OP RHTE # x,63-3.7(-;Z7/Z Harnett County Department of Public Health 23699
PERMIT # 4-b,3a Operation Permit
New Installation Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: !A.= l ( C'Q s -`k xd
Name: (owner) C�b�: BDIVISION LOT #
System Installer: a,w= !t<o ode e Re istration #
Basement with plumbing: El Garage ElumbervfBtfLiStPi g�� t`°�Y� ;2e+��yt�/
Type of Water Supply: El Community Lit Public ❑ Well Distance from well .� feet
System Type: zn b 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.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
111. 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:
V. Other:
❑ D -Box ❑ Pump ❑
Following are the speocations for the sewage disposal system on the above captioned property.
Type of system: li Conventional ❑ Other
Subsurface No. ofr exact length
Drainage Field ditches `j' of each ditch feet
Alarm ❑
Septic Tank: !a rO
width of
ditches
1-12O1-ine ❑ PWR Line
G,r+��cTvrrP
_ gallons kwq-fank: 100 G gallons
depth of
feet ditches inches
French Drain Required: Linear feet %
` l0° 1.20if
Authorized State Agen� �F%7<J Date
14-5-33627R (1)
14-5-33627R (2)
14-5-33627R (3)
14-5-33627R (4)
14-5-33627R (6)
14-5-33627R (7)
14-5-33627R (8)
14-5-33627R (11) 14-5-33627R (12) 14-5-33627R (13)
14-5-33627R (9)
14-5-33627R (10)