OPHTE# 1-5-4Va23 Harnett County Department of Public Health 24535
PERMIT# a�slaLi Operation Permit
�R New Installation _R Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Wi-.UCAS 9.P
Name: (owner) '!_Prr>> L C:'�' -at,S - 1N e, SUBDIVISION rG-iwPs LOT # '50
System Installer: HPzo-, SU—, 1c— Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms '
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: =171— _ 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
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NaX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. hlulAous£ QtN 51�L Ons Ly
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
V Other C.Z '�__�6 N
Septic Tank: l O c d gallons
Pump Tank:gallons
Subsurface
exact length
width of
depth of
Drainage field \\ditches
of each ditch feet
ditches a feet
ditches :50 _f5 inches
French Drain Required
linear feet
Authorized State Agent feu;ilN5 Date