 7 5 7
New Installation X Septic Tank X Nitrification Line ❑
Repair ❑ Expansion
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PROPERTY LOCATION: Nit `~`Z h#
ame: (owner) _ yt vG<
SUBDIVISION
LOT #
System Installer.
Registration #
_
Basement with plumbing: ❑
Garage Number of Bedrooms
3
Type of Water Supply: ❑ Comm
unity Public ❑ Well
Distance from well \C70 feet
System Type:
T
es Y and VI S
t
i
i
5
(In accordance with Table V a)
yp
ys
ems exp
re
n
years.
Owner must contact Health Department 6 months prior to expiration for permit
renewal.
ims system nas 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:
1. 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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
p V tc~~L ArZty
1 1 L 1 G` V C ~GC C C 6~ 0 sa~~~aC
❑
D-Box ❑
Pump ❑ Al
❑
arm
H20Line ❑ PWR Line
Following are the specifications for the sewage disp
osal system on the above captioned property.
Type of system: ❑
S
b
Conventional Other
P U s,? ~ C' ZF ,r, Septic Tank: %04 0
gallons Pump Tank: S Cab allons
g
u
surface
Drainage Field
No, of
ditches LA
exact length width of
of each ditch C) f
depth of
French Drain Reouired:
eet ditches
l i.... P1-
feet ditches I inches
Authorized State Agent 7~!~~~ ~C~S Date COL-- ~A 6
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