OP RNTE# 11 -5-4 (, Harnett County Department of Public Health 24901
PERMIT #Q Operation Permit
�J New Installation '�K Septic Tank `X Nitrification Line ❑ Repair ❑ Expansion
p PROPERTY LOICATION: 0..9 0% 1CM
Name: (owner)Srr.%wiuce� NCl DuttpftL65 SUBDIVISION�-yAmvsea.s 1wiLoci LOT # S—
System Installer: GENee b ret o Registration #
Basement with plumbing: ❑ Garage's Number of Bedrooms `t
Type of Water Supply: ❑ Community Xl Public ❑ Well Distance from well feet
System Type:?Lr _ 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.
,ilia >p,vm ,m uan ,mance m ampuance mm appncame norm tuitions beneral statutes, Rules for Sewage Treatment and
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PERMIT
Performance: System shall perform in accordance with Rule .1961
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No X,
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑
C
conditions of the Improvement Permit and Construction Authorization,
H2OLine ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional � Other CZ Fs ow Septic Tank 1000 gallons Pump Tank
Subsurface No. of exact length width of depth of
Drainage Field ditches I. of each ditch a;"i O feet ditches S feet ditches Ig' 30
trench Drain Required: linear feet
Authorized State Agent Datealza9 d
PWR Line
gallons
inches
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