OPNTE# 19 -S 4310 Harnett County Department of Public Health 25062
PERMIT # �`�3-7 Operation Permit
. z New Installation 'X Septic Tank >( Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: N PRuGS GC .
Name: (owner) cLo >>e. Co 'Si^tc-. SUBDIVISION LOT # �6_
System Installer: N o,(w)N c;,C 1 `sa Registration #
Basement with plumbing: ❑ Garage 'J;Z' Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: =L r� 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 Statures. 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.
11. 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 ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
Other 1:.Z,ri77:-0 ',(
Septic Tank: 1,000 gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
3
depth of
" W
Drainage Field ditc
of each ditch 0s1Q feet
ditches feet
ditches inches
French Drain Required:
Linear feet
Authorized State Agent t 6 Date