OPHTE# 1 -4Is» Harnett County Department of Public Health 24904
PERMIT # ag� Operation Permit
New Installation 14 Septic Tank V Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: �e"s)G4OSrx "
Name: (owner) Cs I MQ6<j-a 0 \' ,Ps .S5 y SUBDIVISION CPa>-o1ANPP P o j LOT # 3_j'-_
System Installer:= 1Eo xj 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.
Phis system has been installed in mmpliana with applicable Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoriaatiom
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PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
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.
❑ D -Box ❑ Pump ❑ Alarm ❑ 1120Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above capti ed property.
Type rf system: ❑ Conventional Other �arnR3w�e �QA-_ Septic Tank: 10C 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field dit hes 1 of each ditch feet ditches feet ditches 'anal inches
French Drain Required: �_ Linear feet
Authorized State Agent ' �%� R-C'y5 Date _ 911-711,7