OP RHTE# /0-5--2 g., Y4 Harnett County Department of Public Health
PERMIT # 2k, 3 i 9 Operation Permit 2 2 01 5
M'New Installation R, Septic Tank Cr Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: 7": 1-d-
Name: (owner) S~- nc; l ~ Nt SUBDIVISION I. LOT # i 7
System Installer: Registration #
Basement with plumbing: ❑ Garage /Number of Bedrooms 3
Type of Water Supply: ❑ Community WPublic ❑ Well Distance from well feet
System Type: = 0- 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 incompliance 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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rtKMI I IUNUII IUNS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 ❑ H201-ine ❑ PWR Line
Following are the specifications for the sews disposal system on the above captioned property.
Type of system: ❑ Conventional 70ther z-Fla„I Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches o2 of each ditch feet ditches '7 feet ditches 36 inches
French Drain Required: Linear feet
Authorized State Age Date 81YI.-O//