OP RHTE# 1--2-'-'i2k5QUa, Harnett County Department of Public Health 25039
PERMIT # a 97 3a Operation Permit
New Installation V Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) -t-C, SUBDIVISION QP%\,-. a,— LOT # 15'g
System Installer:_Gam �c2 Sault, L Registration #
Basement with plumbing: ❑ Garage T54umber of Bedrooms
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.
IMS system nos been imtalled in complianu with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all condltiom of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS
I. Performance:
II. Monitoring:
Ill. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned �ro erty.
Type of system: ❑ Conventional Other G*+a. 6&1, UA F � Y1�0/ Septic Tank: 10 0 0 gallons Pump Tank: gallons
Subsurface No. ofexact length width of depth of
Drainage Field hes S of each ditch 'a'..o feet ditches 3 feet ditches ly inches
French Drain Required:—� Linear feet
Authorized State Agent t-4* 5 Date
11, s- L)ac nom_