OPNTE# i7-�a Harnett County Department of Public Health 24873
PERMIT # a965S Operation Permit
New Installation X Septic Tank �< Nitrification Line ❑ Repair ❑ Expansion
1PROPERTY LOCATION: Fr�gFpoC fl�we
Name: (owner) \41pyoEc:. )Omen SUBDIVISION LOT # O
System Installer, go l db JtorvcA -..asRegistration #
Basement with plumbing: ❑ Garage XI Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: —:7" a Types V and VI Systems expire in S years.
(In accordance with Table V a) r Owner must contact Health Department 6 months prior to expiration for permit renewal.
MIs system has been immlled in compliance with applimble Noah Carolina %erul Smmtes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Consnunion Authorization.
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PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring: As required by Rule .1961.
IN. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ Na
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional X Other Z FLaw Septic Tank: 10 1z 0' gallons Pump Tank gallons
Subsurface No. o exact length width of depth of
Drainage field ditches 3 of each ditch o feet ditches _ feet ditches 1Y'a inches
French Drain Reauired z�� _ hn regia
Authorized State Agent V y��� 4r~ - Date 1 -4 t
17-5�'��boa.