OP11 - 5-4131'
HTE# 0-5-41313 Harnett County Department of Public Health 25071
PERMIT # Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I�PMFILO �o
Name: (owner) -oc % +9 SUBDIVISION LOT #
System Installer. Lias«,6- SoyNSeN Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community , Public ❑ Well Distance from well feet
System Type: 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.
oris 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 [instruction Authorization
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rtRMll CUNDIIIDNS:
I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2O1-ine ❑ PWR Line
Following are the
specifications for
the sewage disposal tern on the above captioned property.
Type of system:
El Conventional
Other l:. Z FLo-,( Septic Tank: 1000
gallons Pump Tank: gallons
Subsurface
No. of
exact length width of
depth of
Drainage field
ditches
1 of each ditch 130 feet ditches 3
feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 1h
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