OPHTE# 11 --5-a-~'11o Harnett County Department of Public Health
PERMIT # a66~o Operation Permit 2 2 7 2 4
New Installation ~ Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: f7c~xs Qp
Name: (owner) ~,e~FSC:'~arnP,S ~ctrhF s SUBDIVISION LOT #
System Installer: ~TEfl cZ~rwN Registration #
Basement with plumbing: El Garage Number of Bedrooms y
Type of Water Supply: ❑ Community lt~ Public ❑ Well Distance from well 1 b O feet
System Type: 3;~ a Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
]his 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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PERMIT CONDITIONS-
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. 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 ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captione property.
Type of system: ❑ Conventional Other C--,N MgFSZ ~Q~-1'' Septic Tank: \40~)_ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches i of each ditch a.OO feet ditches 3 feet ditches all-3Cf inches
French Drain Required: Line eet
Authorized State Agent Date N NN-J~--LA )