OPHTE#I() .a s :)m 57) Harnett County Department of Public Health
PERMIT # 0 C Operation Permit 21 8 5 4
'D, S
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5--~,s,,~ inrZ fl
Name: (owner) ;>,it\c" =-)o ~L-:0"0C- c- SUBDIVISION QN .w Q17 Qiil- t~ LOT # I?,
System Installer: Mvg_. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well i (76 feet
System Type: lv 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
PERMIT CONDITIONS:
1. 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 ❑
H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ca tioned property.
Type of system:
❑ Conventional Other
P0,97" ET Septic Tank: 1000
gallons Pump Tank: IMO gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
of each ditch C?b feet ditches
feet ditches aC' inches
French Drain Required-_ inear°feet
Authorized State Agent b~~. t Date i= C''
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