OP RHTE# IS-5-TI640Q. Harnett County Department of Public Health 24088
PERMIT # a-:ltl L(O Operation Permit
New Installation 'R� Septic Tank X Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: L)a
Name: (owner) i 1'1—1 0N5ITIC \A0"';'5 SUBDIVISION cao-tC LOT # V�
System Installer: C',s,�s�a,c 7 oyp Registration #
Basement with plumbing: ❑ Garages Number of Bedrooms
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: T^-,. 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 applimble North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions oI the Improvement Permit and tonswaion Authorization.
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PERMIT
PERMIT CONDITIONS
I. Performance: System shall perform in accordance with Rule .1961.
If. Monitoring As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewa a disposal system on the above captioned property.
Type of system: ❑ Conventional Other �� rs�.totir Septic Tank: t OQ C9 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches �) of each ditch 'Ati0 feet ditches feet ditches I���b inches
French Drain Reauired-�- —"�Wlear feet
Authorized State Aeent ��� i���\� pz'!�k5 Date
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