OPHTE# %a° s - IY-rdV Harnett County Department of Public Health
PERMIT # a~ t s~t Operation Permit 21 81 5
dNew Installation E> Septic Tank 0 "'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) J'~c-,mc. SUBDIVISION 0,4~-~~~ ~c=A.~¢ LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -7
Type of Water Supply: ❑ Community 114ublic ❑ Well Distance from well feet
System Type: ?1~-- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his 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:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage. disposalsystr on the above captioned property.
Type of system: El Conventional [B' Other csc, Septic Tank: 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of q
Drainage field ditches of each ditch feet ditches 3 feet ditches ~rj 20 inches
French Drain Required: Linear feet 11
Authorized State Agen r~g a G` , Date 11,9 fall
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