OP RRHTE# SJy AS°13 Harnett County Department of Public Health 2 0 7 3 0
PERMIT # 3 5 Operation Permit
f New Installation Septic Tank ❑ Repair ❑ Nitrification Line,~Q Expansion
PROPERTY LOCATION:
Name: (owner) J I L(t' ~ S SUBDIVISION LOT #
System Installer: I oL~~" ~~r~c S Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Sup I : ❑ Community 11~_TlljWc ❑ Well Distance from well feet
System Type: l.~ , r ( LLL & 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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nance witn appocame north larohna beneral Statutes, Rules for Sewage Treatment and Disposal
and all conditions of the Improvem
t Permit and Construction Authomation.
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1. Performance:
11. 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 E~e
If yes, see attached sheet for additional operatio ditions, maintenance and reporting
Following are the specifications for the sewadisposal sys, m on the above captioned property.
Type of system: ❑ Conventional Cher „t -c 1- \-t Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of C~
Drainage Field ditches ` of each ditch - feet ditches feet ditches X f -inches
French Drain Required: f t _ Linear feet
Authorized State Agent v Date " 22 -
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