OP RHTE# 13 5-'30-14,af Harnett County Department of Public Health 24449
PERMIT Operation Permit
New Installation �K Septic Tank )C Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C=�
Name: (owner) s i CNNC-, t_ gy 1 _QSr1-v SUBDIVISION PgFs ops PC), r,iE LOT # S 3�2
System Installer: S'swa�,e.` c.. Registration #
Basement with plumbing: ❑ Garaged Number of Bedrooms ':!>
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well feet
System Type: -'fib Types V and A Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
e'pmol nm umn nowneu ni tampname mm appn(ame noon tarwma uenerdl starves, holes tar sewage vearment and unposal, and an conditions of the Improvement Permit and tonsmmdon 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 ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H20Lh e ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: E3 Conventional Other Pump is E Z Fs_ew Septic Tank: s00 p gallons Pump Tank: ko D o gallons
Subsurface No. of exact length width of depth of
Drainage Field s t of each ditch eir50 feet ditches 3 feet ditches inches
French Drain Required: _ Linear feet
Authorized State Agent y�� RL=rtS Date
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