OP RHTE# ')~ 'a- Harnett County Department of Public Health
PERMIT # �533o Operation Permit 22445
New Installation �< Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: X14 %L , Luof v
Name: (owner) a, -L CL PA«- - Ao r SUBDIVISION CNVLOL \00r , QP,rs LOT # S1
System Installer: 14t t?,yraE _S ca,4Ej Registration #
Basement with plumbing: ❑ Garage ,� Number of Bedrooms I
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 100 feet
System Type: 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.
ims system nas oeen instauea in compuance win apphcame north Larmma uenerai xatutes, nines for sewage ireatment ana uisposai, ana an conmtions m the improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
I. 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: plu>ne0or- a:Vea�fi:;' tltir,'4 °N0 Rv"W ut9"�60
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the abo(v capti° d property.
Type of system: El Conventional Other CN-Noa n+ &2— �2� �/ Septic Tank: 106CJ gallons Pump Tank: gallons
Subsurface No. of ` /'exact length width of depth of
Drainage Field ditche of each ditch coo feet ditches feet ditches inches
French Drain Required: \ _V1_ '
Authorized State Agent RO \A; Date 91 G 11?-,