OP RHTE# ►a; S'-1cW30Harnett County Department of Public Health 24608
PERMIT # ST Operation Permit
New Installation Septic Tank XNitriftcation Line ❑ Repair ❑ Expansion
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PROPERTY LOCATAN: Name: (owner) S'iOla aC., L Z%Ast-oERS Ni— SUBDIVISION _ ;F o. s Ro% LOT # 1`��
System Installer: �w xGl z_ gut s.0 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: = 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.
Ims system has been installed in compliance with applimble North Carolina Genenl Snmtes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Aumorindon.
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PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N0
If yes, see attached sheet for additional operation cc
IV. Operation:
V. Other
maintenance and reporting.
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OUne ❑ PWR Line
Following are the
Type
specifications for
❑
the sewa a dispas I system on the above captioned property.
Ne'K �a.On
of system:
Conventional
Other 10 F-� I Septic Tank: 10 O
gallons Pump Tank: 10D gallons
Subsurface
Na. of
exact length width of
depth of
Drainage Field
ditches
l of each ditch I �ad feet ditches 3
feet ditches &0`30 inches
Frenchrel
Linear feet
Authorized State Agent :!!� Date
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