OPHTE# I6-5- `3 '1 Harnett County Department of Public Health 24085
PERMIT #1� 6 Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �P,aS 1av6
Name: (owner) 14orwNC' rr L SUBDIVISION LOT # a9
System Installer: 0-ry%5 (IrTYR.\c>(-pseto Registration #
Basement with plumbing: El Garage Number of Bedrooms 3 x
Type of Water Supply: ❑ Community %X Public ❑ Well Distance from well 100 feet
System Type: ?L. 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 tonswaion Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 cc
IV. Operation:
V. Other.
maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the
sewage disposal on the above captioned property.
Type of system:
El Conventional
�sYstem
Other `-2^ Septic Tank: 1 000
gallons Pump Tank: gallons
Subsurface
exact length width of
depth of
Drainage Field
ditches
of each ditch i S feet ditches 3
feet ditches I i'a:L� inches
French Drain Reauired:
inelnteet
Authorized State Agent YA ?45 --*A5 Date
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F,
16-5-3%33-7