OPHTE# 1�-� �t3s6`I Harnett County Department of Public Health 25047
PERMIT # 3po�y1 Operation Permit
New Installation X Septic Tank >4 Nitrification Line ❑ Repair ❑ Expansion
_ PROPERTY LOCATION: RAnyoq: Qo
Name: (owner) 1 Y r_62 M A-M,,,,A S SUBDIVISION LOT #
System Installer, gosay THor.sog Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 14�
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: := s Types V and VI Systems expire in S years.
lln accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihn system has been imtalled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions or the Improvement Permit and Construttion Authorisation
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PERMIT CONDITIONS
I. Performance:
System shall perform in accordance with Rule .1961.
11. Monitoring.
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NK
If yes, see attached sheet for additional operation conditions, maintenance
and reporting.
IV. Operation:
V. Other.
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❑
D -Boz ❑ Pump ❑ Alarm ❑ H2O1.1ne
❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional V Other E7Z- �:10j
Septic Tank1�'(6 Q gallons
Pump Tank gallons
Subsurface
Drainage Field
No. of exact length
ches a of each ditch C;0 feet
width of
ditches 3 feet
depth of
ditches "�1 t inches
French Drain Required:
Linear feet
Authorized State Agent t5 Date
�1:
I - S-'13S�1