OPHTE# L.ss-3.r`ssr Harnett County Department of Public Health 23717
PERMIT # d.8 3 SI Operation Permlt
Z New InstallationSeptic Tank RI�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ZsW S%o, c Ra.
Name: (owner) J,: 4.} -e l4am.Q bAa:(d..r SUBDIVISION Pte+ LOT # �7_
System Installer: 0+{:t Pl.. J Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 171" Public ❑ Well Distance from well feet
System Type: = 9 Types V and A Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system on been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and lonstrunion Aumonaanon
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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 001
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewapAisposal system 99 the above optioned property.
Type of system: ❑ Conventional Other G: 7— Septic Tank: /000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 80 feet ditches 3 feet ditches A inches
French Drain Required: Linear feet
Authorized State A 04--;. - f! Date /�/ //ce_r
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