OPHTE# � q- Harnett County Department of Public Health 24938
PERMIT # a�aa� 0 eration Permit
New Installation Septic Tank I �Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: q8 V: ,c- MGctc> C{ 6c,�L rn ct� f3�j,
Name: (owner) lx--TJrf12A "C21R .`> SUBDIVISION LOT ^ -33
System Installer: ' n Registration #
Basement with plumbing: ❑ Garage G24tmb f Bedrooms
Type of Water Supply: ❑ Community EaA u Iic ❑ Well Distanc well f"A feet
System Type: ag &pck( ,c\ S Types Y and YI Systems expire in S years.
(In accordance with Table V a) Owner t 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 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 ❑ 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 dis o ystez�n the above captione�
Type of system:
❑ Conventional
French Drain Required: Linear feet
Authorized State Agent C Date
er
Lows v] Septic Tank: 1cY� gallons
Pump Tank: gallons
Subsurface
No. of
exact length width of
3
�
depth of
a6
Drainage Field
ditches -
of each ditch feet ditches feet
ditches inches
French Drain Required: Linear feet
Authorized State Agent C Date