OPHTE# 1`7-5-1k2 j) Harnett County Department of Public Health 25054
PERMIT # Qat"H Operation Permit
New Installation Septic Tank 1W Nitrifies ion Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'djNtt. LucpsS
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Name: (owner) v Ea e 0 e.s I" 4 SUBDIVISION Swe..ter pma LOT # _Sr�_
System Installer: Jo . r-,, Sties G Registration #
Basement with plumbing: ❑ Garage � Number of Bedrooms 3_
Type of Water Supply: ❑ Community K. Public ❑ Well Distance from well feet
System Type: c, 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 with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all costumers; of the Improvement Permit and Construction Authorisation
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑
Following are the specifications for the sewage disposal system on the above�o`ptioned perry.
Type of system: LJS?�L �5.� Conventional Other C*r\'oSeptic Tank: MJF gallons Pump Tank: _
Subsurface No. of exact length width of depth of
Drainage Field ditches I of each ditch feet ditches 3 feet ditches
French Drain Required: Linear feet
Authorized State Agent � ����'�- Date
PWR Line
gallons
inches