OP RHTE# /I—J Y18274 Harnett County Department of Public Health
PERMIT # .2-7 (-O3 Operation Permit 22969
KI'New Installation Ef Septic Tank 51- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'J-44
Name: (owner) ',Q stn Cc� �� �r�� - °�� SUBDIVISION /''i� ���✓�i�,s� LOT # 6
System Installer: -7 o 4- 11 fug bey Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community [Public ❑ Well Distance from well feet
System Type: zr to 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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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:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sews disposal system on the abov� captioned property.
Type of system: El Conventional Other vw� CZ-F,7..,i Septic Tank: 100 gallons Pump Tank: 1000 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches j of each ditch J c/ C) feet ditches feet ditches 1_ inches
French Drain Required: Linear feet
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Authorized State Agent .� Date
/ ,5 -S" "3/6.2 A