OP RRRRRHTE# oI,~-~-►$ nQtt, Harnett County Department of Public Health 2 0 5 7 4
PERMIT Z Operation Permit
)"ew Installation peptic Tank ❑ Repair >~T Nitrification Line ❑ Expansion
PROPERTY LOCATION: II woad
Name: (owner) SUBDIVISION (,J,)-) R aj « 2>; LOT #
System Installer. Mi) 4'jPrch--e Registration # o)q q_
Basement with plumbing. ❑ Garage E Number of Bedrooms 3_
Type of Water Sup7.7- ❑ Community - Public ❑ Well Distance from well l0 feet
System Type: G/c>t/ - 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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nas Deen mstauea in compliance with
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North [arolma General Statutes, Rules for Sewage Treatment and
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and all conditions of the Improvement Permit and construction Authorization.
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1. 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 conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sTother disposal sy}4m gq the above captioned property.
Type of system: ❑ Conventional r - L rr\0%,/ Septic Tank: )i D30 gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch 3 feet ditches feet ditches inches
French Drain Required: linear feet
[Authorized State Agent Date
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