OPNTE# I (�—�a'5�� Harnett County Department of Public Health 24437
PERMIT# Operation Permit
XNew Installation � Septic Tank "K Nitrification line ❑ Repair ❑ Expansion
PROPERTY LOCATION: Nwy 4 a
Name: (owner) 1�^—��c `� v c s L SUBDIVISION LO'
System Installer: dJ6N elsS`4r--Q"-%N Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 106' feet
System Type: _ --T" 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.
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This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Conawdion Authorization.
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PERMIT [ONDITIONS:
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 ❑ NA
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem o I�the above captioned property.
Type of system: ❑ Conventional OtherZY1—G�/ Septic Tank: 10 00 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch C0 feet ditches 3 feet ditches inches
French Drain ReauireA� � r feet
Authorized State Agent may\ 26i-15 Date