OP RHTE#I°aHarnett County Department of Public Health 24306
PERMIT # Operation Permit
%3� New Installation IR Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Ro
Name: (owner) SUBDIVISION _ 1%C E LOT # D.) --
System Installer: OL14 N, s i1 SOL -1 ty Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms L -i_
Type of Water Supply: ❑ Community Public ❑ Well Distance from well %td feet
System Type: G 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 applicable North Carolina Geneml Statures, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and (contraction Authorization
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Nb V.SE
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G` DB
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rcanu cununruns:
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 ❑ NoX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box
❑ Pump ❑
Alarm ❑ H2OLims
❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
Xl Other G4cavr�WM' `Oi��
Septic Tank: 100 0 gallons
Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field
of each ditch 3 8c) feet
ditches 3 feet
ditches inches
French Drain Regl.64�
Linear feet
Authorized State Agent w� ,�V�Qr.-),is Date
by
I ( �- 5-3,)