OPHTE# Of "r zJy~3 Harnett County Department of Public Health 2 01 1 8
PERMIT # ~ S /01- Operation Permit
2' New Installation c Tank ❑ Repair lam' Nitrification Line ❑ Expansion
f PROPERTY LOCATION:ly~1 dal/~~,/~r
Name: (owner) ~ic~ a aacr SUBDIVISION %✓~Jn LOT # /8
System Installer: w Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Jam'
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 1L g 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.
[his 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. renormance:
II. Monitoring:
III. Maintenance:
Nystem shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sew disposal system on the above captioned property.
Type of system: ❑ Conventional Other te 2 Ft.,,J~ Septic Tank: IMO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch J00 feet ditches -3 feet ditches 18'zZ inches
trench Drain Required: Linear feet
Authorized State Agen- Date .Z l•2 y
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