OPHTE# /3 - 5 -31' -1 / 3 Harnett County Department of Public Health
PERMIT # a�s-et Operation Permit 22937
0New Installation C2' Septic Tank CR'litrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) Co - +LJr &* -Id: SUBDIVISION <, ,r-- f-1— ,A:15C-z) T Ju f- LOT # 178
System Installer: C, JS Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms s
Type of Water Supply: ❑ Communi P"Public El Well Distance from well feet
System Type: �� G 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 ana uisposal, ano an conmuons or the improvement rerm¢ ana Lonstrucnon eumonzanon.
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PERMIT CONDITIONS:
I. 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:
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❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the ajbove captioned property.
Type of system: ❑ Conventional Other Qi >Gk- (J CA61. , Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch J,0 feet ditches feet ditches 00 inches
French Drain Required: Linear feet
Authorized State Agen /� w Date
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