OP RHTE#-0,Y =so0 aka 2 1Z Harnett County Department of Public Health 2 0 6 3 3
PERMIT # s a0 Operation Permit
C ~w Installation Se tic Tank ❑ Repair~Nitrification Line ❑ Expansion
PROPERTY LOCATION: 113cl
Name: (owner) p Q PASV\ O_N_N s SUBDIVISION 0 A C'_ LOT # _
System Installer: • S Ti R; c k ~ r4-, Registration #
Basement with plumbing: ❑ Garage J4 Number of Bedrooms __3
Type of Water Supply: ❑ Community "SC-Public ❑ Well Distance from well feet
System Type: C. Z F 1ov 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.
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PERMIT CONDITIONS:
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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1. Performance:
11. Monitoring:
III. Maintenance:
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System shall perform in accordance with Rule .1961. r'
As required by Rule .1961.
As required by Rule .1961. Other.
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IV. Operation:
V. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting
Following are the specifications for the sewage disposal V stem on the above captioned property.
Type of system: ❑ Conventional -Y Other X - 2 F I c>Q Septic Tank: 0"'9' gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch- feet ditches feet ditches l~'d inches
French Drain Required: Linear feet
Authorized State
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