OPHTE# -1 S - S-3 S-30 Harnett County Department of Public Health 2- 3-6�3
PERMIT # �'�� c) Operation Permit
New Installation -V Septic Tank `�` Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) p 1-4 C— SUBDIVISION i, ,;,ErL& ysv LOT #
System Installer: v!,y Y,. 4 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community `.TRr Public ❑ Well Distance from well 100 feet
System Type: _ c , 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.
ims system nas peen instaueo in compliance wan applicable Rortn larolma ueneral Wtutes, 8ules for )ewage Ireatment and
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and all conditions of the Improvement Permit and Construction Authorization.
PEK1111 CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other,
❑ D -Box ❑ Pump ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other t—= V:,L 0 W
Subsurface No. of exact length
Drainage Field ditdiei of each ditch 0 feet
French Drain Reouired: Linear feet
Alarm ❑ 1-12O1-ine ❑
PWR Line
Septic Tank: t8Q C3 gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
Authorized State Agent ��� - N� Date 5115-