OP RHTE# D?-.50,x- 191 S3,11L Harnett County Department of Public Health 2 0 7 4 8
PERMIT # Y (3 'Z Operation Permit
New Installation Septic Tank ❑ Repai4 Nitrification Line ❑ Expansion
PROPERTY LOCATION: 1,j
Name: (owner) S)la" CI L~ SUBDIVISION LOT #
System Installer: - Registration #
Basement with plumbing: ❑ Garage --44 Number of Bedrooms 2
Type of Water Su ❑ Community D Public Well Distance from well 1-P { feet
System Type: I'rtc C1 (12 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.
,uu >rxcni nae ueeo untmiea m compliance wim appucame north tarohna General Statutes, Rules for kwage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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DFRMIT rAkIntTlnYc•
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I. Performance: System shall perform in accordance with Rule .1961.
Il. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No`~4-
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposaltem on the above captioned property.
Type of system: ❑ Conventional ' 4 Other /t'A4 C •p) Septic Tank: ~7~) gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch i feet ditches feat ditrhoc ;-h-
French Drain Required: linear feet
Authorized State Agent Date 0612-D~
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