OPHTE# 17_S-40 bi Harnett County Department of Public Health 24905
PERMIT # I 1 Operation Permit
New Installation "I�k Septic Tank Nitrification Line ❑ Repair ❑ Expansion
nn \` PROPERTY LOCATION: Oats Pzn
Name: (owner) I ackG 6 T to c-4 S LI—C, SUBDIVISION _ QA LmO t Y� LOT # 0i fo
System Installer: Cvo,c Ga2r6cL Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 11� Types V 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.
mis system has been Waned in compliance mth applicable north Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (nmtrumon Authoriudon.
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PERMIT CONDITIONS -
I. Performance:
System shall perform in accordance with Rule .1961.
If. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ 110)9�
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑ H2OLine
❑ PWR Line
Following are the specifications for the sewage disposal system on the ab4ve captioned grope�
Type of system: El
Conventional �, Other G9a.�e,Uy tK%Xe 3f tit °l
Septic Tank toe 6 gallons
Pump Tank: gallons
Subsurface
No. of exact length
width of
depth of
Drainage Fieldditc
eTi� of each ditch "SO 0 feet
ditches -- feet
ditches 1, inches
French Drain Required:
Linear feet
Authorized State Agent'"�\»i Date