OPHTE# (O—'S-3-06 Harnett County Department of Public Health 24427
PERMIT 0 eration Permit
New Installation N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
t� � r_ PROPERTY LO(ATION: �,ii Lvc s
Name: (owner) t'�CLkiNsI L -'Z NSi . \,4 d SUBDIVISION LOT #
System Installer. N cam, 4 St,,�N , c, Registration #
Basement with plumbing: ❑ Garage N�K Number of Bedrooms . 9
Type of Water Supply: ❑ Community li� Public ❑ Well Distance from well feet
System Type: —X1Z 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.
anis system nae been installed in mmpbance with applicable xorth Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authonanon.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No�K
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 captioned property.
Type of system:
❑ Conventional
X Other E'1 S. a,, Septic Tank: SOOs
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditcses
I of each ditch a --i0 feet ditches 3
feet ditches�$�' Q_ inches
French Drain Require
6(eet
Authorized State Agent :!� Date