OP RHTE# &—`A-3`'611 Harnett County Department of Public Health 24317
PERMIT # �$°1H0 Operation Permit
New Installation 'R, Septic Tank ')< Nitrification Line ❑ Repair ❑ Expansion
F� PROPERTY LOCATION: \4%uu Lvcp,� Rn
Name: (owner) T1TLta� vG �,NSS ,1N e- SUBDIVISION Sree—,-,j.PZ 1L LOT # A5
System Installer: H o a o a 4 S ce c, Registration #
Basement with plumbing: ❑ Garage' R Number of Bedrooms _Ll
Type of Water Supply: El Community �e Public El Well Distance from well T�O� feet
System Type: 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 ha been installed in compliance with applicable North Carolina General statutes, Rules for Sewage Treatment and Disposa4 and all conditions of the Improvement Permit and construction Authorization.
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PERMIT CONDITIONS
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other,
Subsurface system operator required? Yes ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Operation:
V. Other.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for
the disposal system an the above captioned property.
Type of system:
❑ Conventional
�sew{age
�'l Other EZS'Lt4w„ Septic Tank T000
gallons Pump Tank: gallons
Subsurface
No. of
__�dditc
exact length width of
depth of
Drainage Field
ees
) of each ditch 1B0 feet ditches 3
feet ditches inches
French Drain Reouired: w
Linaar feet
Authorized State Agent v�� ���� HS Date Sa,l S1) 6
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