OPHTE#1_)`5-4)3'70 Harnett County Department of Public Health 24728
PERMIT # a�l�J2—� Operation Permit
New Installation )5k Septic Tank >( Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: c7AwaDC.LlAOt!(� O4%,( a
Name: (owner) Co C_ SUBDIVISION 11 ooGb[ I.Av.&5 LOT # -71
System Installer. Rc> &MN'tJ Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 4
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: _711 I Types V and A 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 hen installed in compliana with appliable North Carolina General Sawnes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consustmon Authorization.
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PERMIT CONDITIONS:
1. 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 ❑ N
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑
Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the
sewage disposal system on the above
capti ed property.
Type of system: ❑ Conventional
XI Other C"INwitfR (idla"
_ Septic Tank M0
gallons Pump Tank gallons
Subsurface �No. of
Drainage Field
exact length
width of
nS 3
depth of
aRches�
of each ditch
feet ditches
feet ditches I1•a.4 inches
French Drain Required:
feet
Authorized State Agent_ ��� ��� � wa,05 Date
1-5'113-)