OPH T E # 110 2 -S(- Harnett County Department of Public Health
PERMIT # s Operation Permit 21 7 9 2
New Installation"l Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W )a..,c. ~L9
Name: (owner) 5 ~GnrA-cuc 1A0 ~c. SUBDIVISION LOT # aG
System Installer: C--)-c-y-, Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community 'KPublic ❑ Well Distance from well 16 feet
System Type: to 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:
1. Performance:
11. 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 ❑
Following are the specifications for the sewage disposal
Type of system: ❑ Conventional , Other
Subsurface No. o
Drainage Field ditches
French Drain Reouired:-,,,--
Pump ❑
in on the above captioned property.
G:'0"
exact length
of each ditch C feet
Alarm ❑ H201-ine ❑ PWR Line
Septic Tank: 160 O gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches I -3 a inches
Authorized State Agent "1\1~~ KGNS Date 11130110