OPHTE# 11-5'uQ911 Harnett County Department of Public Health 25104
PERMIT # `AT14 3 OlDeration Permit
New Installation )� Septic Tank )K Nitrification Line ❑ R ❑ Expansion
PROPERTY LOCATION: I.pwR6Ne4— 1Lb tsc .4N C' SMI
Name: (owner) A htkiX,li eN SUBDIVISION QLpOei-5% LOT #
System Installer. ';%ro C Registration #
Basement with plumbing: ❑ Garage �$< Number of Bedrooms 3
Type of Water Supply: ❑ Community q Public ❑ Well Distance from well feet
System Type:ala 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.
Ims spam nos been installed in comphana wnh applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and aR conditions of the Improvement Permil and Constmetion Audlorhavon.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
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 -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
following are the specifications for the sewage disposal system on the above ca tionedproperty.
Type of system: El Conventional Other C%A N nB 2. ON Septic Tank 0 gallons Pump Tank: gallons
Subsurface No. ofexact length width of depth of
Drainage Field ditches S of each ditch IS -6 feet ditches feet ditches tQ inches
french Drain Required: linear feet
Authorized State Agent HS Date "1 3 I
1-1-5- ��55�1