OPHTE# N- S,3'115iHarnett County Department of Public Health 23550
PERMIT # a.Eba- Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: t N c. F—,4
Name: (owner) 12> v ►—L.. CL-N,� \ko'mGs SUBDIVISION 9Ro \ q\- LOT #
System Installer: W AY9a E 7�O -A c-4, Registration #
Basement with plumbing: ❑ Garage'Ik' Number of Bedrooms 3
Type of Water Supply: ❑ Community Pudic_ ❑ Well Distance from well 16 0 feet
System Type: 11 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.
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the ahoy ccaptioNd property.
Type of system: ❑ Conventional �, Other �M�E1L �C�t��l Septic Tank: L®0 0! gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of te
Drainage Field ditches of each ditch a.33 feet ditches feet ditches —30inches
French Drain Required: Linear feet
Authorized State Agent Date b } l5`
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