OPHTE# t--? -6-41)6Harnett County Department of Public Health 24758
PERMIT # a'%5t Operation Permit
New Installation )R Septic TankNitrification Line EJRepair L1Expansion
PROPERTY LOCATION: �oLLIYA
Name: (owner) 6n c8 t- r. SUBDIVISION SNE.esNa-ML LOT # %3
System Installer.,soaCs Sf?StC_ E-0-Y\C.E Registration #
Basement with plumbing: ❑ Garage )9, Number of Bedrooms —�
Type of Water Supply: ❑ Com a7i ZX Public ❑ Well Distance from well feet
System Type: t>\ Types V and A 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 Cumhuction Authorization
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PAIR Line Avg
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sewage disposal system on the aboqve captioned property
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Type of system: C3Conventional
X Other C= �s>rne� Mr,3t s o) Septic Tank: 14000
gallons Pump Tank:
K
Subsurface
1
exact length width of
4+OosC
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2
feet ditches 30'�$
C
French Drain Required
G'O c,L•/ G1
Linear feet
PERMIT CONDITIONS
I. 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 ❑ NX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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ID -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑
PAIR Line Avg
Following are the specifications for the
sewage disposal system on the aboqve captioned property
r"
Type of system: C3Conventional
X Other C= �s>rne� Mr,3t s o) Septic Tank: 14000
gallons Pump Tank:
gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field'hes
of each ditch a140 feet ditches 3
feet ditches 30'�$
inches
French Drain Required
Linear feet
Authorized State Agent Date
5
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