OPHTE# 11-5-41N36 Harnett County Department of Public Health 24650
PERMIT# Operation Permit ��
21 New Installation Septic Tank lXNitriffcation line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 11 .13 �5c 17, r, as f s R KUZ:
Name: (owner) C.h�r>e5 M�rsti U T ti 4� SUBDIVISION LOT #
System Installer. Q3s 1s•Ercv-Nu, -1 Registration #
Basement with plumbing: ❑ Garage ❑ tuber of Bedrooms 2
Type of Water Supply: ❑ Community aft' Public ❑ Well Distance from well feet
System Type: -Z- 5%6 44.44'aan * Ir. �9.-- 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.
ibis system has been installed in compliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorizavon.
D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for the sewage disposal
system on the above cap tioneerty.
EKT
Type of system: ❑
Conventional Q�Other
t�F T`V ow
c qn eoar
Pump Tank gallons
Subsurface
Drainage Field
No. of
ditches
02' v£
width of
feet ditches 3 feet
depth of
ditches ZZ
French Drain Required:
_
Linear feet
inches
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PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No GiK
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for the sewage disposal
system on the above cap tioneerty.
Type of system: ❑
Conventional Q�Other
t�F T`V ow
Septic Tank: I gallons
Pump Tank gallons
Subsurface
Drainage Field
No. of
ditches
exact length
of each ditch 7D
width of
feet ditches 3 feet
depth of
ditches ZZ
French Drain Required:
_
Linear feet
inches
Authorized State Agent 117-e- I'" Date
T
IN