OP RHTE# L l"5-eiISSaR Harnett County Department of Public Health 25041
PERMIT # c11S Operation Permit
New Installation Septic Tank ❑ Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: ivc.'a.11- �iGT'
Name: (owner) SOON �?,o��ll .t�N1c cy.C�_ SUBDIVISION LOT #
System Installer: l -on i Sy-toaa C. Registration #
Basement with plumbing: ❑ Garage ❑ Muabeo of Bedrooms s 5D L pq�/ 750 �p�
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.
Ines system has been Installed In mmplunce with applicable notth Urollna General Statutes. Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and ConstNtdon Authorization
rtxnn cuNunlulls:
I. Performance:
11. Monitoring:
Ill. Maintenance:
IV. Operation:
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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.
Other. 'T—Q-PQ Norio � � ria ho 22oE L�SSJ_ x UmP
❑ D -Boz ❑ Pump ❑ Alarm ❑
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional ❑ Other
Subsurface No. of exact length
Drainage Fielded es of each ditch feet
French Drain Required: linear feet
H2OLima ❑
PWR Line
Septic Tank: S300 gallons Pump Tank: ire's gallons
width of depth of
ditches feet ditches inches
Authorized State Aeent 7� Ivo Date L -s -10-11K