OPHTE# I-)-5-LA1u60 Harnett County Department of Public Health 24730
PERMIT # Operation Permit
New Installation �X Se tic Tank J Nitrification Line ❑ Repair ❑ Expansion
` 1 PROPERTY LOCATION: �P%PXta1C cxL �G
Name: (owner) 'r" rgeC].c �-�nr�e5 SUBDIVISION P7.Ienws rxuASuaG LOT # 10
System Installer. C`rsi s a JswL LrLLozN9 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 'SLI a 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 been installed in compliance with applicable North Carolina General Statures, 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.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional )1 Other Z Septic Tank: JOOO gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditch T of each ditch .300 feet ditches 3 feet ditches � inches
French Drain Reauired: Qlnear feet
Authorized State hent 4A'0 Date
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