OPHTE# (6-53"70, I Harnett County Department of Public Health 24524
PERMIT # Operation Permit
New Installation �R Septic Tank 'N� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: RassFsZQ.—,>m' Nf V-0
Name: (owner) W c. SUBDIVISION LOT # \4
System Installer, bnmaaL LLLP O Registration #
Basement with plumbing: ❑ Garage Nr Number of Bedrooms 3
Type of Water Supply: ❑ Community 'N' Public ❑ Well Distance from well So (73 feet
System Type: =1 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 for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
PERMIT CONDITIONS
I. Performance:
11. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑Conventional "'KOther Z-- `—Lr—'V
Subsurface . of exact length e,
Drainage field ditches of each ditch JCX% feet
French Drain Reauirt� feet
J
H2OLine ❑
PWR Line
Septic Tank: 100 O gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches l� a� inches
Authorized State Agent f�-- Date
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