OP RRHTE# ts-s- +33ao Harnett County Department of Public Health 24882
PERMIT # Operation Permit
New Installation bR Septic Tank � Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 4Atcl t, s C6NICLIN L Ra
Name: (owner) Ni_CZQQUe 00 S^.1CA_4 .'L. SUBDIVISION CP LOT # 1
System Installer. C An.a6r4 os, Ca rasr o t acy s a N Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms r
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: —Tt—_'Ic 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 SeatunL Rules for Sewage Treatment and Disposal, and all muditions or 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 ❑ Max
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑
D -Bax ❑
Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the
specifications for the sewage disposal system on the above captioned property.
Type of system:
El Conventional �, Other
�'LFL41r4 Septic Tank: SSOO
gallons Pump Tank gallons
Subsurface
No. of
exact length width of 3
a
depth of
I"i -all
Drainage Field
ditches
of each ditch feet ditches
feet ditches inches
French Drain Repaired:
Linear feet
Authorized State Agent ' IS Date