OPHTE# /O-'S° Zgjo' Harnett County Department of Public Health
PERMIT # Operation Permit 21 8 2 9
RrNew Installation Septic Tank 2"'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) SUBDIVISION es..4-~ ~4 LOT # A. 3
System Installer: c r f 4"1 - Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms
Type of Water Supply: ❑ Community ~ublic 171 Well Distance from well feet
Types V and VI Systems expire in 5 years.
System Type: e-
(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
PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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 operation conditions, maintenance and reporting.
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewa disposa system on the above c,.aPtioned property.
Type of system: ❑ Conventional Other ~cs pia 2 AzaV Septic Tank: d gallons Pump Tank: /ooo gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Age Gw1'~.. Date / ~`~ll
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