OPHTE# �—%-57a'�a3cli Harnett County Department of Public Health 24917
PERMIT # ❑3� 0 eration Permit
New Installation Septic Tank Nitrification Line ❑ Repair El Expansion
PROPERTY LOCATION: Docs Qp
Name: (owner)+�� CONt`15QVGSSox a SUBDIVISION OLOT # V3
System Installer. O -s a Registration #
Basement with plumbing: ❑ Garage 'N Number of Bedrooms i
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: 11> 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Abomination
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ M20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other Septic Tank: %606'0 gallons Pump Tank: t0Q o gallons
Subsurface No. of exact length width of depth of
Drainage field of each ditch % feet ditches feet ditches 36"17 inches
French Drain Required` _ �aear feet
Authorized State Agent —4�� Date