OPNTE#f 6-5--6 `bCOC) Harnett County Department of Public Health 23752
PERMIT # a���r'Y 0 eration Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'S o,am y7 �' NQ'o u t F—j pW
Name: (owner) FrGzHFtLo �i uN G SUBDIVISION LOT # B
System Installer: coA Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: -1= , 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 Statures, Rules for Sewage Treatment and Disposal, and all wnditions of the Improvement Permit and Comnrumon Authorization
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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 sewage disposal system o the above captioned property.
Type of system- ❑ Conventional Other F. ! . �t..0'W Septic Tank: )s000 gallons Pump Tank: gallons
Subsurfaceexact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches alk -A inches
French Drain Requ linear feet
Authorized State Agent "4 X)y Date eA I15
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