OPHTE# I_71 —5-'-N�43I Harnett County Department of Public Health 24766
PERMIT # a'IJ-r.14 �Operation Permit
R New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
n(1 PROPERTY LOCATION: OLO USt4l\
Name: (owner) fly+ LAr Tw¢tt 12 SUBDIVISION N1chmN& V>Eit_ Q.,%oGG LOT # cl�1�t
System Installer. k�u;iXg-'O Registration #
Basement with plumbing: ❑ Garage; Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and VI 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions ay the Improvement Permit and Commuttion Authorization
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YtRNII LONDIIIUNS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box ❑
Pump ❑
Alarm ❑
Following are the
specifications for the
sewage disposal s tem on the above captioned property.
Type of system:
El Conventional
$1 Other 02— '�x.OW
Septic Tank: t O00
Subsurface
No. of
exact length
L' OO
width of 3
Drainage Field
ditches
of each ditch feet
ditches
111201-ine ❑
PWR Line
_ gallons Pump Tank: gallons
depth of
feet ditches I -t inches
trench Drain Required: Linear feet
Authorized State Agent T Date