OPHTE# I1— S-11)337 Harnett County Department of Public Health 24770
PERMIT #'g5a3 Operation Permit
New Installation 'R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: NC,dNQS
Name: (owner) C P+s t_s o ,v C-0 NYc . Go , SUBDIVISION LOT # C
System Installer: Gv_tN:O>s •p" G Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ CommuniPublic ❑ Well Distance from well feet
System Type: � Cl 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 hm been installed in compliance with applicable Ranh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Impmvement Permit and Constmation Authorinuon.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. 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. Nurara.- "ntEs gaOIAD e&Sb e°7F &?PQwNl0'1
❑ —D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine 11PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system:
El Other F Z .a.a Septic Tank: 160 C gallons Pump Tank: gallons
Subsurface o \ exact length width of depth of C)
Drainage Field ditches t of each ditch a0 feet ditches s feet ditches S�—aci inches
French Drain Required: Linear feet
Authorized State Agent go ss Date tall
I � -5- X033 7