OP RHTE# ►6-s'3�taa`6Q Harnett County Department of Public Health 24732
PERMIT # a'1c-1 1 Operation Permit
New Installation IN� Septic Tank X Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: Cr P2 e
Name: (owner) t t c ac+.+.5 , 9t�sv .0 4 YQ,,1516V4 SUBDIVISION I nT It
System Installer. G9-,,x"6r, Srastr- Registration #
Basement with plumbing. ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community raj Public ❑ Well Distance from well Net
System Type: n 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 Authorhalion
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required! Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
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SiRwL CwaontSC NOV 0a31•0%cntzmo (3NS,acmn\1 ., PtfPL1G0dN
D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for
the sewage disposal system on the above captioned propa(Y
Type of system: El Conventional
X Other Cy .Kywat= t„Nc1,r,3C ii o )o
Septic Tank: 104345 gallons
Pump Tank: gallons
Subsurface No. ofexact
length
width of
depth of
Drainage Field ditches
of each ditch X60 feet
ditches feet
ditches inches
French Drain Required:
�ar feet
Authorized State Agents Date c'L 6 17
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