OPHTE# IG -5` Harnett County Department of Public Health 24106
PERMIT # 7.q'1T Operation Permit
New Installation -J;� Septic Tank ,< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Lssy L -t G,vnaa
Name: (owner) C'L--/v'F— R a SUBDIVISION LOT #
System Installer: L—a"t sE ow�sow Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms �J
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well ) O feet
System Type: "AL1 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.
Has system has been installed in compliance with applicable North Carolina General statutes, Rules for Sewage Treatment nd Disposal, and all conditions of the Improvement Permit and construction Authomation.
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1. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm
Following area specifications for the sewage disposal system on the above captioned property.
Type of systemConventional ❑ Other
Subsurface f exactlength
Drainage Field ditches of each ditch feet
French Drain Required: �. _ Linear feet
01
H2OLine ❑
PWR Line
Septic Tank: 160 0 gallons Pump Tank: gallons
width of depth of
ditches feet ditches AO —36 inches
Authorized State Agent "ll!"alk, "INN Q- HS Date ]S