OP RNTE#)�'S-3ga2�� Harnett County Department of Public Health 24077
PERMIT #d-1 Operation Permit
New Installation Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: nCNn>TvcL Qa
Name: (owner) 00tv» it)13400CE SUBDIVISION lLcfaey a—i-A 00-:L& LOT #
System Installer. C7tKLs;hA_o) er,eT.E Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 15 P ca;4 Ms<¢A wry SAB v s-6
Type of Water Supply: ❑ CommunityPublic L1Well Distance from well 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 General Statute; Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authoritarian
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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 cc
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other E Z VI -0 W Septic Tank 1600 gallons Pump Tank gallons
Subsurface No. ofexact length width of depth of
Drainage field ditches of each ditch \ S O feet ditches 3 feet ditches inches
French Drain Aeauire Linear feet
Authorized State A¢ent 4)15 Date