OPHTE#_ I7 _5-y )—f —K
PERMIT # ao)4%
Name: (owner) _ I"IG�r_e
System Installer: Gan�"
Basement with plumbing: ❑ Garage
Type of Water Supply: ❑ Community
System Type:
(In accordance with Table V a)
Harnett County Department of Public Health 24761
Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: "Sprlslem e, rip t
oMj�7 LLC SUBDIVISION Oaa-4.r v NC LOT # 174
E*wc a e- Registration #
Number of Bedrooms 3—
Public ❑ Well Distance from well feet
Types V and VI Systems expire in S years.
Owner must contact Health Department 6 months prior to expiration for permit renewal,
ims system has been installed in complianm with applicable North Carolina General Sal 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.
II. 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 disposal system on the above captioned prope
Type of system: ❑
Subsurface
Conventional
No.
,>k Other C.asaahQx&i. (Pwae.3C \A \0)) Septic Tank 100 0
r—
gallons Pump Tank gallons
Drainage Field
of
ditch
exact length width of
O
each ditch ale feet ditches 3
depth of
feet 18
French Drain Required:
linear feet
et
ditches inches
Authorized State Agent `14-- �� Date 61