OPHTE 5735 e-_01 Harnett County Department of Public
23649
PERMIT # Operation Permit
New Installation XSeptic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: to
Name: (owner) P-4--cy% WP, SUBDIVISION LOT # -�
System Installer: M » c v i q:�,Q Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: � 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.
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PERMIT CONDITIONS:
I. 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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the ab ve capt�d property.
Type of system: ElConventional Other e 1 �Nt, 1� J Septic Tank: 100 C; gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch feet ditches feet ditches a2-1_3 6 inches
French Drain Reauired: _ Linear feet
Authorized State Agent 2 Date
I E;- 5 -3�� 0 1