OPHTE# 19 -,5- 11-113-710 Harnett County Department of Public Health 25089
PERMIT # .21,-0 1 Operation Permit
New Installation '?q Septic Tank -)ffg. Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LO(ATION: GI PI^tSPIT„ Lie
Name: (owner) SurAAivryL NOK C vtLflfaS SUBDIVISION Ih?—,o0- LOT # i±4—
System Installer: Gcr4E:> Registration #
Basement with plumbing: ❑ Garage -a Number of Bedrooms
Type of Water Supply: ❑ Command � Public El Well Distance from well feet
System Type: h 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 Ranh Carolina General_ Statutes, 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.
II. Monitoring:
As required by Rule .1961.
III. Maintenance:
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No -
If yes, see attached sheet for additional operation conditions, maintenance and
reporting.
IV. Operation:
V. Other:
❑
D -Box ❑ Pump ❑ Alorm
❑
H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal sytem son the above captioned property.
Type of system: El
Other E F e /
Septic Tank: 160 4�1
gallons Pump Tank: gallons
Subsurface
No. of enact length
width of
depth of
Drainage Fiel-40—es
\ Of each ditch ate. feet
ditches 3
feet ditches inches
French Drain Required:
\ Linear feet
Authorized State Agent —,Ik� � . Iq-eA-S5 Date 6
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