OPHTE# vy-~=.21-,S-J- Harnett County Department of Public Health 21 14 2
PERMIT # 0 eration Permit
Q' New Installation Septic Tank ❑ Repair ~ Nitrification Line ❑ Expansion
PROPERTY LOCATION: A ,°cr,-- ~~r,~~.
Name: (owner) c ( ;l ~t; y,,r SUBDIVISION ~o.f~:r ~~t LOT # 19.2
System Installer: ~S"-~ a ~r /,/~r~ Registration #
Basement with plumbing: ❑ Garage [r~ umber of Bedrooms 3'
Type of Water Supply: ❑ Community h~f Public ❑ Well Distance from well feet
System Type: M Cr- 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.
this system has been installed m compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and [onstruction Authorization.
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I. 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 sews disposal system on the above captioned property.
Type of system: ❑ Conventional Other Z F16,J Septic Tank: f QO 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage field ditches of each ditch feet ditches feet ditches f 00 inches
french Drain Required: Linear feet
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