OPHTE05-536x4(- Harnett County Department of Public Health 23826
PERMIT# a.65O= Operation Permit
New Installation Se tic Tank Nitrification Line E] Repair E:1 Expansion
PROPERTY LKATION: Q-rcT a6 04
Name: (owner) M r<kEE )tAa r,nr s SUBDIVISION C)OaG�OW : LOT # \S-6
System Installer. Registration #
Basement with plumbing: ❑ Garage R Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well -1, O O feet
System Type: b Types V and A 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 Statures, 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.
Il. 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 ElH2OLine
❑ PWR Line
Following are the
specifications for
the sewage disposal s stem on the above ca bone roperty.
EAChMO
Type of system:
❑ Conventional
Other fL cSol Septic Tank: Y 000
gallons Pump Tank: S 000 gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
ditches
i of each ditch aZ�C- feet ditches 3
feet ditches inches
French Drain Required: Linear feet
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Authorized State Agen fi Date %/ / 7ZQ <1
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