OPHTE# I' - 5 -yy 7W Harnett County Department of Public Health 24716
PERMIT # 2`�SSa Operation Permit
ew Installation 2r Septic Tank 2 Nitrification Line ElRepair ❑ Expansion
PROPERTY LOCATION: :516cru5s u.,ac cr. �cl i snn�s'ea. vz'wJ
Name: (owner) C nF 4o, ,.v,-:,: nc . SUBDIVISION LOT # yS
System Installer: nxigs Registration #
Basement with plumbing. ❑ Garage umber of Bedrooms "3
Type of Water Supply: ❑ Community 2"PDblic ❑ Well Distance from well feet
System Type: Z5`/v rL s. " 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.
[his system has been installed in compliance with appriable Norah Carolina General Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authonzation
PERMIT CONDITIONS
I. 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 ❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sewage �dpi posal
system on the above captioned property.
Type of system:
❑ Conventional fJ�Dther
04 r—k s \,x r— Septic Tank tyc.:C-,
gallons Pump Tank gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches 3
of each ditch feet ditches 3
feet ditches V inches
French Drain Required: linear feet
Authorized State Agent �— Date I ca s /aattq
ph
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