OPHTE# ►5�s-3b Harnett County Department of Public Health 23858
PERMIT # 0 I0 Operation Permit
New Installation 'N Septic Tank 'X. Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Flaov m Q -J
Name: (owner)RL+wN SUBDIVISION LOT # 1
System Installer: lei-Ljo v do c Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community -7�K Public ❑ Well Distance from well T00 feet
System Type: `,:� 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 Geneml Statutes, Rules for Sewage Treatment and Dispmal, 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 ❑ Alarm ❑ 11201-ine ❑ PWR Line
Following are the specifications for the sewage disposal s tem on cthe above captioned property.
Type of system:
EJ � Other Z I LC'W Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditche3�S of each ditch g0 feet ditches 3 feet ditches inches
French Drain Reouired: _ \\ Linear feet
Authorized State hent ��\� `��\\ )9s Date