OP RHTE# 09- S - z1sIge Harnett County Department of Public Health 2 0 4 4 6
PERMIT # ZS/ Z Z- ,Operation Permit
[a New Installation Ld Septic Tank ❑ Repair L3" Nitrification Line ❑ Exnancinn
PROPERTY LOCATION:
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Name: (owner) , SUBDIVISION ~orJ LOT #
System Installer D Registratio
Basement with plumbing: ❑ Garage Number of Bedrooms 3
Type of Water Supply: El Community Y Public ❑ Well Distance from w feet
System Type: 2;F
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47 7 zti Types V d VI Systems expire in 5 years.
(In accordance with Table V a) Owner st contact Health D artment 6 months prior to expiration for permit renewal.
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This system has been installed in compliance with applicable North [arolina General Sta s, Rules for
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Treatment and tisposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. 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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z91 2C- y ( " , s l _ Septic Tank: 1 60 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch 9 feet ditches feet ditches E g inrhac
French rain Required: Linear feet
Authorized State Agent Q,a ~ N /1'x"-,,~ ~ Date ZZ C) 9
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