OPNTE# 1-1" '5"-413Ps Harnett County Department of Public Health 24764
PERMIT # aabSl Operation Permit
New Installation �K Septic Tank )" Nitrification Line ❑ Repair ❑ Expansion
( PROPERTY LOCATION: Ot_o \)SLi'2.1
Name: (owner) Gcny Q�O%N-50TH c-,Fg SUBDIVISION=crtMV+s� aoe-7:.a,v; LOT # l
System Installer. EooN6 Q,9<1 -a; -EQ Registration #
Basement with plumbing: ❑ Garage X Number of Bedrooms L•
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.
This system has been installed in
PERMIT CONDITIONS
I. Performance:
11. Monitoring.
III. Maintenance:
IV. Operation:
V. Other.
with apphtlble north Urollna 4eneral stables, ions Tor )ewage Ireatmet anis
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nog
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
'43%
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispose I system on the aAove captioned propert
Type of system: ❑ Conventional Other AKMWg- PVt.,G3� hF} SO Septic Tank: 1000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches t of each ditch Q4'1'0 feet ditches 3 feet ditches 13-30 inches
French Drain Required: Linear feet
Authorized State Agent !�� ���� �� Date S sa°t n
1--J-5-LA\3,S-
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