OPHTE# 1-* —S—yfyYb Harnett County Department of Public Health 24844
PERMIT #Q)'a 465 Operation Permit
ew Installation Septic Tank rl kation Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ays A—) (' ,'a br. ycsvt��a�� rU 5rL I�ca4)
Name: (owner) 5.c SUBDIVISION A P LOT # 63
System Installer. Q\.o b M Registration #
Basement with plumbing: ❑ Garage fiber Bedrooms SL
Type of Water Supply: ❑ Community LYnblic ❑ Well Distance from well ^'A feet
System Type: 26- ; L S -as — Types V and VI Systems expire in S years.
(In accordance with Table V a) �wner 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 Con IIII Authorization
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. 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 -Box ❑ Pump ❑ Alarm ❑ H2O1-ine ❑ PWR Line
Following are the specifications for the sewage sposal system on the above captioned property.
Type of system: ❑ Conventional f�er &! , tww "`� Septic Tank: la.,� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches % of each ditch C,<:�, feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent s Date III I ki itDI
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