OPHTE# 13 `5 -3i &U Harnett County Department of Public Health 23172
PERMIT # ? Operation Permit
R' New Installation Cr Septic Tank E Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: _ Z)r! fin % ;n
Name: (owner) ?47bz4e� /'� o SUBDIVISION ;2 F A LOT # _i
System Installer: LL 2-eI( -o f Registration #
Basement with plumbing: ❑ Garage 13�umber of Bedrooms
Type of Water Supply: ❑ Community [?r Public ❑ Well Distance from well feet
System Type: ' � 17 GI) V I`r'e+ % i Types V and VI Systems expire in 5 years.
(In accordance with Table V a) wner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General
I
1 4)
PERMIT CONDITIONS:
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I. Performance: System shall perforr i i accordan with Rule .1961.
II. Monitoring: As required by Rule 161.
III. Maintenance: As required by Rule
Subsurface system operator required? Yes ❑ No ❑ �54 _t;
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
the Improvement Permit and Construction Authorization.
M
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the seewwagyclisposal 4em on thq above - captiioneed property.
Type of system: El Convent E3. Other 25 /c j l�0 t uJ:}•r Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches `I of each ditch feet ditches feet ditches ZV inches
French Drain Required: Linear feet
Authorized State Agent C Date I— 6 Z G