OPHTE# Harnett County Department of Public Health
PERMIT # Operation Permit 21 7 6 4
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1'1~2r~ IRD
Name: (owner) C~ rz z fl Vk SUBDIVISION P."t)~ &Faa.~ LOT # 1 _
System Installer --k E.q ?D Qow cv Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well l~d feet
System Type: 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.
ims system nas been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and -all itions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned petty.
Type of system: ❑ Conventional X Other t ,53C-tL Q v \C Z' Septic Tank: S UGC) gallons Pump Tank: gallons
Subsurface No. of exact length width of g
depth of
Drainage Field ditches of each ditch (y 0- feet ditches 3 feet ditches 30
French Drain Reauired: I. r,.,.. inches
Authorized State Agent V Date tC LAO
Apr-
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11
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