OP RHTE#Harnett County Department of Public Health
PERMIT # Operation Permit 2 2 0 5 3
9 New Installation Li Septic Tank /Nitrification Line ❑ Repair ❑ Exoansion
PROPERTY LOCATION: c)
Name: (owner) ~~1ff 72SUBDIVISION LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms . l
Type of Water Supply: El Community L Public ❑ Well Distance from well feet
System Type: c avt3 sr., ='1 - %;,zLe,, 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 applicaEle North Carolina General Statutes, Rules for Sewage Treatment
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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.
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 ❑ Alarm ❑
Following are the specifications for the sewa disposal system on the above captioned property.
. es, T~tic Tank:
Type of system: El Conventional Other 4A
Subsurface No. of exact length width of
Drainage Field ditches- of each ditch C' feet ditches
French Drain Reauired: Linear feet
H2OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches Z inches
Authorized State PA,ent ~ 2 Date 1 -1 -I I
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11-5-25936R (2) 11-5-25936R (3) 11-5-25936R (4) 11-5-25936R (5)
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11-5-25936R (6)
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