OP RHTE# O \ 5 Harnett County Department of Public Health 23276
PERMIT Operation Permit
New Installation -K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Pa>v s��s�
Name: (owner) lLL tin �c^ SUBDIVISION �_wc7 atr «A S•.sor�� LOT #a
System Installer: ZSd Registration #
Basement with plumbing: ❑ Garage'X Number of Bedrooms 3
Type of Water Supply: ❑ Community ;X, Public ❑ Well Distance from well t.b ® feet
System Type: .... ) ❑ a, 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.
Ibis 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
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the above captioned pr erty.
Type of system: ❑ Conventional Other P.�$E� Cn -O Septic Tank: 100 O gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch �sO feet ditches 3 feet ditches ili? inches
French Drain Required: � ti's_ Ln%Tea feet
Authorized State Agent ��``�s \ \���,``�� , tom, _____ Date Sj 4
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