OPHTE# 57SA'. Harnett County Department of Public Health 25064
PERMIT #Z�3VO3 Operation Permit
New InstallationSeptic Tank Nitrification Line ElRepair ElExpansion
\\ PROPERTY LO[ATIO : Ws,-s—vE CRs^6z0sy
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Name: (owner) nss A0nC6V1L;06sz s SUBDIVISION Ce,.,rici6iLN LOT # 'i
System Installer. Mo55 Registration #
Basement with plumbing: ❑ Garage `i� Number of Bedrooms
Type of Water Supply: ❑ Community 'A Public ❑ Well Distance from well feet
System Type: -M a 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.
lots 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
I. Performance:
System shall perform in accordance with Rule .1961.
ll. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required! Yes ❑ Np�'
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑
1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal stem on the above captioned property.
Type of system: ❑
Conventional Other
Septic Tank: t O 150
gallons Pump Tank gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches of each ditch -aa o feet
ditches 3
feet ditches inches
French Drain Required: Linear feet
Authorized State Agent PIL-415 Date II
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