OPTs-s-3�1a3
HTE#X5.5-3� Toti Harnett County Department of Public Health 23769
PERMIT # a$5T j Operation Permit
New Installation �K Septic Tank )i< Njt(ification line El Repair El Expansion
PROPERTY LOCATION: S Nay oc. e. Nei
(owner) Lv t<ag< r2gal�Ac�y k lAm(k� SUBDIVISION MTct� $2ANc, L LOT #
System Installer. s_[. C.o . Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms L _
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well LM feet
System Type: 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 uncalled in compliance with applicable North Carolina Geneml Smmtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other: lid VAcy'73& ®N S,TE %. i,rnE SvsrALLC�rfOnr
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
following are the
specifications for
the sewage disposal s stem on the above caf none d °P�erty.
Type of system:
❑ Conventional
Other E',m H�Fi2- lQ'A ' Septic Tank:
gallons Pump Tank: gallons
Subsurface
No. ofexact
length width of
depth of
Drainage Field
ditches
of each ditch T 5 feet ditches 3
feet ditches 1% inches
French Drain Required: linear feet
Authorized State Agent 1351 Date 101191 s"
�6-5-3-1)