OPHTE# 1G—S- s3I Harnett County Department of Public Health 23989
PERMIT # -3t' Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1 T N N
Name: (owner) �'L�Cc A2 �0" E� SUBDIVISION�o.Ns 0);:3 LOT # a7
System Installer: SONG—p5 C, Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community3ublic El Well Distance from well 1 -OO feet
System Type: 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 Communion Authorization
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PERMIT CONDITIONS:
1. 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 ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above ff�a�pooned,'f�rbperty.
Type of system: ❑ Conventional Other C1iRth$P1L- ILiZ� / Septic Tank TOS gallons Pump Tank AC1Q5 a gallons
Subsurface No. of exact length width of depth of
Drainage field --kEbts 1 of each ditch N O feet ditches feet ditches ali3-4 inches
French Drain Required_ Linear feet
Authorized State Agent Date
L5- 5-3C53C�