OPHTE# TS�—'J��7 Harnett County Department of Public Health 23849
PERMIT # a�53i Operation Permit
New Installation V Sepptic Tank 'K Nitrification Line EJ Repair ❑ Expansior
PROPERTY LOCATION: K�
Name: (owner) SEN�STPili ��N
OGLL SUBDIVISION�Esc�E t2vta LOT #
System Installer. Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms I—•
Type of Water Supply: ❑ Community 'R Public El Well Distance from well A O p feet
System Type: e, 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 Stawtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authormtion.
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I. Performance:
II. Monitoring:
III. Maintenance:
1V. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
following are the specifications for the sewage disposal system qn the above captioned property.
Type of system:
El Other l:ZL.a�/ Septic Tank: Soon gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field — Aitch 4 of each ditch feet ditches 3 feet ditches�'3� inches
French Drain Required: 1 � linear feet
Authorized State Agent pL�15 Date