OPHTE# /J4-00 rl Harnett County Department of Public Health
PERMIT # a�7 �� I Operation Permit 22930
Q"'New Installation DR" Sep is Tank E"—Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: rj
Name: (owner) SUBDIVISION LOT # —7 0
System Installer: J �,, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms Fi
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: 2r—& 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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YtKMII IUNUIIIUM:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑
Following are the specifications
for the
Type of system: ❑
Conventional
Subsurface
No. of
Drainage Field
ditches /
French Drain Reouired:
Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
sewffl disposal system
llon he above captioned property.
Other C � — Septic Tank: jd4 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch J00 feet ditches 13 feet ditches 16-00 inches
Linear feet
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Authorized State A $ en w�,... � �� Date
/9 li-I 3 �-rt