OPHTE# IS' `-�35�`� Harnett County Department of Public Health 23839
PERMIT # 1 Operation Permit
New Installation'1� Septic TankNitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 'PonjDZZ ,
Name: (owner) Cvm86sLips,,o Kac, SUBDIVISION Cc>'gzzL%yP, S(—�SGNS LOT# S�
System Installer. ti E o 2.> n.)rr tv Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public LJWell Distance from well t00 feet
System Type: x-11 -ch 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.
Isis 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.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ NoA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Box
❑ Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned proppe�rty.
Type of system: ❑
Conventional
Other C sy a ns3f11 CC�11
Septic Tank: t 0 0 c.) gallons
Pump Tank: gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditch sof
each ditch 'SO Q feet
ditches feet
ditches t inches
French Drain Required:
_U near feet
_
Authorized State Agent�� 1,6)rV5 Date
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