OPHTE# 0- 5-40654 Harnett County Department of Public Health 24465
PERMIT # a��O Operation Permit \�,�
X New Installation �l
Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W11L L.VGFAS K9
Name: (owner) ?rt_A�+ Cv, g^s . �NG SUBDIVISION Sws;E . P—%Mtt_. LOT # `10)
System Installer: Hacxo),J 5 e-nG Registration #
Basement with plumbing: ❑ GarageNumber of Bedrooms _ t
Type of Water Supply: ❑ Community Public El Well Distance from well I c feet
System Type: --7= 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.
This system has been installed in compliance with appliable North Carolina General Statuses, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PERMIT CONDITIONS
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
If
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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.
Sr5 E... T"SS(,l "—E0 tn. L h4H3 0v2ED
❑
D -Box
❑ Pump ❑
Alarm ❑ 112O1-ine
❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
X Other F— Z �>' -
Septic Tank: 10 gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches
of each ditch c 'F 6 feet
ditches _3 feet
ditches � inches
French Drain Required:
eufeet
Authorized State Agent Date