OPHTE#%5-53 Q'J o Harnett County Department of Public Health yy
PERMIT # Operation Permit
New Installation � Se�Ttic Tank Q Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ) t" ~� i^
Name: (owner) z G.o-sc-_ �\ n r,� SUBDIVISION LOT # 5n
Registration #
System Installer: a in, , t
c o.-. _ �_
Basement with plumbing: ❑ Garage "R Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well t l' feet
System Type: _ . 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 appliable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
If. 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for
the sewage disposal system on the above
capots d,property.
Type of system: ❑ Conventional
,W' Other '` rtc:."e _'
�e; J
Septic Tank: gallons Pump Tank gallons
Subsurface -..Na,. of
exact length
width of depth of
Drainage Field ditch'e's ---.1
of each ditch
1 rO feet
ditches �' feet ditches inches
French Drain Reiluired:,�.,_
_ Linear feet
Authorized State Agent ': = .. sF_', Date
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