OP RRHTE# Harnett County Department of Public Health 2 0 7 6 2
PERMIT #v' Operation Permit
C>F-4~ew Installation 4RLdeptic Tank ❑ Repaid Nitrification Line ❑ Expansion
PROPERTY LOCATIL2~
Name: (owner) eat /,fir-c) SUBDIVISION _ r....~ LOT # ~L
System Installer. %2 tJ n Registration
Basement with plumbing. ❑ Garage ❑ Number of Bedrooms 1
Type of Water Suppl : ❑ Community Public ❑ Well Distance from well feet
System Type: Types V and VI Systems expire in 5 years.
(In accordance with Ta le V a) Owner rust contact Health Department 6 months prior to expiration for permit renewal.
rcnrni WrIUMVns.
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 se age disposal sy` in on the above captioned property.
Type of system: ❑ Conventional Other - c,~A 'A Septic Tank: gallons Pump Tank: gallons
Subsurface No. of f exact length width of depth of
Drainage Field ditches 1 of each ditch ~t feet ditches- feet ditches inches
French Drain Required: Linear feet
Authorized State Agent 2 Date
this system has been installed in compliance with a icable North Carolinaveral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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