OPHTE# I �'S +►O``l� Harnett County Department of Public Health 24910
PERMIT # 2 °150Lj Operation Permit
New Installation 'Nk Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'Ts 0.24%to ®2Ny b
Name: (owner) G ch "o �c N -y 1 oc-,m 4e-1 E. SUBDIVISION L -#rSs%y" LOT # 5_
System Installer: C �N6T ib K sN6aa Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 7=ZbTypes 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.
[his system has been imalled in compliance with appliable Norah Carolina General Statutes, Rules for Sewage Treatment and Dis oml, and all condinons of the Impmeemem Permit and Constmfion 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box
❑ Pump El -Alarm
❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the abov�ecapti dd property.
Type of system: 11 Conventional
� Other CHgv'.96
Septic Tank: 1000'
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditch
of each ditch ro O feet
ditches 3
p
feet ditches 0 inches
French Drain Required:^
Linear feet
Authorized State Agent_ Date
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