OP RHTE# I(o'rJ—*-%7SOVZ Harnett County Department of Public Health 24275
PERMIT # Operation Permit
New Installation �< Septic Tank k Nitrification line ❑ Repair ❑ Ex ansion
PROPERTY LOCATION: -953 la-ttxnsot,, CaAc-r Ia a01-
Name: (owner) So u tti.6c s SEtr-st S�)G- - Tai I`. Gnr nS ,SUBDIVISION LOT #
System Installer. ��„s C✓Saa.,e��Ant� 3 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well tO0 feet
System Type: —= r 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 factors, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nq�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other: C ;3.462 AQQ-. -N 6A V r5L 'IF—I—V
❑ D -Box
❑ Pump ❑
Alarm ❑
11201-ine ❑ PWR Line
Following are the specifications for
the sewage disposapl system own She above captioned property.
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Type of system: ❑ Conventional
A Other } Uc+1Q a o GZ. .,r
Septic Tank SBO 0
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditches
of each ditch 7 S feet
ditches
feet ditches lZ—)6 inches
French Drain Required:
r feet
Authorized State Agent -1"--� � v\ iii Date
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