OP RHTE# 114-5-144%(Z Harnett County Department of Public Health 23865
PERMIT # a-7`l9.°� Operation Permit
New Installation � Septic Tank Nitrification Line E]Repair ❑Expansion
PROPERTY LOCATION: —r N Qo
Name: (owner) SUBDIVISION V\0Q2cGc VLpCr LOT # 3Qi�
System Installer: tiowr-- GAax.,ea.. Registration #
Basement with plumbing: ❑ Garage � Number of Bedrooms _y
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1,C)o feet
System Type: —11 5 Types V and A 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 General Sates, 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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑
PWR Line
Following are the specifications for
the sewage disposal system on the abov capon d property.
Type of system: El Conventional
)5; Other C)4Py\Q%.CL kiu' Septic Tank: 50)00
gallons Pump Tank:
gallons
Subsurface No. of
exact length width of
depth of
Drainage Field di s
i of each ditch e�C) feet ditches �✓
feet ditches
Wi 3 b inches
French Drain Require
Linear feet
Authorized State Agent (>aN!S Date