OPHTE# 14-5.754 S10 Harnett County Department of Public Health 23854
PERMIT # Operation Permit
New Installation `$( Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
` PROPERTY LOCATION: N I�LtNau �sxayCe ep
Name: (owner) Z%IMf.S C-*Nii {Afs4al SUBDIVISION llopzzfwtc— LOT #
System Installer: M it tet'_ 5 t my so ti Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well IC')C) feet
System Type: =.s Types V and VI Systems expire in S 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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rtNMll lUNuuluNS:
1. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the
sewage disposal system on the above captiongd property.
Type of system: ❑ Conventional
Other C lApi � -LiA
Septic Tank: SC?<J'J gallons
Pump Tank: gallons
Subsurface No. ofenact
length
width of
depth of
Drainage Field
of each ditch 154 feet
ditches feet
ditches 7L4`34, inches
French Drain Reauired:
\ Linear feet
Authorized State Agent Z, \4445 Date i1IH� I�
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