OP RHTE# 1G'S-'�� (Z Harnett County Department of Public Health 24745
PERMIT # a�b`13-] Operation Permit
New Installation X Septic Tank )< Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 1 rr,a EL a y 6
Name: (owner) )P,cvc C�✓seor+AOME5 \N3 C,_ SUBDIVISI o,W E LOT # �1
System Installer: t -A e,-<,Vopa'\ Registration #
Basement with plumbing: ElGarage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public E)Well Distance from well feet
System Type: ! � b 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.
11. Monitoring: As required by Rule .1961.
III. 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.
❑
D -Boa ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: ❑
Conventional .4
Other 9-zP L -W sr Septic Tank tp0 O
gallons Pump Tank 10'0 P gallons
Subsurface
No. of
exact length width of
depth of
Drainage Field
d it s a
of each ditch -330 feet ditches 3
feet ditches F inches
French Drain Recoiled:
_
Linear feet
Authorized State Agent QE" 5 Date
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