OPHTE# 1`9 —5-I-13690 Harnett County Department of Public Health 25090
PERMIT # 3cC53S Operation Permit
New Installation X Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Tu2i rfcn_
Name: (owner) &Tpo&�Z PN25q �c�uuv5 SUBDIVISION LOT #
System Installer: Obl3gi lNehPo3 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms --5
Type of Water Supply: ❑ Community .72L. Public ❑ Well Distance from well feet
System Type: 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 Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PLRMIf CUNDITIUNS:
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 Cl No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑
Pump ❑
Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal
system on the above captioned
property.
Type of system: ❑ Conventional 1!8� Other
Z—Z ';: L-Q��
Septic Tank v b °
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditche
of each ditch \
feet ditches
feet ditches au -3 a inches
French Drain Required: Linear feet
Authorized State Agent w\� �j Date 6 Iw