OP RHTE# 2 Harnett County Department of Public Health 23427
PERMIT # �- 7 Operation Permit
dNew Installation IJ Septic Tank P�Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1`7 eJ-
Name: (owner) r-k t'j. l k z SUBDIVISION /A- LOT # 12-
System Installer: ,ems C!44 d.Ld ;e Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community ZPublic ❑ Well Distance from well feet
System Type: 2z j 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.
[his 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.
III. 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:
Pump ❑ Alarm ❑ 11-12O1-ine ❑ PWR Line
sew disposal system on the above captioned property.
other q ""e Septic Tank: /0Q 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch feet ditches 3 feet ditches 3 0 inches
Linear feet
Authorized State Agen ` - �,T/''� -� .a �� - I- Z7 Date /�,i ? / °/�
V. Other:
❑
D -Box ❑
Following are the specifications for the
Type of system: ❑
Conventional
Subsurface
No. of
Drainage Field
ditches
French Drain Reauired:
Pump ❑ Alarm ❑ 11-12O1-ine ❑ PWR Line
sew disposal system on the above captioned property.
other q ""e Septic Tank: /0Q 0 gallons Pump Tank: gallons
exact length width of depth of
of each ditch feet ditches 3 feet ditches 3 0 inches
Linear feet
Authorized State Agen ` - �,T/''� -� .a �� - I- Z7 Date /�,i ? / °/�
3,Z,73 (.A