OP RHTE# C)RHarnett County Department of Public Health
PERMIT # s Operation Permit 21 9 6 2
New Installation 'N, Septic Tank "X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: CAZA--l~YW-C ynk~-' 'Z>
Name: (owner) VkOcnC. C-0 -v5-• SUBDIVISION ZP" L.lr,t LOT # N5_
System Installer: ' -,e-,cl,,,\(,A Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \00 feet
System Type: a 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 Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. 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 ❑ Alarm
❑ H20Line ❑ PWR Line
Following are the spe
Type of system: ❑
cifications for the sewage disposal system on the above captioned property.
Conventional Other
Septic Tank: I OC C0 gallons Pump Tank: gallons
Subsurface
Drainage Field
No. of
ditches 4
exact length
of each ditch a3 b feet
width of depth of
ditches feet ditches 61? inches
French'Drain Required: Line feet
Date
Authorized State Agent- ? l~ 1
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