OPHTE# /J--5-- 3 G %c>ZV Harnett County Department of Public Health 23251
PERMIT # a__�yV 84 Operation Permit
C' New Installation E "'Septic Tank ler"-Nitrification Line ❑ Repair ❑ Expansion
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PROPERTY LOCATION: �'rs R�-
Name: (owner) J�,\j vs1 90 1-pf SUBDIVISION f �(e" i G� r✓' LOT # 33
System Installer: /%1_ ." _Fe 0�:(_ Registration #
Basement with plumbing: El Garage El Number of Bedrooms
Type of Water Supply: ❑ Community GY'Public ❑ Well Distance from well feet
System Type: =5 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, R s 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No W,
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 seewwa ee disposal system on the above captioned property.
Type of system:
El Conventional LJ' Other
L ZG Septic Tank: /00 Q
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches _01,
of each ditch Q O feet ditches
feet ditches /v' 2Z inches
French Drain Required: Linear feet
Authorized State Agen 64. &`- Date F71 � 2 j� _
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