OP RHTE# 1I - S"41:1,450L Harnett County Department of Public Health 24615
PERMIT # a°� Operation Permit
New Installation Septic Tank
,X Nitrification Line El Repair .Expansion
_ PROPERTY LOCATION: t4r.QJLI 120 C N
Name: (owner) J I- C- 0._. Roa6cys W 9xy SUBDIVISION LOT #
System Installer. so li�¢owt`r Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms
Type of Water Supply: ❑ Community -X Public ❑ Well Distance from well feet
System Type:G 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 imtalled in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
too �G—
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PERMIT CONDITIONS
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
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.
V. Other.
❑ D -Boz
Following are the specifications for
Type of system: ❑ Conventional
Subsurface No. of
Drainage Field — fci2i s—
French Drain Reouiccd:
❑ Pump ❑ Alarm ❑
the sewage disposal system on the above c Cloned erty.
Other CV)P"M96Q- Septic Tank: a0oa
exact length width of
of each ditch c3feet ditches 3
ear feet
Authorized State Agents ���5 Date g
H2OLine ❑
PWR Line
gallons Pump Tank gallons
depth of
feet ditches IK -JL inches
ID`S zira4s0-