OP RHTE#o6- s-14577118 Harnett County Department of Public Health 19669
PERMIT # ';.4 CQ9 Operation Permit
New Installation ~'n Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: Rs ~t_ CH„~~,, Ro _
Name: (owner) ~oH N7 R~P,~xSo~S SUBDIVISION LOT #
System Installer 1vEy maw Nsa rf Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms 3 {
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 50 feet
System Type: _1 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 Mtatkd in compMarKt with applicable North Czrohna Gemral Statutes, Wks for Sewage Treatment and D al, and aN cor4bom of the Im oremed Permit and Construction Aufthzatioo
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1. Performance:
II. Monitoring
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
V. Other.
Subsurface system operator required? Yes ❑ No
H yes, see attached sheet for additional operation conditions, maintenance and reporting.
VV P.\obo
following are the specifications for the sewage disposal system on the above captioned property. t'n a'YV"
Type of system: Conventional ❑ Other Size of tank: Septic Tank: I000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch 10 0 feet ditches 3 feet ditches l~- inches
French Drain Reouired:fPnr
Authorized State Agent , e,- Date v 1)s4 8