OPHTE# Harnett County Department of Public Health
PERMIT # a60 Operation Permit 21911
New Installation `E~ Septic Tank "E~ Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1-ItiL~MA~s GQ-(Nc ot-°
Name: (owner) yaWIC CGrvv-~ . Co )ir4 c. SUBDIVISION 2Q-cs~ \3ozw LOT #
System Installer: P.x n Co,-r,q ,6A aar5 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well ~Q ® feet
System Type: Types V and VI Systems expire in 5 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
with applicable North Carolina General Statutes, Rules for Sewage Treatment and Uisposal, and all conmteons or me
i p Urn? R,EP~~a
rermit anu wuxiuumu nuumn<auvu.
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 ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional V Other Puny 7o F-Z 'V I-ON4 Septic Tank: SoC~r, gallons Pump Tank: t® Q) gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 100 feet ditches 3 feet ditches '~LO-W inches
French Drain Required:
Authorized State Agent ML 96~ Date
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