OP RRRHTE#_0 8 - r- /,768 72lz 12 Harnett County Department of Public Health
PERMIT # ::Zu 7 `l7 - Operation Permit 22191
Ly New Installation R" Septic Tank 1l ?"Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 7-,',i2
(owner) SUBDIVISION /~a k r-~n r P f LOT # l 7
System Installer: Registration #
Basement with plumbing: ❑ Garage lid umber of Bedrooms _1
Type of Water Supply: ❑ Community V public ❑ Well Distance from well feet
System Type: C d 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 appltcable North Lamina beneral )tatutes, nines for Newage treatment ano Disposal, ano an conoltlons of the improvement rermlt and Lonstruchon AUthorization.
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PERMIT CONDITIONS:
1. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sews disposal system pn the above captioned property.
Type of system: ❑ Conventional 19 Other CzF1 v-'
Subsurface No. of exact length
Drainage Field ditches of each ditch 0 feet
Alarm ❑ H201-ine ❑ PWR Line
Septic Tank: C,j 0 gallons Pump Tank: gallons
width of depth of
ditches 13 feet ditches inches
French Drain Required: Linear feet
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Authorized State Agen :,/c ~l~f Date ~-°~2-
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