OPHTE# 1(m" 5'3'613 Harnett County Department of Public Health 2 4 4 4
PERMIT # Operation Permit t
New Installation X Septic Tank >< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 3(-1 GrtGW,a L). -As Da
Name: (owner) Cv+n%G'LLi%"o lAom6i 1rye— SUBDIVISION GanauNf, SEA5o.N5 LOT # '80
System Installer:NEO Q:aao,v Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms `_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ted feet
System Type: ---I= v, Types V and VI Systems expire in S 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 Authorisation
PERMIT CONDITIONS
1. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑
Following are the specifications for the
sewage disposal system on the above captioa�e,`�f property.
Type of system: El
Conventional
Other CrIAraxa L CQIAI� Septic Tank: focr.'
gallons Pump Tank.-
ankSubsurface
Subsurface
Nof
exact length width of
depth of
Drainage Field
ditches
of each ditch S S'O feet ditches 3
feet ditches
French Drain Required:
ear feet
Authorized State Agent V24x5 Date
PWR Line
gallons
S1'3 d inches
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