OPHTE# ► o-s-aLAS9 , Harnett County Department of Public Health
PERMIT # Z i1 Operation Permit 21 7 6 0
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ~'o NnE2c~sP,
Name: (owner) SUBDIVISION CPkC14t_,t~P LOT # 5
System Installer: S E-o N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms L+
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 b O 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.
finis system has been i
nstalled 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:
1. 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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H120Line ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned operty.
Type of system: ❑ Conventional V Other G~ tr.3t:~ (G v t c K u Se tic Tank: t 0 0
Subsurface No. of p 0 gallons Pump Tank: gallons
exact length width of depth of
Drainage Field ditches ~ each ditch ISO feet ditches 3 feet ditches a L % -3
French Drain Reouired-n~ a inches
Authorized State Agent Date 161 x6) 10