OPHTE# 15—r C- 11� Harnett County Department of Public Health 23857
PERMIT # Operation Permit
New Installation 'K Se tic Tank > Nitrification Line E] Repair 11 Expansion
PROPERTY LOCATION: sc ,' , v r Lv
Name: (owner) V1 ''A 0r45) -T(,— H o nGS SUBDIVISION ba, (.G5coo u� LOT # C
System Installer: Ori_-, Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community 'K Public ❑ Well Distance from well N b 0 feet
System Type: =Z � 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 Noah Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoriniion.
NC
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PERMIT CONDI110NL
I. Performance:
11. 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 ❑ NXO
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
P +aP f�l�Ce V SZ.F l O�"it0 O � JA(� 1'YGV.� �L Jt%'TI B N
❑ D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the specifications for the sewage disposal
system on the above c�aP.tioned property.
Type of system: ❑ Conventional Other {�um4
i o �Z It -D�y
Septic Tank: gallons
Pump Tanka 000, gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field dIt!R
of each ditch 1Q0 feet
ditches '3 feet
ditches 1'2 1. inches
French Drain Required: Linear feet
Authorized State Agent ���5 Date
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