OP RHTE# \I 5-'QP Harnett County Department of Public Health 23404
PERMIT # �2 -t~1G Operation Permit
New Installation >k Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) '� ca- tiSGJC SUBDIVISION LOT #
System Installer: 9" c��c= )iAo"r" "NO Registration #
Basement with plumbing: ❑ Garage "k Number of Bedrooms
Type of Water Supply: ❑ Community ❑ Public X Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Depart months ' r to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatmen nd Dispof,'Iloand a ll %conditions of the Imp ovement 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 ❑ NOX
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation: ;)%00 Ov;! D.�O %oG \J&,�o 0? 3'-00 \) " C)W 3 0 0
f'1, vrs t-sveL 010 \/C-ro 19 `Ta.'Z:!� 9-1 31! ,V'
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned prope
Type of'system: El Conventional Other �ZFL,,,r, (i`�ta�a'rGG pl-S Septic Tank: 1500 gallons Pump Tank: )!SCC gallons
Subsurface No. of oe exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3) feet ditches 1 inches
French Drain Required: \°'Linear feet
Authorized State Agent ��`�� J r� Date Idal1
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