OPHTE#LEr5-3'7-7°1 Harnett County Department of Public Health 24583
PERMIT #'a`f Operation Permit
New Installation ', Septic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LO(ATION:_ C )tea
Name: (owner) IPV. buL. 1-y0�4 SUBDIVISION MP,-%or.E LOT # y 6
System Installer. L–Aq "L—T S"Prtfill- Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Comm uni Public [IWell Distance from well feet
System Type: sip 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 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.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other. `-'ueYL.y O.U., 0. L"S— 34s efLes, Ar62-LlvG
❑ D -Box ❑ Pump ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional 'e Other Qu.�e TO E�—fines Septic Tank: T 'DO or gallons Pump Tank: I D6d gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches It. of each ditch tYO feet ditches feet ditches J.ZA inches
French Drain Require_'rcat feet
Authorized State Agent W--)45 Date 6I a' ),
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