OP RHarnett
County Department ' Public I.I::
PERMIT # Operation Permit
New InstallationSeptic Tank Nitrification Line ❑ Repair 1:1 Expansion
PROPERTY LOCATION: \d t L_ t— Lj
Name: (owner) SUBDIVISION C+,toL-,,,tt., P% LOT #
System Installer: `4 Py Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community, Public ❑ Well Distance from well r 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.
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
PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation a
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captio4fed property.
Type o ❑ Conventional I� Other C�—���.g s2 �Q'aSeptic Tank: I00C/
Subsurface of exact length width of
Drainage Field ditches of each ditchfeet ditches
French Drain Required: Linear feet
Authorized State Agent �a��, ������ Date
112OLine ❑
PWR Line
gallons Pump Tank: gallons
depth of
feet ditches inches
)31)5'
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