OPHTE# Harnett County Department of Public Health 24573
PERMIT # Operation Permit
New Installation �a Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
n PROPERTY LOCATION: Po.4aE"sN Qo
Name: (owner) SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage sli< Number of Bedrooms S
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100* feet
System Type: 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.
[his system has been installed in compliance with applicable North Carolina General Salutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pennit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 ❑ 1-1201-ine ❑ PWR Line
Following are the specifications for the sewage dise2al—lystern o�t the above captioned property.
Type of system: ❑ Conventional Other 1 M -C t�;+\4j Septic Tank sI gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field dkehesof each ditch IVO feet ditches feet ditches it'a inches
French Drain Required-,----\ linear feet
Authorized State Agent ' \�� —%11L \96 +5 Date