OPNTE# 1 4 -5- 39151 Harnett County Department of Public Health 24651
PERMIT # 49 Operation Permit
Lx3' New Installation E?�Septic Tank LR' Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L` eSC.p n \e 2d . C 5ti l5 T<%
Name: (owner) SSI\u M06 SUBDIVISION 14vr:r6A5 LOT # C
System Installer. La« Registration #
Basement with plumbing: ❑ trarage ❑ Number of Bedroots _q
Type of Water Supply: ❑ Community ❑ Public 5? Well Distance from well i3C' feet
System Type: ZSia /LEo n fy5 nlQE�i Types V and VI Systems expire in S years.
(In accordance with Table V a) -04er must contact Health Department 6 months prior to expiration for permit renewal.
this system has been Installed in mmplunce with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Communion Authorization
rtRRll CONDITIONS:
1. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
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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 conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned orooem
Type of system: ❑ Conventional �ther - f 1�/ , as ��— Septic Tank: / U �r� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ��� �� Date b (u ( T—QL—
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