OP RHTE# c~a- 5 ----1C'5I Harnett County Department of Public Health 21 4 9 4
PERMIT # Operation Permit
New Installation X Septic Tank ❑ RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: STOGY-NIP(~ V-Z
Name: (owner) ~E-RauN C SUBDIVISION LOT #
System Installer: '\cv r- \ GCL- C,v ek?, cdz.c-.cj-,\ Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well t00 feet
System Type: ~~ZS Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner most contact Health Department 6 months prior to expiration for permit renewal.
imS system has been i
F nstalled in compliance with applicable North Carolina General Statutes, Rules for Sew a 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.
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
Following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other F---' . Septic Tank: t000 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch $0 feet ditches 3 feet ditches ZYinches
French Drain Required: mar feet
Authorized State Agent_ ~ E Date G~~6~16