OPHTE# 1-7-5-- 469 $' y Harnett County Department of Public Health 24520
PERMIT # Z 17'3 Z- . Operation Permit —/
C>� New Installation Septic Tank Lts Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:3z.,/1t1W 9
Name: (owner) l�4 0wk:s 3 C DG SUBDIVISION LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage Com]' mber of Bedrooms
Type of Water Super❑Community [31 Public ❑ Well Distance from well feet
System Type: J 10 >412, T pes V a VI Systems expire in 5 years.
(In accordance with Table V a) (3I.1/ must t.I,gealt,Dy�mem 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
1. Performance:
Il. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
North Carolina General Statutes, Rules for Sewage Treatment Od Disposal, and all
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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.
Permit and Connmaion Amhonution.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew disposals ons aabo�ve captioned rop,rty.
Type of system: ❑ Conventional Other 2D /(�(Jf�C�t(J'� Septic Tank allons Pump Tank gallons
Subsurface No. of exact length width of depth ofs /—`I
Drainage Field ditches of each ditch �n%2 feet ditches feet ditches I e'—Winches
French Drain Required: Linear feet
Authorized State Agent /'` (e`�N�u� Date
17-5-40984 (1) 17-5-40984 (2) 17-540984 (3) 17-5-40984 (4) 17-5-40984 (5)
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17-5-40984 (6) 17-540984 (7) 17-5-40984 (8) 17-540984 (9) 17-540984 (10)
..ter
17-540984 (11) 17-5-40984 (12) 17-5-40984 (13) 17-540984 (14) 17-540984 (15)
17-540984 (16) 17-540984 (17) 17-540984 (18) 17-540984 (19) 17-540984 (20)
17-540984 (21) 17-5-40984 (22)