OP RHTE# I � —S Ll '% 9, Harnett County Department of Public Health 25091
PERMIT # Operation Permit
New Installation 'V< Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: PooSe+Q.1)
Name: (owner) LYo -a $t,sAee4h rat t: SUBDIVISION LOT # a
System Installer: Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms S—
Type of Water Supply: ❑ Communityl Public ElWell Distance from well feet
System Type: r 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 appliable North Carolina General Salutes, Rules for Sewage Treatment and Disposal, and all anditiom of the Improvement Permit and (manction Authorization.
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
It. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation ca
IV. Operation:
V. Other.
maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: E3Conventional Other E-7— 'Ft ow Septic Tank: 12.S6 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches S of each ditch 3 feet ditches .3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ' } Date 6 a 6 1�