OPHTE #_ IJ--J=3f'77j'" Harnett county Department of Public Health 23677
PERMIT # -2" oa:? I Operation Permit
Cr New Installation Cr Septic Tank C"Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 1z,v--1wSUBDIVISION /� �,��� rte,., LOT # 7
System Installer: L C-1 _4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms .3
Type of Water Supply: ❑ Community VPublic ❑ 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 comoliance with aoolicable North Carolina General Statutes- Rules for Sewaue Treatment and Disnosal- and all conditions of the Imnrnvemnt Permit and fnnsrrurtinn huthnri7ntinn
YtKMII LUNUMUNS: '
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 sewa disposal stem on the above captioned property.
ntional O
Type of system: ❑ Convether eZ Septic Tank: l00y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches r! of each ditch U 0 feet ditches 3 feet ditches J 0 ® / S inches
French Drain Required: Linear feet
Authorized State Age t ,. c Date
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YtKMII LUNUMUNS: '
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 sewa disposal stem on the above captioned property.
ntional O
Type of system: ❑ Convether eZ Septic Tank: l00y gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches r! of each ditch U 0 feet ditches 3 feet ditches J 0 ® / S inches
French Drain Required: Linear feet
Authorized State Age t ,. c Date
�S-5=3S-77S