OP RRHTE# 08-5- 0117&14e Harnett County Department of Public Health 2 0 4 5 3
PERMIT # ZSI Zs Operation Permit
Ltd New Installation 5 Septic Tank ❑ Repair E; Nitrification Line ❑ Expansion
PROPERTY LOCATION:S<Z5-5"7-Name: (owner) /~i~/n_ /~r¢•c / SUBDIVISION LOT #
System Installer orrvo SynL c,4--mw/j Registration #
Basement with plumbing. ❑ Garage ❑ Number of Be rooms S-
Type of Water Supply: ❑ Community V Public li~ Well Distance from well feet
System Type: Zb-% c?GpcL~Lt~ ST, 44- IV G _ea c.a y 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.
This system h
been installe m compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditi s of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
V. Other.
Following are the specifications for the seewwWdisposal system on the above captioned property.
Type of system: ❑ Conventional Other 1-/0 ~10yult)4 Septic Tank: I Z00 gallons Pump Tank: gallons
Subsurface No, of exact length width of depth of
Drainage Field ditches Z of each ditch f `7S feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State AgkL-.,.~~ ~ Date
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