OPHTE#►6-5 3a��� Harnett County Department of Public Health 24544
PERMIT # a°S OSS Operation Permit
New Installation '5�, Se tic Tank V Nitrification Line El Repair F-1Expansion
PROPERTY LOCATION: LN
Name: (owner) �Si62h i ASL -VQ. SUBDIVISION — LOT # a
System Installer: L—Nin;4 Ti taNQY E Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: p 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 on been installed in compliance with applicable North Carolina Genenl 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 perforin in accordance with Rule .1961.
If. Monitoring As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above, captionedroperty.
Type of system: 11Conventional Other GaDtracn 1 Septic Tank: LOo 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field—�itch�itche� of each ditch3O feet ditches 3 feet ditches lar inches
French Drain Required Gnear feet Cocoa
Authorized State Agent 'Or\ 'JSV " \RGl>s Date
I (;� - 5-3 CA