OP RRHTE# \1- - _�LCoC- iaDQQ_ Harnett County Department of Public Health
PERMIT # moo Operation Permit 22539
New Installation X Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C csz�--ou5 Zj-�
Name: (owner) \ktxy o r4 SUBDIVISION '-,orrc� C-?—pS5 LOT # t0—
System Installer: 'c'1 twS Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well \ OC) feet
System Type: )2T )p Types V and V1 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:
I. 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 ct
IV. Operation:
V. Other:
❑ D -Box ❑
Following are the specifications for the
Type of system: ❑ Conventional
Subsurface ___N0-
Drainage Field ditches
French Drain Reauired:_ r
maintenance and reporting.
Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
sewage disposal system on the above captioned property.
Other { VtYQ 0 LZ Ft ow Septic Tank: ►OdCO gallons Pump Tank: 1000 gallons
exact length width of depth of
of each ditch_ feet ditches 3 feet ditches i� a inches
Authorized State Agent QG))S Date v% k