OP RHTE # 16-L Harnett County Department of Public Health
PERMIT # 9.29-7 Operation Permit 22518
N New Installation �K Se tic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) VAQ" --6m vsN SUBDIVISION LOT # �70
System Installer: t a— ic�2;��� 'c-y r4v31"4 C. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 5
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: It7 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:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ Pump ❑ Alarm ❑ 1-12O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other P u ,,Y -7 o F- F,,tlW Septic Tank: 10 W gallons Pump Tank: 10100 gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch ` feet ditches 3 feet ditches .�Zi 3 inches
French Drain Reauired�." Cam. _ � eet
Authorized State Agent - ?C—OIAS Date
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