OPHTE# 16-531 Harnett County Department of Public Health 24753
PERMIT At 'Q�nO°\ Operation Permit
New Installation Septic Tank X(� Nitrification line 111 Repair L1Expansior
PROPERTY LOCATION: ZSya�1a , De..
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Name: (owner) CP%5&5, DJit.01NC INC, SUBDIVISION Itacb,,, 901-scE LOT # )2-)1—
System Installer: Eoo,E Gw-L.aFc-,, Registration #
Basement with plumbing: ❑ Garage '51� Number of Bedrooms
Type of Water Supply: ❑ Community )k. Public ❑ Well Distance from well feet
System Type: 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 Nonh Carolina Genenl Sunums, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Comwaion Authornanon.
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PERMIT
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 -Bax ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above caption) property.
Type of system: ❑ Conventional Other�ra rnvTo Q>AKw,&6R tLc.3 c, V�' \0 eptic Tank: 10 OP gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch O -J -S' feet ditches 3 feet ditches inches
French Drain Required: at feet
61 S Date
Authorized State Agent��X
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