OPHTE#IS-5-PD1 Harnett County Department of Public Health 24100
PERMIT #5y1 Operation Permit
New Installation "'R Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: fnc-"r TLd. M ILL SFA
Name: (owner) Q_o%Ea! SL.op,,� SUBDIVISION — LOT # Qg
System Installer. `T-6an-/ M r es_ey Registration #
Basement with plumbing: ❑ Garage K Number of Bedrooms j
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well 1 OT 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 apphable Nonh Carolina beneral Statutes, Rules [or sewage Imatment and nisposal, and all mnddmns of the Improvement rerma and ldmtm(non Authonnnon.
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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 ❑ AN
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑
❑ Alarm ❑
H2OLine ❑
PWR Line
following are the specifications for the sewage disposal system on the abypeocapti d property.
Type of system: ❑ Conventional Other �CV'�SrCL �LXV1k Septic Tank: 1 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field s� 1 of each ditch feet ditches feet ditches .�I inches
French Drain Retained: '90-aeer_feet
Authorized State hent 14=") Date