OPHTE# 13 —5`- 324LQ- Harnett county Department of Public Health 23476
PERMIT # Operation Permit
2� New Installation Septic Tank Vitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: x—?—.igcs-t wa-m c
Name: (owner) _ SUBDIVISION elm LOT #
System Installer: c1 1 4b Registration #
Basement with plu bing: ❑ Garage Number of Bedrooms 3
Type of Water Suly: ❑Community �ublic ❑ Well Distance from well T6onths
System Type: Z Types V anin 5 years.
(In accordance wit Table V a) Owner must contact Health Deparior to expiration for permit renewal.
This system has been Installed in comaliance with aoolicable North Carolina General S atwes. Rules for Sewaee Treatment and Disoof the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. Performs ice: System shall perform in accordance with Rule .1961.
II. Monitori g: As required by Rule .1961.
III. Maintena ice: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional op�ation conditions, maintenance I and reporting.
IV. Operatio
V. Other:
❑ I D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field ditches
D
H2OLine ❑
PWR Line
e disposal system on the above captioned property.
Other Septic Tank: i b o 6 gallons Pump Tank: gallons
exact length width of depth of
of each ditch too feet ditches 3 feet ditches 2L —jl inches
French Drain Required: Linear feet
Authorized State A f — i Date iv —W —i)r