OPHTE# ��0'�390b 1 Harnett County Department of Public Health 24304
PERMIT #�11 Operation Permit
New Installation � Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: LAwtZ£,�Cr�4
Name: (owner) —T+ pnoe00-SlE5 SUBDIVISION LOT #
System Installer: 7� o,e t.c3 Registration #
Basement with plumbing: ❑ Garage '8� Number of Bedrooms �_ A
Type of Water Supply: ❑ Com muni °K Public ❑ Well Distance from well LM feet
System Type: 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 Stawtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement permitted Construction Authorization
PERMIT CONDITIONS
I. Performance:
H. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑
D -Box ❑
Pump Cl
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for the disposal system on the above capneged property.
El Type of system:
`�sew(age
Conventional Other
C�'a+s+LaFSL �Q�—/
Septic Tank 180 0 gallons
Pump Tank gallons
surface
No. of
exact length
width of
depth of
Drainag
ditches �_
of each ditch k0 O feet
ditches ,� feet
ditches �� inches
French Drain Reqm
Linear feet
Authorized State Agent_ �� Date
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