OP RHTE# n?- s= r ~-7 YTe Harnett County Department of Public Health 2 0 6 9 5
PERMIT # ~2- Vcjfl- Operation Permit
J New Installation F "Septic Tank ❑ Repair K?'-Nitrification Line ❑ Expansion
PROPERTY LOCATION: L,~ r~~~ tBCe►~~.
Name: (owner) w kf SUBDIVISION &ree.J LOT # o2;,_
System Installer: a t >F ~ s -A:1( wd Registration #
Basement with plumbing: ❑ Garage ?"'Number of Bedrooms 2
Type of Water Supply: ❑ Community 12""Public ❑ Well Distance from well feet
System Type: G' 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.
ims sptem nas been mstauea in compliance with applicable North tarolma General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
Performance: System shall perform in accordance with Rule .1961.
Monitoring: As required by Rule .1961.
Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No Ca'
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other
Following are the specifications for the seewwy disposals stem on the above captioned property.
Type of system: ❑ Conventional L`S Other EZ r(01-3
Subsurface No. of exact length
Drainage Field ditches of of each ditch 300
feet
French Drain Reauiredr ~~rtear (aat
Septic Tank: /OC1 U gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches 16 inches
Authorized State Agent -N~~ Date 'dl6lo)
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