OP RHTE#Q(o-s-~ 5 '14 ~,Q2 Harnett County Department of Public Health
PERMIT Operation Permit 21 9 4 6
New Installation 'X Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: O®c_s ep
Name: (owner) GY~„c)b)rwN Vks3 cnZ5 SUBDIVISION Q0Loo1ts. }i-L5 L 0 T # a~
System Installer: <D-s,s S"ScttiC.~.LA.N~ Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Communi Public ❑ Well Distance from well IIZQ 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 Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
11. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑ Conventional Other EZ. S"'l_m'l Septic Tank: I (h00 gallons Pump Tank: gallons
Subsurface No. o exact length width of depth of
Drainage Field ditches of each ditch '3Qd feet ditches feet ditches Sit inches
French Drain Reauired:,,_ eet
Authorized State Agent ""4,\\ , Date
1777
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