OPHTE# 15'5'37 11 s Harnett County Department of Public Health 23869
PERMIT # 1MS4% Operation Permit
New Installation �K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 11 t a_t_M KN G mail G Qo
Name: (owner) Oa a Qt> aSM OC SUBDIVISION LOT #
System Installer. Cwzca., Ar,co*-a Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms !—
Type of Water Supply: ❑ Community ❑ Public >� Well Distance from well 85 feet
System Type: SSS 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 compliant¢ with applioble North Carolina Genenl Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NA
If yes, see attached sheet for additional operation cc
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above cjptioned party.
Type of system: El Conventional � Other Csa Atr\60L. �QtiiSeptic Tank: I C0C'i gallons Pump Tank: gallons
Subsurface'No-o exact length width of depth of
Drainage Field ditches of each ditch I � feet ditches 3 feet ditches ig inches
French Drain Reouired: � near feet
Authorized State hent ,� \�\�\\ r 1,c Date