OPHTE# L(*- 5-392, � Harnett County Department of Public Health 24828
PERMIT #_'Z-&950 —Operation Permit -
L -A' New
ermit_
LA'New Installation D�Teptic Tank kation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: li o G a f-! k) c/ 0�
Name: (owner) t&Sr i LNUA SUBDIVISION
LOT #
System Installer. CSir\ Registration #
Basement with plumbing. ❑ Garage CI-Irtimber of Bedrooms __
Type of Water Supply: ❑ Community L7—PDbric ' ❑ Well Distance from well ^ 4 feet
System Type: ?5 'io< e,�'-r,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.
con 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 Consnction Authorization.
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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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned pro er .
Type of system: ❑
Conventional ❑mer != �a Septic Tank: 190 , gallons Pump Tank:gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches
French Drain Required: feet ditches _� inches
q Linear feet
Authorized State
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