OP RRHTE# 07- 5-16-7 Q~ Harnett County Department of Public Health
PERMIT # a (o s °t Operation Permit 21 6 5 8
.New Installation 0 Septic Tank iZ~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Lcr" c < Q I Nt ic
2 cl
Name: (owner) L'i S SUBDIVISION G A ~ c w cS LOT # 1 _
System Installer: k z Registration #
Basement with plumbing: ❑ Garage 5K Number of Bedrooms
Type of Water Su ply: ❑ Community ~ Public ❑ Well Distance from well 10 ~ feet
System Type: ~,,,.,,n f. r- 2- F 10%-i 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, Rules for Sewage Treatment and Disposal, and all conditions of the
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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System shall perform in accordance with Rule .1961. f`` U
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Permit and Construction Authorization.
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V. Other
❑ D-Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage dispos system on the above captioned property.
Type of system: ❑ Conventional TX Other d1 ~t -L C\ Septic Tank:
Subsurface No. of exact len th width of
Drainage Field ditches of each ditch feet ditches
H2OLine ❑
E~1'L b~'v
PWR Line
gallons Pump Tank: )I gallons
depth of
feet ditrhPC inrhoc
. 4~- U, C:y-
French rain Required: linear feet
Authorized State Agent Date
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HTE# ; I Permit # F
E
narnett County Department of pjblic nealth
Site Sketch
PROPERTY LOCATON
ISSUED TO: SUBDIVISION '
_ , LOT # t
Authorized State Agent:
Date: `i
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~74 3y 7s
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Cy 77."
Nov
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