OP RHTE# to° j--_19 I1241 Harnett County Department of Public Health
PERMIT # 2 6a-~~ Operation Permit 21 8 9 4
New Installation ;K Septic Tank A Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N~~-1a
Name: (owner) 9P g_>) SUBDIVISION Gw LOT # -3
System Installer: C~ c s 'DI Q_, Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 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 Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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 opera ton ct
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposal system on the abov~ptio~ned~property.
Septic Tank: 100Cl gallons Pump Tank: 4000 gallons
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Type of system: El Conventional Other QU~ __)o
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch O feet ditches 3 feet ditches `g inches
French Drain Required: feet 1 ~
Authorized State Agent Date'
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