OPHTE# n9- Sda-'-?i.s'1Y Harnett County Department of Public Health 2 0 7 4 5
PERMIT #3 Operation Permit
C6~_New Installation 04~r_ Septic Tank ❑ Repair~Nitrification Line ❑ Expansion
t PROPERTY LOCATION: 1 23J-
Name: (owner) w t~ Can SUBDIVISION _.c r - /~2 5 LOT #
System Installer. 130 Registration #
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms
Type of Watey~Supply: ❑ Commu~ty
Pubtlic~ ❑ Well Distance from well feet
System TYPe:++f~--''`-'`~ t c l< 1 Types V and VI Systems expire in 5 years. TIT 6
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
nns srxem nas peen mnaneo in compliance with
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Permit and Construction Authorization.
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PERMIT CONDITIONS: /I n f lilt rh e c
I DerEnrm<fn~e• Cve}nr.. .•L it a_ I---- IN-.- Ini~
- -r._... r. .....nom., - f - r r
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 s 7
disposal s
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em on the above captioned property.
boo
ype o
system:
Conventional _ I'
0ther
--rl ~ I) t; I,, y
Septic Tank: U gallons Pump Tank:
gallons
Subsurface No. of
Drainage Field ditches _
exact length
of each ditch feet
width of depth of
ditches feet ditches
!
t X inches
trench Drain Required: linear feet -
Authorized State Agent Date lJ
North larohna General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the
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