OP RRHTE# 14-53"Q'1 OIA Harnett County Department of Public Health 23992
PERMIT # Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LKATION: SoJcu �yEC2.
Name: (owner) S 1-1Q nw4X-A1 �.zg6say�'a SuSD.a SUBDIVISION — LOT #
System Installer: 0,; .a N5 Mraot-T" Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community "DQublic ❑ Well Distance from well 100 feet
System Type: _).4. 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 appliable 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.
II. Monitoring: As required by Rule .1961.
Ill. 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 sewage disposals
stem on the above captioned property.
Type of system: ❑ Conventional X Other
2 �' O+ r
Septic Tank S OOd gallons
Pump Tank gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches 4
of each ditch Q,(5 feet
ditches _� feet
ditchesinches
French Drain Reauir-� Unear
feet
Authorized State A¢ent ��\~�� V --)is Date -3IQ5I LG
VI-) — 5-3uac�Sb. -