OP RRHTE# 1 X4 -5 -341St 1R(L Harnett County Department of Public Health 24109
PERMIT # 9:1660 Operation Permit
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ka11 L„
Name: (owner) IN tJ � r:zX50\) ets p N SUBDIVISION 1 Ae16os RT ncE LOT # `itD
System Installer: 1 — N Qa. m sa 4 Registration #
Basement with plumbing: ❑ Garage ��❑.{ Number of Bedrooms Lk
Type of Water Supply: ❑ Communi X Public ❑ Well Distance from well _IM feet
System Type: 1> 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 Caralina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement remit and Unsnatan mmon:anon.
❑LL
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NtlLlT6
A
PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other. ���
Subsurface system operator required? Yes El NA
If yes, see attached sheet for additional operation a
maintenance and reporting.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the sewage disposAl system on the above ca boned property.
Type of system:
El
X Other �yMp t o EZ�yryw, Septic Tank 1000
gallons Pump Tank: d0 gallons
Subsurface
_*-4LIn
exact length width of
56 3
depth of
Ali -30
Drainage Field
ditchesof
each ditch feet ditches
feet ditches inches
French Drain Reouirad!*�,
ar feet
Authorized State Agent Date y 1 14 16
L 4 -S -3LA 15 we