OPHTE# G"5-4OS4 Harnett County Department of Public Health 24551
PERMIT# aei13� Operation Permit
New Installation "i Septic Tank )R Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: W%pggarrt/ Ra
Name: (owner) SUBDIVISION F1, aEN Lc,-f6LOT # 8 G
System Installer. o Ow N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communis Public ❑ Well Distance from well 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.
this system has been installed in compliance with applimble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construmon Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation cc
IV. Operation:
maintenance and reporting.
V. Other. Sesc, 4CC--&p lw S'a,p, N L_„" a QQepgL S RP2S1 �uSy
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captionederty.
Septic Tank: t d 00
Type of system: ❑ Conventional �
Other G�'n�� Ce1v, p gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches �_ of each ditch feet ditches 3 feet ditches 11: 'QLH inches
French Dram eqw --Linear feet
Authorized State Agent�� �N--� Date
V� -- S -L-"),3 A 5
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