OPHTE# \'-I- 4 Li O(,pSd Harnett County Department of Public Health 24876
PERMIT # ar1 �i 0 i Operation Permit
New Installation 'K Septic Tank bl Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:_I !?nc
Name: (owner) 0&��L.P G SUBDIVISION fi-pdC LOT #
System Installer. Gwi r-" SC-O'l t G Registration #
Basement with plumbing: ❑ Garage XNumber of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: = h 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.
This system has been installed in compliance with appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authumz6on.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. 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 ewa a
dispos system on the above captioned grope
Type of system: ❑ Conventional L Other
iD �g `LQ CkwL L N 10
Septic Tank 1000 gallons
Pump Tank 100 0 gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches }
French Drain Required:
of each ditch x.56 feet
Linear feet
ditches i feet
ditches 1i3'a.'g inches
Authorized State Agent `w !� RE:115 Date
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