OPHTE# 16-5 -:M Harnett County Department of Public Health 24526
PERMIT # a')o�0 Operation Permit
New Installation 'K Septic Tank '�e Nitrification Line ❑ Repair ❑ Expansion
DD PROPERTY LOCATION:_2>avc,6
Name: (owner) kor,G} SUBDIVISION -Z'61AC-56" 'FVAi,-M5 LOT # Qa
System Installer. E,PaG QPP C.Q- Registration #
Basement with plumbing: ❑ Garage 12< Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: i c Types V and VI Systems expire in S years.
(In accordance with Table V a) 1 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 for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Commoctlon Authorization
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PERMIT CONDITIONS
I. Performance:
System shall perform in accordance with Rule .1961.
II. Monitoring:
As required by Rule .1961.
111. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
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 abo]fe caphaNd property.
Type of system: El
Conventional Other �y-1 Gasrr& hf�. �
Septic Tank: I oa 6
gallons Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditctes of each ditch S06 feet
ditches 3
feet ditches (Q inches
French Drain Reeuired:
near feet
Authorized State Agent �, b% Date