OPHTE# IS -Sar -3-74q) Harnett County Department of Public Health 24086
PERMIT Operation Permit
New Installation `< Septic Tank k Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W4,44PF6�7 �z
Name: (owner) 1iT1-1 6Nsyr-a SUBDIVISION "At,, LrT GooyC- LOT # to
System Installer: n > >a.' Lx Le"Ja ' Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 140 feet
System Type: t 1) Types V and A 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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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No)4
If yes, see attached sheet for additional operation ct
IV. Operation:
V. Other.
maintenance and reporting.
❑
D -Box
❑ Pump ❑
Alarm ❑ 111201-ine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Xe Other QV MP -- U E -a r1_0W
Septic Tank: so6o gallons
Pump Tank: IDOCi gallons
Subsurface
exact length
width of
depth of
Drainage Field
FA
of each ditch IC9 o feet
ditches 3 feet
ditches l� inches
French Drain Required:
'near feet
Authorized State Agent PC --A5 Date