OPNTE# Harnett County Department of Public Health 23933
PERMIT # c20 (-Z-z,0 eration Permit
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G� NeW Installation Septic Tank CNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: %Lo v .Cd
Name: (owner) C'_tio r ter %e ea/ SUBDIVISION LOT #
System Installer: O -4' -f�s .4�e.x.4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: JT a 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 has been installed in compliance with applicable North Carolina General Statures, 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.
11. 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 ❑
Alorm ❑ H2OLine ❑ PWR Line
Following are the
specifications for
the sew,aR� disposal system on the above captioned property.
Type of system:
11 Conventional
L'I Other k'z G/w w
Septic Tank: /000 gallons Pump Tank: gaflons
Subsurface
No. of
exact length
width of depth of
Drainage field
ditches
of each ditch // U feet
ditches �� feet ditches /8'2` inches
French Drain Required: ��Liinnearfeet
Authorized State Agen' — '; ! ��� . �.er Hf Date /Z'?d •26 /6
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