OPHTE# 1 )'�j'i$ Harnett County Department of Public Health 25026
PERMIT # a*100 Operation Permit
New Installation Septic Tank Nitrification Line Repair ❑ Expansion
PROPERTY LO(ATION: I l.455 as- U C xL -
Name: (owner) PQVLn SM �y SUBDIVISION LOT #
System Installer. 1—ann-e Sx, -e9& Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community '>( Public ❑ Well Distance from well feet
System Type: 7:= ems, 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 quem 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 Authorization
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PERMIT CONDITIONS
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required.? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D•Box ❑ Pump ❑ Alarm ❑ H201.ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional � Other &r2—FWw Septic Tank 1000 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche of each ditch WCe feet ditches 3 feet ditches 1$ 4LI inches
French Drain Required: Linear feet
Authorized State Agent &A5 Date �g
1-1-43-L�\tC'Y