OPHTE#) POy�y�l�� Harnett County Department of Public Health 24569
PERMIT # agaCy Operation Permit
New Installation �R Septic Tank )�[ Nitrification Ling., ❑ Repair ❑ Expansion
PROPERTY LOCATION: 10 5.4C71N 14 f N:i,p v4A_q> CL,Name: (owner) n\\OmG-,' b -c- SUBDIVISION GP+20t_s.ra SC 5oN5 LOT # I►_
System Installer: 8o a cww ams Registration #
Basement with plumbing: ❑ Garaged Number of Bedrooms L—
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well feet
System Type: mamh 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 Consmuction Authorimon.
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PERMIT CONDITIONS
I. Performance:
II. 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 ❑ Nox
If yes, see attached sheet for additional operation ca
maintenance and reporting.
❑
D -Box ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the
sewage disposal system on the above,�c�9gqbonedd �RroPerry.
Type of system:
El Conventional
Other G�at�99?_ W1.A Septic Tank: 6000
gallons Pump Tank: r 0oa gallons
Subsurface
No. of
exact length width of
`�
depth of
Drainage Field
rhes
of each ditch I feet ditches 3
feet ditches 30 inches
French Drain Required;
Linear feet
Authorized State Agentll!.G—atS Date
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p.