OP RHTE# 17-5' Q Harnett County Department of Public Health 24911
PERMIT # f151'Sq Operation Permit
"k New Installation 'X Septic Tank 'K Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: I tas —�cL Q s
Name: (owner) V aC- rbCzl/ E)ll C�`0�tca-1 SUBDIVISION LOT #
System Installer. C)t .s ST@-ic tl.n„Sy Registration #
Basement with plumbing: ❑ Garage ElIftmsbero(- Bed rooms Tin 8so-r-waua6la
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 compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of 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.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Boz ❑ Pump ❑
Fill—
Following are the specifications for the sewage disposal s stem ¢�Pe the above captioned property.
Type of system: ❑ Conventional i$ Other 9Z. �s'' —02.2 Septic Tank:
Subsurface No. ofexact length width of
Drainage Field ditches Ll of each ditch 2 0 feet ditches _
142OLIne ❑ PWR Line
t00b gallons Pump Tank: gallons
depth of
feet ditches 1q inches
French Drain Required: Linear feet
Authorized State Agent Date a 20 N