OPHTE#16-5.3�a`t3L} Harnett County Department of Public Health 24435
PERMIT # a��l Operation Permit
New Installation ;K Septic Tank >Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PucT�rj
Name: (owner) G 2� 9 V 614 [ nw-IIftN5E SUBDIVISION \JsxcoxiA LOT #
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms_
Type of Water Supply: ❑ Community K Public ❑ Well Distance from well 160 feet
System Type: 1S 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.
INS system has been installed in mmpliana 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:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NAS�
If yes, see attached sheet for additional operation conditions, maintenance and reporting
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal s stem on the above captioned property.
Type of system: ❑ Conventional
Other E-2- 'C:LGYJ
Septic Tank: V 0 QI gallons
Pump Tank: gallons
Subsurface No. of
exact length .
width of
depth of
Drainage Field ditc
s'41 of each ditch is feet
ditches,
feet
p
ditches inches
French Drain Required:
.biDear feet--
Authorized State Agent 7! �)5 Date
VA
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