OP RHTE#15-53x9 R Harnett County Department of Public Health 24008
PERMIT # ��s 13� Operation Permit
New Installation �K Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: QQ '-,4zrT
Name: (owner) GvC%w5 SUBDIVISION52asZN-E. LOT # .465
System Installer: E OD\ 6 G P+n NF1Z Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well LQ -Q 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.
This 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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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 a
IV. Operation:
V. Other:
maintenance and reporting.
❑ D -Bax ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewage disposals stem on the abovee/ wcaptio property.
Type of system: ❑ Conventional Other+aAta.9�1- lCa2 Septic Tank: I n0� gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drain a Field ditches T of each ditch %bi r) feet ditches _3 feet ditches it inches
French Dram i '� linear feet
Authorized State Agent Date
71
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