OPHTE# e-S=ZsnKf Harnett County Department of Public Health
21068
PERMIT # Z6o73 Operation Permit
New Installation Septic Tank ❑ Repair i Nitrification Line ❑ Expansion
PROPERTY LOCATION•
Name: (owner)sn~ SUBDIVISION LOT # z
System Installer: Registration #
Basement with plumbing: ED] Garage Number of Bedrooms 3
Type of Water Supply: E01 Community Ee Public ❑ Well Distance from well feet
System Type: ml Z IcdZnJ s ?j ,Ge -j Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
1-111 nos peen mstauea in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
PERMIT CONDITIONS-
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I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. 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 sew disposal system on the above captioned property.
Type of system: ❑ Conventional Ei~ Other ZTL FkDV 0U-. J Septic Tank: I D o a gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch ~b feet ditches -S feet ditches 2L•' inches
French Drain Required: Linear feet
Authorized State Ag nt~ Date /o - zti- ID
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