OP RHTE# ~a~173~Harnett County Department of Public Health
PERMIT # b 9T `I Operation Permit 22006
IF/New Installation 17i etic Tank Nitrification Line ❑ Repair ❑ Expansior
PROPERTY LOCATION: X14 yak
Name: (owner) .4 ri Ccdt 4a`-%Ac-~-= of. SUBDIVISION LOT # 1-
System Installer: Registration #
Basement with plumbing: ❑ Garage [Z' . umber of Bedrooms
Type of Water Supply: ❑ Communi LYt Public ❑ Well Distance from well feet
System Type: 6 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 conditos of the Improvement Permit and Construction Authorization
PtKMII LUNUIIIUM:
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:
j
1.15-1 D-Box
d~ Pump 0`
Alarm c5
H201-ine ~ PWR Line
Following are the specifications for th
e sew a disposal system on the above ca tinned property.
Type of system: ❑ Conventional
Other s ~ CZ f~
Septic Tank:
gallons Pump Tank: / 4 ~j ei gallons
Subsurface No. of
Drainage Field ditches--- -
exact length
of each ditch feet
width of
ditches
depth of
feet ditches 0 ` inches
French Drain Reouired;
Authorized State Agent N, y 5 Date J)
/0 -s= vZy7 324
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