OPHTE# S-� t -i2 Harnett County Department of Public Health 23963
PERMIT # Operation Permit
New Installation Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I -ANE AD
Name: (owner) V q ` y try&: �00v It_DGk�SUBDIVISION — LOT # a
System Installer: C3c..o 4: scL.c>e;t_Qe,-t9 Registration #
Basement with plumbing: ElGarage Number of Bedrooms 3 T
Type of Water Supply: ❑ Community Public I—]WellDistance from well 1De feet
System Type: -r. 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 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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Na
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field
French Drain Reouiredt
Pump ❑ Alarm ❑
112O1-ine ❑
PWR Line
sewage dispose system on the above w tioned property.
Other V ymP_5 o L _Ew Septic Tank: 10f3 0 gallons Pump Tank: 10 OO gallons
exact length width of depth of
e� of each ditch �_ feet ditches 3 feet ditches If, inches
Linear feet
Authorized State Agent�����06� Date S/))))(
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