OP RHTE# 43 °S 30 b3 ,Z12- Harnett County Department of Public Health
PERMIT # R 7324 Operation Permit 22926
L✓J New Installation C"Septic Tank 2'*- Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: U10 Id �a t
Name: (owner) v vv do My SUBDIVISION Ae t/ 2: j �P LOT # iok
System Installer: Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 4
Type of Water Supply: ❑ Community 0-Public ❑ Well Distance from well feet
System Type: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.
mis system has been mstaued in compliance with applicable North Carolina t,eneral )tatutes, Rules for Newage Ireatment and
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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.
11. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No 0'
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 sew3p disposal system on the above captioned property.
Type of system: ❑ Conventional El Other F2— Septic Tank: laf G gallons Pump Tank: gallons
Subsurface No. of A, -
A—, -exact length 30 width of depth of
Drainage Field ditches 3 of each ditch 6 0 feet ditches 3 feet ditches / $ inches
French Drain Required: Linear feet
Authorized State Agent C_ . �C Date % ea- 1-2- 6lY