OPHTE# ►*-) -5- 40565 Harnett County Department of Public Health 24618
PERMIT #-a) 14-0 Operation Permit
New Installation )X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N 7�7
Name: (owner) SUBDIVISION LOT #
System Installer. To Q>ZOw N Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: -M 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 Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
Ill. 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 -Boz ❑ Pump ❑
Alarm ❑
11201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captionedpr�erty.
Type of system: El
Conventional XI Other CjaPrYs odSlL CQ1� J
Septic Tank 100 0
gallons Pump Tank gallons
Subsurface
N exact length
width of
depth of
Drainage field
ditches of each ditch aces
feet ditches 3
feet ditches is -ao inches
French Drain Required;.
\ r feet
Authorized State Agent��` ��� \\ t� Date
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