OPHTE# 1 -5 ' II 61y Harnett County Department of Public Health 24752
PERMIT # a.5 �'�� Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N6P11af&-.aoc D 10 n
Name: (owner) MG C. 65 C SUBDIVISION OA-c.o sz C LOT # V13
System Installer. Loo -,E. GoU, Ct Registration #
Basement with plumbing: ❑ Garage � Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: = )r) Types Y 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Pennit and Conmuction Authoriaa6on.
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PERMIT CONDITIONS
I. Performance:
Il. Monitoring:
111. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above capst�io_ne—d _property.`�
Type of system: ❑ Conventional 'X Other Pua e 1 ut.*1Aw 136x1 NCS 3 C 1's t Q/ Septic Tank: 1000
Subsurface No of exact length width of 3
Drainage Field dlTclm of each ditch adS feet ditches
French Drain Require Linear feet
H20Line ❑
PWR Line
_ gallons Pump Tank: 1000 gallons
depth of
feet ditchesT7_�u� inches
Authorized State Agent_ _1�1 \� pia, Date J� 1\°1
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