OP RHTE# 11— 5--a'%6cI0— Harnett County Department of Public Health 24577
PERMIT # ag111D Operation Permit
New Installation '�5< Septic Tank W Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: �_7assN `�
Name: (owner) Siwxae,.%. $u+R_o&A5 SUBDIVISION TR�OanS 'to)ym LOT # 1143
System Installer: S,R>.ae,. t^ Registration #
Basement with plumbing: ❑ Garage 1K Number of Bedrooms3
Type of Water Supply: ❑ Community �)< Public ❑ Well Distance from well feet
System Type: ZTT.4 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.
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 construction Authorization
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PERMIT CONDITIONS
I. 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 ❑ Nc
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box
❑
Pump ❑ Alarm ❑
1-12O1-ne ❑ PWR Line
Following are the specifications for
the sewage disposal
sstem on the above captioned property.
Type of system: El Conventional
Other
leZ.. Fa.e.w Septic Tank: sf3w
gallons Pump Tank: gallons
Subsurface(
exact length width of
depth of
Drainage Field ditches
of each ditch Si -i V feet ditches
feet ditches d� 3C) inches
French Drain Required.
`twar feet
Authorized State Agent �-N' Z614S Date 51 zaI h
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