OP RRHTE#M Harnett County Department of Public Health
PERMIT # 2.5336 Operation Permit 21 5 8 4
New Installation~Septic LTank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: C-L ,
Name: (owner) c^ I Lam) ti v C- -t;7 M N 7 5 SUBDIVISION Sry I_, LOT # Li
L System Installer: A r fl,Gn2vGki Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 Ocd feet
System Type: e. 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.
ims 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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PFRMIT rnNDITIOW.
1. Performance:
II. Monitoring,
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other
Subsurface system operator required? Yes ❑ No~>
If yes, see attached sheet for additional operation co
maintenance and reporting.
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
following are the specifications for the sewage disposals stem on the above captioned property.
Type of system: ❑ Conventional Other E qo ~i Septic Tank: 1 OL1 C~ gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches o each ditch `7 a feet ditches feet ditches inches
French Drain Reauired:
Authorized State Agent M~~- V16 Date 8
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