OPHTE# I-7- S -e la❑3cJ Harnett County Department of Public Health 25030
PERMIT # Operation Permit
New Installation �X Septic Tank �X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: M pry— 'P --o
Name: (owner) c ry o b p H 6 M SUBDIVISION MaIJ F_ Pccju,5 LOT # it
System Installer. C�ts cy"cn.,o Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: T c 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.
[his system has been instated in wmpliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and tonsrracnon Authorization.
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PERMIT CONDITIONS
I. 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 ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D•Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'M Other EZriOw Septic Tank %My' gallons Pump Tank: gallons
Subsurface . of exact length width of depth of
Drainage Field ditches of each ditch a O O feet ditches 31 feet ditches It ',2h inches
French Drain Required: r feet
Authorized State Agent w :� %55 Date
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