OPHTE# Harnett County Department of Public Health
24097
PERMIT # a`10.� Operation Permit
. New Installation -N4�k Septic Tank Nitrification line ❑ Repair ❑ Expansion
GE 2a c MOn i.LES PROPERTY LO(ATION: F1o1�lzL ilu, �y�
Name: (owner) 0s FassAA C eLGi-iVo 7 -VW% e.Q, SUBDIVISION — LOT #
System Installer: 1--ts2{L---j 5MP,zR6 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well I C)(:I feet
System Type: = 0. 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.
Ims system has been installed in compliance with applicable Nonh Carolina General Sntutes 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.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator requiredf Yes ❑ No
If yes, see attached sheet for additional operation cc
IV. Operation:
Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ) Other 1= -2— Law Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface \ No. of exact length width of depth of f
Drainage Field �eN s of each ditch a�� feet ditches 3 feet ditches I$ 3b inches
French Drain Require -Linear feet
Authorized State Agent :!&� a Date -71 t311
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