OPHTE# J 1 ^ Harnett County Department of Public Health
PERMIT # 8"-Gc_A3e Operation Permit 2 21 4 8
New Installation 'K Septic Tank ~'k Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: OJC~2,10
Name: (owner) G;-,4.y ~as 1 ~~os t \AGtnE5 SUBDIVISION (;-F-- -LOT #
System Installer: C YN,6 rz1c~c L0 - Registration #
Basement with plumbing: ❑ Garage `I Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well VQ0 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-
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other ~vt~~ 10 F_Z F' 1111 Septic Tank: ~(000
Subsurface No. of exact length width of
Drainage Field ditches of each ditch gd feet ditches
French Drain Required: -nel
Authorized State Agent Date
H2OLine ❑
PWR Line
gallons Pump Tank: )ICD& gallons
depth of
feet ditches- inches
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