OP RHTE# 0 ~ -sue- cb -7 164 Harnett County Department of Public Health 2 0 5 8 3
PERMIT # ay 8 Operation Permit
New InstallatiortJZ-Septic Tank ❑ RepaisK Nitrification Line ❑ Expansion
PROPERTY LOCATION: //c "I
Name: (owner) I(AA A t ?n~ SUBDIVISION rt v,.~ LOT #
System Installer: off,. `I cry Registration #
Basement with plumbing ❑ Garage oZ-Number of Bedrooms 113
Type of Water Su ply: ❑ Community ,4_ Public ❑ Well Distance from well /"OJ feet
System Type: , , I, c.11 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Ow Per must contact Health Department 6 months prior to expiration for permit renewal.
Ims 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:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
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 sew a disposal system on the above captioned property.
Type of system: ❑ Conventional `Other l ~L, I c (i L( Septic Tank: gallons Pump Tank gallons
Subsurface No. of exact length width of depth of j
Drainage Field ditches of each ditch ~3 feet ditches feet ditches t dJ a ~ inches
French Drain Required: Linear feet
Authorized State Agent U'-- ~ Date 0 3-1 f-0 41
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