OP RHTE# 10- Sa- 315QQ Harnett County Department of Public Health 24116
PERMIT # Operation Permit
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
`` PROPERTY LOCATION: Cov..tn2-ystoE. �_
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Name: (owner) 1 sck'V—G %AorhG5LLQ, SUBDIVISION _�P,xr,oa5 LOT # 5
System Installer. Ecro�G c;v-sbt fL Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms -3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well Y feet
System Type: iSs_ Types V and VI Systems expire in 5 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 Nonh Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all ronditions of the Improvement Permit and Construction Authorization.
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I. Performance: System shall perform in accordance with Rule .1961.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Max
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLina ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captio property.
Type of system: ❑ Conventional Other �R nBUL CQLn� Septic Tank: 000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field es of each ditch cias feet ditches 3 feet ditches I �" VO
inches
French Drain Required: ---,a.— Is., linear feet
Authorized State Agent TZ/—A'\:� Date
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