OPHTE# V1- 5—L'155-1 Harnett County Department of Public Health 24767
PERMIT # i54a. Operation Permit
l New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
CC�� \\ PROPERTY LOCATION: 30 hPwc�n& I(LN'k
Name: (owner) t't�cNs-10 a CJ5'S dM t QvNe4. SUBDIVISION S v rn c, &zu N LOT # I
System Installer: G .r,sz `J e'N s G Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms t'1
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: -, a b 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 of the Improvement Permit and Construction Authorization
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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 ❑ NPK
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑
112O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abov captioned prope
Type of system: El
Conventional ', Other �kmla /I-, UI�3G "NJ 1
Septic Tank: tdOO
gallons Pump Tank sOO6 gallons
Subsurface
No. of exact length
width of
depth of
Drainage Field
ditches L of each ditch T45 feet
ditches '5
feet ditches '11D inches
French Drain R linear feet
Authorized State Agent qv -sADate 1 T Ag
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