OP RHTE# l_q - s -Lk-9 Harnett County Department of Public Health 24710
PERMIT # 24 353 Operation Permit
C�ew, Installation Septic Tank El"A'itfification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 19 A yon 61 . C4)-1k'n5 2l . Sit /414`)
Name: (owner) 2 \ 6k 6EaSUBDIVISION y:U>n LOT #
System Installer:Registration
Basement with plumbing: ❑ GarageNum r of Bedrooms
Type of Water Supply: ❑ Community L-I—Public ❑ Well Dista n well N4 feet
System Type: 5Types 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.
MIS system has been Installed in oomph na with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit no lonsnumon Authorization.
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PtRMII CUNDIMUNS:
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 Ea-�
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Field ditches 3 of each ditch '60 feet
H2OLme ❑
PWR Line
Septic Tank: /CX>y gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent Date 1c�//Y%—;iCA