OPHTE# 11-5`0 Harnett County Department of Public Health 24154
PERMIT # a�1997 Ooeration Permi _ �
New Installation Septic Tank E�'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: q&5) Lc,n Ac,^ a_) LSrL 1530
Name: (owner) 6irh Os i OL -ss Lc c SUBDIVISION LOT #
System Installer: WpA"t� c,.we&Ae_,- Registration #
Basement with plumbing: ❑ Garage�f S<
Bedrooms —
Type of Water Supply: ElCommunity 'e ublic ❑ Well Distance from well feet
System Type: .QS%. a,< -Aur. Lwr. Sys_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 Smmtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961. '-T6 l,Aa.+6cb�J rz2J
11. Monitoring: As required by Rule .1961. Sn a53.�
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 ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage di stem on the above captionneed,,.praperty.
Type of system: El Conventional L Ir -10 :,V,ls, Septic Tank: 1a� gallons Pump Tank: gallons
Subsurface No. of exact length `�— width of depth of
Drainage Field ditches S of each ditch —4O feet ditches 73 feet ditches 90 inches
French Drain Required: Linear feet
Authorized State Agent ��_lf� Date k:,Jk 16