OP RHTE# Is 5 36�65cZ Harnett founty Department of Public Health 24543
PERMIT # o`i�\\� Operation Permit
❑ New Installation ❑ Septic Tank �k Nitrification Line ❑ Repair X Expansion
PROPERTY LOCATION: 1�ew.Ca P�a�s Qv
Name: (owner) SUBDIVISION LOT #
System Installer: _�e�w1+Q�3 Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well feet
System Type: =b 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.
Ihn system has been installed in compliance with applicable Nonh Cuolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Constmmon Authorization.
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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 conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑
Following are the �sp{ecifications for the sewage disposal system on the above captioned property.
Type of system: `� Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches of each ditch go feet
French Drain Requirgd_— ---,feet
Alarm ❑
H2OLine ❑
Septic Tank So)-j-Ti4C gallons Pump Tank:
width of depth of
ditches feet ditches a-"'30
Authorized State Agent QZ;�45 Date
PWR Line
gallons
inches
I S- s 3 ,z-7 0