OPFITE# d 9- r- 1"7 5-.i Harnett County Department of Public Health 21 15 8
PERMIT # ,Z 6-,X U Operation Permit
New Installation L Septic Tank ❑ Repair I9' Nitrification Line ❑ Expansion
PROPERTY LOCATION: II 5 ~4-,e1.
Name: (owner) J4.--.r 31,tc SUBDIVISION &4, LOT # X90
System Installer: 14 v-r Registration #
Basement with plumbing: ❑ Garage P?' Number of Bedrooms~
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: 7-77- 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 peen Instanea in compliance with
North Carolina General 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.
111. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No IiK
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 E 2 f /a Septic Tank: / W V gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches of each ditch feet ditches feet ditches / 16 inches
French Drain Required: Linear feet
F uthorized State Agent ,R Date /
a 7-5- = Z1 f-_7
-71
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