OP RHTE#DK- 5c~- ~~y2 Harnett County Department of Public Health 2 0 9 7 8
PERMIT # X53? Operation Permit
1 New Installation ~4 Septic Tank El Repair W Nitrification Line ❑ Expansion
PROPERTY LOCATION: 'X l
Name: (owner) ~~~'1 c~t~ S SUBDIVISION IP~ LOT # `T S
System Installer Registration #
Basement with plumbing. ❑ Garage Number of Bedroomsf
Type of Water Supply: ❑ Community 9- Public ❑ Well Distance from well feet f
System Type: C- L 1 o6 'rCF Types V and VI Systems expire in 5 years. 4 ,
(In accordance with Table V a) --~Ownner must contact Health Department 6 months prior to expiration for permit renewal.
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nw rptem ❑m urea nataneo in compuance wim appm(ame Nortn Lamina beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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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 operatio t
IV. Operation:
V. Other
maintenance and reporting.
Following are the specifications for the sewa a disposal system on the above captioned property. I
Type of system: El Conventional Other E. I- 1~ Stu Septic Tank: l ~ gallons Pump Tank gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches 3- feet ditches Y inches
French Drain Required: linear feet
Authorized State
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