OP RRHTE# Ia ;,r-a $>~-~z2 Harnett County Department of Public Health
PERMIT # ~--7 Operation Permit 2 2 3 5 2
'New Installation 'Septic Tank 2" Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION:
Name: (owner) 4A Cow ~rvc SUBDIVISION LOT # Fc/
System Installer: Registration # i
Basement with plumbing: ❑ Garage Number of Bedrooms ,3
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: Jam- ~r- 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 nas peen mstaoea in compuance wttn appncame Nortn taratma uenerai statutes, nines tor sewage treatment ana uosposat, ana au commons m the improvement rermit ana t.onstructton Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
111. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑
Following are the specifications for the sew a disposal system on the above captioned property.
Type of system: ❑ Conventional Other GzF~o
Subsurface No. of 'J exact length
Drainage field ditches of each ditch (9 feet
Alarm ❑
H2OLine ❑
Septic Tank: l o O ® gallons Pump Tank:
width of depth of a
ditches 3 feet ditches
PWR Line
gallons
inches
French Drain Required: Linear feet
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Authorized State Agen E"` Date /"G ~~l
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