OPHTE# l( —5-3Ci 6a I Harnett County Department of Public Health 24666
PERMIT # Z cfXq Operation Permit
�w Installation a Septic Tank 2- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: (a Par I IVI
Name: (owner) SUBDIVISION c P LOT # 502
System Installer. 6{Wzr-j A0, ..:—c. Registration #
Basement with plumbing: ❑ Garage fiber of Bedrooms -3
Type of Water Supply: ❑ Community clic ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner ust 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.
III. 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 ❑ H2O1-ine ❑ PAIR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 2'Other /V row '722T—t- Tank 1000 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of 5
Drainage Field ditches of each ditch 180 feet ditches 3 feet ditches inches
French Drain Required: Linear feet
IAuthorized State Agent Date 08//6L / Z61 -3-
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