OPHTE# �5'S 3si�6 Harnett County Department of Public Health 25058
PERMIT # a"��� l Operation Permit
New Installation �& Se-pfyc Tank 'A Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �t+OMAGx- 9�D
Name: (owner) Ro Q>b=;a i_ O N Ce, SUBDIVISION �Z. % R 6. LOT # Ll
System Installer. i o an my C<ai.E/ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: a. Types V and A 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 Rarth 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
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 ElPump ElAlarm 1-1M20Line ElPWRLine
Following are the specifications for the sewage disposals tem on the above captioned property.
Type of system: El Conventional ]& Other disposals
LVI-ow Septic Tank: s'00d gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch S �0 feet ditches 3 feet ditches 1'9 inches
French Drain Required: Linear feet
Authorized State Agent Date 5 3