OPHTE# 0 7-3--aa37--(. Harnett County Department of Public Health 21 13 5
PERMIT # Operation Perrnit
(ew Installation L~ Septic Tank ❑ Repair El'-Nitrification Line ❑ Expansion
PROPERTY LOCATION: 0-77 c....} -
Name: (owner) Cj bz< L4 ~s1 SUBDIVISION %/,4- (kcik't LOT # r(,
System Installer: ecl w w Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms
Type of Water Supply: ❑ Community C?'ublic ❑ Well Distance from well feet
System Type: 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 system has been installed m compliance with applicable North Carolina General Statutes, Rules for kwage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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1. Performance:
II. Monitoring:
III. Maintenance:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
IV. Operation:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
V. Other: .J a 8 d / t? cQd~
Following are the specifications for the sews a dispo I system on the above captione~d,~Prope
Type of system: ❑ Conventional VOtherr..s,wo -o dcs:&,k y ~ hi-- Septic Tank: 640 gallons Pump Tank: / 04 4 gallons
Subsurface No. of exact length width of depth of
Drainage Field of each ditch F _ feet ditches 3 feet ditches C/ inches
French Drain Required: kiagar feet
Authorized- State Agent \ - Q-c-NS Date
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