OP RHTE# �L Harnett County Department of Public Health 25103
PERMIT # :)M-0 I Operation Permit
New Installation 'R Se is Tank X Nitrification Line ❑ Repair ElExpansion
PROPERTY LOCATION: Lcay
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Name: (owner) C4-ceyTort,--ycL� riagy SUBDIVISION LOT #
System Installer: C ' M 9L%J'ngs14t. Registration #
Basement with plumbing: ❑ Garage 'X Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well 100 feet
System Type: 1L]_ 13 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and construction Authimeamm
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PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes "❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Set IQ
LA 'Fon. "C ainrc%c"V
❑
D -Box
❑ Pump ❑ Alarm ❑
H2OLine ❑ PWR Line
Following are the specifications for
the sewage dispos I system on the above captioned prope
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d
Type of system:
El Conventional
�. Other vv�nP 1 r GyNcr% C00Septic Tank: 1--%S
gallons Pump Tank: ryS gallons
Subsurface
No. of
exact length width of
5O4 3
depth of
Drainage Field
ditches
T of each ditch -feet 1 ditches
feet ditches inches
French Drain Required: Linear feet "N"'°1"4 a"O epv;v
Authorized State Agent Date 7 -S)r