OP RHTE# 10-S-as0o-1 P, Harnett County Department of Public Health
PERMIT # Operation Permit 2 1 ` 7 6
New Installation N Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:C.ooL(~)Pc-Nar-s ZD
Name: (owner) ticl~ot~R~ ~o in 9h oc- SUBDIVISION LOT # 1
System Installer: Q.;Ky Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 5
Type of Water Supply: ❑ Community ~K Public ❑ Well Distance from well l00 feet
System Type: -1 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.
This system has been installed in compliance with applicable North Larohna beneral )tatutes, Rules for )ewage treatment and uisposai, ana an conatnons m me
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 1A of each ditch feet
French Drain Required: n Lin
Alarm ❑
H2OLine ❑
Septic Tank: 10Q)C) gallons Pump Tank:
width of depth of
ditches 3 feet ditches
PWR Line
gallons
inches
Authorized State Aunt , ~.GXS Date ll 1O 1 C1