OP RHTE# iL�+-5- 513'R Harnett County Department of Public Health 23844
PERMIT 4Q) Operation Permit
New Installation 'N Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
gill 0;1fill (QFI:11DP
Name: (owner) "11-" 10,31 SUBDIVISION C) c, vT LOT #f"f—)
System Installer: _ (� : is 0 Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms L—
Type of Water Supply: ❑ Community Public ❑ Well Distance from well V00 feet
System Type: Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
[his system has been installed In compliance with applicable north Carolina General Writes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
rtKnu LUnOnlunS:
I. Performance:
Il. Monitoring.
III. Maintenance:
IV. Operation:
V. Other.
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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 ca
maintenance and reporting.
❑ D -Boz ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: El Conventional )K Other Z 4�,r,r- Septic Tank: 10 n 0 gallons Pump Tank: gallons
Subsu ac No. of exact length width of depth of
Drainage Field dmtc 4' of each ditch G O feet ditches 3 feet ditches 18 _3 0 inches
French Drain RequirlhL Uinear feet
Authorized State Aeent Rbh5 Date
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