OPHTE# 1-)-5-4119-) Harnett County Department of Public Health 24595
PERMIT # X39 Operation Permit
❑ New Installation ❑ Septic Tank'
Nitrification ne� Repair XExpansion
PROPERTY LOCATION: _Sntw,ss NaqA2,xs
Name: (owner)Po+ca,M 'c
''PNoh-hPA SUBDIVISION KaNN.s Co4Et:�. LOT #
System Installer: NOJousGFP St_?°it`xr� iNL- Registration #
Basement with plumbing: Cl Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: �% Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner most 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 Pemtit and Commrction Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. 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.
❑ D -Box ❑ Pump ❑ Alarm
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: X Conventional ❑ Other
Subsurface No. of u(sw exact length
Drainage Field hes _J0—of each ditch Cat 0 feet
French Drain i
Requred: Linear feet
L
H2OLine ❑
Line
Septic Tank: loco gallons Pump Tank gallons
width of depth of t= vtOw
ditches 3 feet ditches f9 -a0 inches
Authorized State Agent ------ Date
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