OP RHTE# IL -S 3s5ai7)2 Harnett County Department of Public Health 24048
PERMIT # ZE40 ` Operation Permit
I New Installation ❑ Septic Tank d Nitrification Line ❑ Repair dExpansion
PROPERTY LOCATIONof:.10'14�
Name: (owner) +k�)eA 4ft4,dLo& SUBDIVISION QJA=1 6W,4Z LOT # / 91
System Installer: C /srr Registration #
Basement with plumbing: ❑ Garage umber of Bedrooms `f
Type of Water Supply: ❑ Community Vpublic ❑ Well Distance from well Net
System Type: Xrd— IM Types V and VI Syste s expire in S years.
(In accordance with Table V a) Owne must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable Nod Carolina General Statutes, Rules for Sewage Treatment and Disposal, and a condi0ons of the
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I. Performance:
System shall perform in accordance with Rule .1961.
If. 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:
V. Other.
❑
D -Box ❑ Pump ❑ Alarm
❑ H2OLine
❑ PWR Line
following are the specifications for the sewWe disposal system on the abgve captioned property.
Type of system: ❑
Conventional _Other Z4;%ff 4Xr) V 5W-3.
Septic Tank: -�Skgallons
Pump Tank: gallons
Subsurface
Drainage Field
No. of exact length
ditches of each ditch feet
width of
ditches 3 feet
depth of
ditches Zz inches
French Drain Required: Linear feet
Authorized State Ag �' �26�-3 Date 5r- Z5 -1(o
16-5-38597R (1) 16-5-38597R (2) 16-5-38597R (3) 16-5-38597R (4) 16-5-38597R (5)