OP RHTE# n-5�314Harnett County Department of Public Health 25070
PERMIT # 1 Operation Permit
,>< New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: QL"i Looe I�D
Name: (owner) SeyN C ANyE2 SUBDIVISION LOT #
System Installer: y6trt oti r O _ a Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'Z Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 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 Sciences, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Rermit and construction Authorization
I
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Si o u sE
D
2
E
Loop es
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
ll. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ NoN
If yes, see attached sheet far additional openti 1 csinditions, maintenance and reporting.
IV. Operation:
V. Other.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage dispos�I system on the abovg ca_ption roperty.
Type of system: ❑ Conventional 'A Other IXaRR�E(L 15�2`h` Septic Tank: IOOn gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches 11v of each ditch -21�-)0 feet ditches 3 feet ditches inches
French Drain Required: vLiaear feet
Authorized State Agent & si5 Date 5
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