OP RHTE# iI- s a� ��v2 Harnett County Department of Public Health
PERMIT # Operation Permit 22389
L� New Installation 2'�Septic Tank Ci�'Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: ?d
Name: (owner) �5 �e�e�, �^�9 -C1 SUBDIVISION � ;4vv► LOT # —3e
System Installer: Te -r-i -y 11.'Ole- Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: UL G 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.
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 ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewo dispos I system on the `t�lbove aptioned property.
Type of system: El Conventional Other ve c�C y (,�� Septic Tank: 1000) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches l of each ditch 410 feet ditches -5� feet ditches J 6 — Z` inches
French Drain Required: Linear feet p Ll�^ /
Authorized State Age n /�C=� Date /0/1 �zo�2
I/- - Z t- G 6 " 12-