OPHTE# I'� Harnett County Department of Public Health 23856
PERMIT # Operation Permit
New Installation 1�1:,' Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION: ANT vc X i O ca,C3y LN
Name: (owner) w SUBDIVISION T4 oTGar:� R.osE LOT # Li-)_
System Installer.'-wolt c- . 7 Registration # 1 f 7
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 16 O feet
System Type: �-,o 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 installed in compliance with applicable North Larobna General Statutes, Rules for lewage Treatment and eisposal, and all conditions of the Improvement Permit and Lomtruction Authorization.
1 �
1A0 vsC
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. 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 th sewage disport system ons ab w Honed property.
of
Type of system: ❑Conventional �
Other vtrq �a r -0—y Septic Tank:
1 C) 00
gallons Pump Tank I �t�0 gallons
Subsurface No. of
' )
exact length width of
CJ
3
depth of
111 30
Drainage Fie ches
of each ditch feet ditches
feet ditches inches
French Drain Required:
Linear feet
Authorized State Agent
Date
II
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