OPHTE# V%—&43S-1 1 Harnett County Department of Public Health 25031
PERMIT # & 3b Operation Permit
XNew Installation )Kj Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: DPArwGA
Name: (owner) pJPscag000 CJe+a%06A5 SUBDIVISION Lsr,L,r, 9_wF.2 z_6,rjKCI0N LOT# 1(33
System Installer. C'YvTs5 Srio..Ncz a——
P,� Registration #
Basement with plumbing: El Garage El Number of Bedrooms
Type of Water Supply: ❑ Communi ❑ Public � Well Distance from well `T O feet
System Type: _ x T t 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 4th applicable North Carolina General Statutes, Rules far Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
It. 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: Vjsa rca.-aC. Z"IL_An. INN—v. OP VN54Ecr, 0A q b t'eCe((a�T YG
❑
D -Box
❑ Pump ❑ Alarm ❑
1-12O1-ine ❑ PWR Line
Following are the
specifications for
the sewage disposal system on the above captioned property.
Type of system:
❑ Conventional
X Other E -Z- Rrra.ow Septic Tank: s045 0
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
a. of each ditch feet ditches
feet ditches g inches
French Drain Require3: Linear feet
Authorized StateAgen Date 3 t9 )
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