OPHTE#_0 8 °J' P, 1V Harnett County Department of Public Health
PERMIT # Operation Permit 2 21 8 9
dNew Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: o2t N
Name: (owner) J~ SUBDIVISION LOT #
System Installer: 20 c v 4 //114 Registration #
Basement with plumbing: ❑ Garage ❑ mber of Bedrooms
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: _A 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 Larolma General Ntatutes, Rules for
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Ireatment and
and all conditions of me improvement rermlt and lonstruCUOn AUmorizatlon.
PERMIT CONDITIONS: c~ 1 6
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewVge dispost!!~4 system on the above captione property.
Type of system: ❑ Conventional 0 Other `-ci Ors%c Gtr" Septic Tank: ®v~1 gallons Pump Tank: 1 o00 gallons
Subsurface No. exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches Z inches
French Drain Required: ~et
Authorized State Agent"` Date
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