OPHTE# 11 5 —41'744/
PERMIT # Q 5-�q
Harnett County Department of Public Health 24863
Operation Permit
EalIew Installation eptic Tank itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: SLI C:, (CnS y�.Ioci)
Name: (owner) c-, SUBDIVISION LOT' � sl
System Installer: 2 sU Bh.; �5 Registration #
Basement with plumbing: I—]Garagef er of Bedrooms 3
Type of Water Supply: ❑ Community 13-rub—fic ❑ 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 Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authori ation
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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:
Other.
❑
D -Boz
❑
Pump ❑
Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the
specifications for
the sewage ditposal
system on the above captioned
ro
Type of system:
❑ Conventional
F�er
Qq C.w'uihla-ems
Septic Tank: SC:XiC) gallons Pump Tank: NCYY° ; gallons
Subsurface
No. of
3
exact length
width of depth of
3 : GL'
Drainage Field
ditches
of each ditch
feet ditches feet ditches incIses
French Drain Required: Linear feet
Authorized State AgentDate 0_l l