OP RHTE# /N ✓r77.rO C Harnett County Department of Public Health 23935
PERMIT # eZ®oti 7. Operation Permit
VNew Installation Tank 103 Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:{ Ja <f zol.
Name: (owner) A/ 4- li Ceel't<r. rk as. SUBDIVISION (/ea_k^gA4 LOT # !s"
System Installer: 04+',f S+r:ckl.ad Registration #
Basement with plumbing: ❑ Garage ❑ umber of Bedrooms
Type of Water Suppl, ❑Community L� Public ❑ Well Distance from well feet
System Type: 7_�C- Types V and VI Systems expire in S 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 Genenl Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and lnnstmetion Authorization.
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PERMIT CONDITIONS: 6-7cc C. if f— 14,
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:
Other.
❑
D -Box ❑
Pump ❑
Alarm ❑ H2OLine
❑ PWR Line
Following are the
specifications for the sewdisposa
the above captioned property.
Type of system:
El Conventional WI Other
/aw
Septic Tank: gallons
Pump Tank gallons
Subsurface
No. of
exact length
width of
depth of
Drainage Field
ditches %
of each ditch 0 feet
ditches _� feet
ditches a'/ inches
French Drain Required: Linear feet
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Authorized State Agen <Lew Date _//e21 2a//o