OP RHTE# %u -5435`115M Harnett County Department of Public Health 24090
PERMIT # a Operation Permit
New Installation' Se tic Tank Nitrification Line ElRepair F-1Expansion
/^ PROPERTY LOCATION: cx�a
Name: (owner) YNvj "t T 2V z�-Ah G N SUBDIVISION LOT # Lr4
System Installer: I+iorxz,- QL—yrn91N c. Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L -
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: mi Ch 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 imtalled in compliance with applicable North Carolina General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
PLKMII CUNDITIUNS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
fl6
P Cha t
V MQ
2t RSA 2
PC.�X
I%)� 110USE 15i"
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P� V
f OS OARLEY
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other E-2— Flovv Septic Tank: 1 0 6 G gallons Pump Tank: gallons
Subsurface No. of \ exact length width of depth of
Drainage Field ditches T of each ditch <&%O feet ditches 3 feet ditches i�—a� inches
French Drain Required: r feet
Authorized State Agent - Date lc
1� _s_ �33 �s��