OP RHTE# S6-�'3°�� Harnett County Department of Public Health 24452
PERMIT #'1901-1 Operation Permit
New Installation � Se tic Tank Nitrification Line El Repair ❑ Expansion
PROPERTY LOCATION: ocz' Ro
Name: (owner) is +114 Ccyvxssa.vCsoc-S SUBDIVISION LOT # 176
System Installer: Ov a s Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms Li
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well SC)0 feet
System Type: _ S 1_ «. 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.
[his system has been installed in compliance with applicable Nonh Carolina General Statutes, Rules for Sewage Treament and Disposal, and all conditions of the Improvement Permit and Constmttion Authorization
PERMIT CONDITIONS
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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HOUSE
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑No
If yes, see attached sheet for additional operation co
maintenance and reporting.
❑ D•Box
❑ Pump ❑
Alarm ❑
H2O1-ine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional
)1 Other L Z Fe ow
Septic Tank: 10 0 o
gallons Pump Tank: gallons
Subsurface No. of
exact length
width of
depth of
Drainage Field ditc e
1 of each ditch %00 feet
ditches 3
feet ditches 1Y-30 inches
French Drain Required__
"beear feet
Authorized State Agent e!� ¢6)�.5 Date
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