OPHTE# Harnett County Department of Public Health
PERMIT # &Yc Operation Permit 21 71 8
[New Installation 52 Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: /5 ~/5i itn~3,}
Name: (owner) j)jZLtJ zZet~~ 60we SUBDIVISION LOT # Z
System Installer: d4zLeZ -5;,,4 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance fro, we[ feet
System Type: Z 2~r J 1%j Sj - --f, 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
with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
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.
❑ D-Box ❑ Pump ❑ Alarm ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewwa d disposal system on the above captioned prgerty.
Type of system: ❑ Conventional Li] Other 191, 3Z" H( ank: G 0 E 3 gallons Pump Tank: gallons
Subsurface No. of exact length "'width of depth of
Drainage Field ditches 2 of each ditch 17-0 feet ditches feet ditches inches
French Drain Required: Linear feet
Authorized State Ag~ht Date - j f
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