OPHTE # iy s�Ys��- Harnett County Department of Public Health 23716
PERMIT # d -617y Operation Permit
4r New Installation (repA'c Tank ET1itrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: QId a -Q rr, AC1
Name: (owner) 13%SUBDIVISION LOT # 6�
System Installer. ones c Registration #
Basement with plumbing: ❑ Garage ❑l Number of Bedrooms
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Type of Water Supply: Community IR/Public ❑ Well Distance from well feet
System Type: =Z2 Types V and A 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 thgjmprovement Permit and Construction Authorization
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PERMIT CONDITIONS
CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa a dispo I system on t above captio a property.
Type of system: ❑ ConventionalOther Jay.P �x J�cr %A,brr Septic Tank: gallons Pump Tank: OtsCS gallons
Subsurface No. of ? enact length width of depth of
Drainage Field ' cher ,/ of each ditch do feet ditches 3 feet ditches (2Y.10 inches
French Drain Required: Linear feet
Authorized State Agent t\'- '% \_ ya; As Date