OPHTE# I�;-- s' `313 S% Harnett County Department of Public Health 24041
PERMIT # a-859(, Operation Permit �/
New 'Installation Tank f Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 5x— 144E A—,—rCzN 5 izA
Name: (owner) �'. �— ,�rti - s. SUBDIVISION LOT # Z
System Installer: Registration #
Basement with plumbing: ❑ Garage LKumber of Bedrooms 3
Type of Water Supply: ❑ Community Z Public ❑ Well Distance from well feet
System Type: '?v 4, Zs Z CL ee T 3 C.�Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must con a Health Department 6 months prior to expiration for permit renewal.
has been installed in compliance with asoliable North Carolina General statute. Rules for
PERMIT CONDITIONS:
I. Performance:
If. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
10
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
conditions of the Improvement Permit and Construction Authodaaticn.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sew a disposal system opn above captioned property.
Type of system:
❑ Conventional
�the
Other 2S`2 LGII ,t&r —
Septic Tank: / 6 O gallons Pump Tank: %ate gallons
Subsurface
No. of
y
exact length
width of 2 depth of
Drainage Field
ditches
of each ditch feet
ditches �L feet ditches Zo inches
French Drain Required: Linear feet
Authorized State Ag� -+—� �.Q,,,1..9> �"'�� Date 4— ' �—
�i�4�.=wb�•,a�1. - - KT—�( `�^'1`T!}.s�l..,y., !� �E31 wll:�ti�ri .. �. .ai
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