OPNTE# tL+ m -�3�on Harnett County Department of Public Health 23413
PERMIT # Operation Permit
New Installation X Septic Tank '>� Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) v�,ongt5 Yii-Xere5c 6 SUBDIVISION LOT #
System Installer: — 7Lc2,Kt,-i MaR2s--;, Registration #
Basement with plumbing: ❑ Garage' K Number of Bedrooms
Type of Water Supply: ❑ Community `< Public ❑ Well Distance from well 100 feet
System Type: c 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
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 ❑
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, stem on the above captioned perty.
Type of system:
El Other �)DN �' Septic Tank: tOOD gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch L�_ feet ditches feet ditches �— inches
French Drain Required: ear feet
Authorized State pent V-6- Date 10
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