OPHTE# I-5 37 Harnett County Department of Public Health 24523
PERMIT # -QW % Operation Permit
New Installation N Sepptic Tank 'X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: `OtvOEQOSP. �7
Name: (owner) 1--yot.4 4iu,LoGsz-) SUBDIVISION LOT #
System Installer: Lc<anvj SHcaQp E Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communiq_—K Public ❑ Well Distance from well X00 feet
System Type: —ate 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 Statutes, Rules far Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Auehomation
PERMIT CONDITIONS
I. Performance:
II. 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 ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the
sewage disposal s stem on the above captioned property.
Type of system:
❑ Conventional
Other t— FL(iMr
Septic Tank: % 0) gallons
Pump Tank gallons
Subsurface
o.
exact length
width of
depth of
Drainage Field
ditches
of each ditch 0 feet
ditches 3 feet
ditches inches
French Drain ReouRdA
_ t
Authorized State Agent Date
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