OPHTE# /S`� _���s Harnett County Department of Public Health
PERMIT # L? Operation Permit 23016
Z New Installation eptic Tank Q` Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: VZey c
Name: (owner) SUBDIVISION LOT #
System Installer: t'Ta C .,_z,,�, --~— Registration #
Basement with plumbing: ❑ Garagber of Bedrooms_
Type of Water Supply: ❑ Community L'f Public ❑ Well /Distance from well feet
System Type: 7a : ,� t_'z VI Systems expire in 5 years.
(In accordance with Table IV a) 16w er must contact He#h Department 6 months prior to expiration for permit renewal.
This system has been installed id compliance with aoolicable North Carolina
Rules for Sewage Treatment and Disposal, and all conditions of the
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Permit and Construction Authorization.
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
ill. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 2Other %r A"WLV ,,,, Septic Tank: ' 7.100 gallons Pump Tank: � gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 1 2 feet ditches feet ditches Z- inches
French Drain Required: Linear feet
Authorized State Aq& - Z_ / / 100,A i Date I " M
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