OPHTE# I6- 5-363 Harnett County Department of Public Health 24105
PERMIT # Operation Permit
New Installation X Septic Tank )4 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
NElx�a\Ett„�ooQ �rd�
Name: (owner) �E E i �o�C* 1NL SUBDIVISION Qe s c w LOT # S� a
System Installer. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L\
Type of Water Supply: ❑ Commum Public ❑ Well Distance from well 100 feet
System Type: 1 c Types V and VI Systems expire in 5 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.
II. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above japtione, roPerry.
Type of system: ❑ Conventional )Kj Other (Z"�F'"18E17_ CQ \ Septic Tank: t 66 3 gallons Pump Tank: gallons
Subsurfacelo. of exact length _ width of depth of
Drainage Field ditches of each ditch — �� feet ditches_ feet ditches 1`a —34; inches
French Drain Reunited: \ VoaLfeet
Authorized State Agent 'N� 2r t+� Date 9
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