OP RHTE# Qn-5-)-1oabQ.. Harnett County Department of Public Health
PERMIT # Operation Permit 22241
New Installation )q Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 0"o 5sa6
Name: (owner) ~a~>~t- ism ~uflf d~ SUBDIVISION ZEECt IVA M,MS LOT # l3
System Installer: e> Registration #
Basement with plumbing: ❑ Garage A Number of Bedrooms 1~-
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100) feet
System Type: L Cr- Types V and VI Systems expire in 5 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 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.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑
D-Box
Following are the specifications for
Type of system: ❑
Conventional
Subsurface
No. of
Drainage Field
ditches
French Drain Reauired:
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❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
tht< sewage disposal system on the above capti°1d property.
Other C~Pwt113E~Ft- Septic Tank: 6~ 0 gallons Pump Tank: gallons
exact length width of depth of
_ of each ditch 1 fl feet ditches 3 feet ditches a0 inches
Authorized State Agent ~ y~~~~ U -_w Date 3 ) QL!:i I 1
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