OPNTE#_QHarnett County Department of Public Health 211 72
PERMIT # (J Operation Permit
❑ New Installation ❑ Septic Tank ❑ Repair5d Nitrification Line Expansion
PROPERTY LOCATION: D
Name: (owner)~,+tA/~.,r~ SUBDIVISION .~umM LOT # I Oo_
System Installer, wtin t Registration #
Basement with plumbing: ❑ Garage 14 Number of Bedrooms e X.
Type of Water Supply: ❑ Community Public ❑ Well Distance from well 1 0 J feet
System Type: ~1C Types V and VI Systems expire in 5 years.
(In accordance with Tab V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
17„1„1 -111 mxmieu in compliance witn applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Coostruction Authorization.
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PERMIT CONDITIONS:
I. Performance:
11. Monitoring:
III. Maintenance:
IV. Operation:
V. Other.
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No'g
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
Following are the specifications for the sewage disposals em on the above captioned property.
Type of system: ❑ Conventional Other 31.! Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length Adder width of depth of
Drainage Field ditches of each ditch U feet 42 ditches 3 feet ditches I - inches
French Drain Required: Linear feet i, S
Authorized State Agent LA ,.r Date ' - J